SNRI

Posted On March 7, 2020

Serotonin-Norepihephrine reuptake inhibitor
Little or no cholinergic or histaminergic effect
Duloxetine, Venlafaxine, Desyenlafaxine has more inhibition of Serotonin uptake.
Levomilnacipran preferentially block reuptake of norepinephrine

Highly protein bound
Mainly cleared by liver, <1% excreted in urine. Avoid in liver disease, and CrCl <30
Available in generic capsule: 20, 30, 60 mg cap
Cost about $15 for 30 cap
Indicated for: neuropathic painy, fibromyalgia, anxiety, depression, chronic musculoskeletal pain
Off label use: stress incontinence

At 75 mg daily, behaves like “SSRI”
High dose: over 225 mg qd, significant effect on norepinephrine transporter
Clearance: liver and kidney. 34% excreted in urine. Dose reduction need in liver and kidney diseases.
Available in generic XR: 37.5, 75, 150 mg
Cost about $30 for 30 cap
Indicated for: neuropathic pain, depression, Panic, anxiety
OPff label use: migraine prevention, narcolepsy with cataplexy, OCD, premenstrual dysphoric disorder. vasomotor sympotms with menopause, PTSD

Clearance: liver and kidney, 45% excreted unchanged in urine
chronic kidney disease: CrCl <30 and end stage renal disease 25 mg qd, or 50 mg qod
Start dose: 50 mg qd, up to 400 mg qd.
Available in generic ER: 25, 50, 100 mg
Cost about $25 for 30 tabs

Dose: start 12.5 mg qd, may increase daily by 12.5 mg per day, up to 100 mg bid
Available in brand: 12.5, 25, 50, 100 mg tab
Cost: over $400 per month
Excretion: 58% excreted unchanged in urine
Kidney problem: severe CrCl <29, reduce dose to 25 mg bid
- end stage renal disease: use not recommended.