Neonatal venlafaxine discontinuation syndrome: A mini-review

Holland, Jonathon; Brown, Richard

doi:10.1016/j.ejpn.2016.11.003

Cited by 28 publications

(14 citation statements)

References 9 publications

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“…Dependence and withdrawal symptoms associated with both SSRIs and SNRIs have already been described, specifically with abrupt discontinuation of venlafaxine (including Extended Release (XR) formulation) after long-term use [ 9 , 52 , 53 , 54 ]. Symptoms range from mild to severe and include nausea, depression, suicidal thoughts, disorientation, stomach cramps, panic attacks, sexual dysfunction, headaches and occasional psychotic symptoms [ 55 , 56 , 57 , 58 , 59 ]; a newborn discontinuation syndrome has been described as well, at times associated with encephalopathy or paroxysmal episodes [ 60 ]. The management of venlafaxine withdrawal includes the use of other antidepressants (Ads) or venlafaxine tapering doses [ 61 , 62 ].…”

Section: Resultsmentioning

confidence: 99%

Abuse of Prescription Drugs in the Context of Novel Psychoactive Substances (NPS): A Systematic Review

et al. 2018

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Recently, a range of prescription and over-the-counter drugs have been reportedly used as Novel Psychoactive Substances (NPS), due to their potential for abuse resulting from their high dosage/idiosyncratic methods of self-administration. This paper provides a systematic review of the topic, focusing on a range of medications which have emerged as being used recreationally, either on their own or in combination with NPS. Among gabapentinoids, pregabalin may present with higher addictive liability levels than gabapentin, with pregabalin being mostly identified in the context of opioid, polydrug intake. For antidepressants, their dopaminergic, stimulant-like, bupropion activities may explain their recreational value and diversion from the therapeutic intended use. In some vulnerable clients, a high dosage of venlafaxine (‘baby ecstasy’) is ingested for recreational purposes, whilst the occurrence of a clinically-relevant withdrawal syndrome may be a significant issue for all venlafaxine-treated patients. Considering second generation antipsychotics, olanzapine appears to be ingested at very large dosages as an ‘ideal trip terminator’, whilst the immediate-release quetiapine formulation may possess proper abuse liability levels. Within the image- and performance- enhancing drugs (IPEDs) group, the beta-2 agonist clenbuterol (‘size zero pill’) is reported to be self-administered for aggressive slimming purposes. Finally, high/very high dosage ingestion of the antidiarrhoeal loperamide has shown recent increasing levels of popularity due to its central recreational, anti-withdrawal, opiatergic effects. The emerging abuse of prescription drugs within the context of a rapidly modifying drug scenario represents a challenge for psychiatry, public health and drug-control policies.

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Section: Resultsmentioning

confidence: 99%

Abuse of Prescription Drugs in the Context of Novel Psychoactive Substances (NPS): A Systematic Review

et al. 2018

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“…Consistent with this, Kelly et al (Kelly et al, 2014 ) observed that cannabis-dependent participants with depressive disorder are less likely to achieve abstinence when exposed to venlafaxine treatment, suggesting that withdrawal-like symptoms led to continued marijuana smoking in this group. Finally, since venlafaxine and its metabolites cross the placenta, even the newborn can be exposed to the risk of a discontinuation syndrome, which is at times associated with encephalopathy or paroxysmal episodes (Holland and Brown, 2017 ). Although venlafaxine withdrawal can successfully be managed with a short course of duloxetine (Cutler, 2017 ), in order to taper down gradually its dosage the use of tapering strips, containing a slightly lower dose of medication on each consecutive day, has been suggested (Groot, 2013 ).…”

Section: Introductionmentioning

confidence: 99%

Is There a Potential of Misuse for Venlafaxine and Bupropion?

Schifano

Chiappini

2018

Front. Pharmacol.

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Objective: Traditionally, studies on the non-medical use of pharmaceutical products have focused on controlled substances; e.g., opiates/opioids; and benzodiazepines. Although both bupropion and venlafaxine have been reported as being misused, only anecdotal reports have been made available so far. Hence, the European Monitoring Agency (EMA) Adverse Drug Reactions (ADRs), misuse/abuse/dependence and withdrawal, venlafaxine- and bupropion-related, database was here analyzed.Methods: All EMA spontaneous reports relating to venlafaxine (2005–2016) and bupropion (2003–2016) notifications were here analyzed, to provide a descriptive analysis by source, gender, age, and type of report. The UK-based, 2000–2016, Yellow Card Scheme pharmacovigilance database, bupropion and venlafaxine withdrawal reports were compared as well with those pertaining to fluoxetine and paroxetine.Results: Out of 20,720 (bupropion) and 47,516 (venlafaxine) total number of ADRs, some 2,232 (10.8%), and 4,071 (8.5%) misuse/abuse/dependence ADRs were respectively associated with bupropion and venlafaxine. Conversely, bupropion withdrawal-related ADRs were here reported in 299/20,720 (1.44%) cases and in 914/47,516 (1.92%) cases for venlafaxine. Overall, all bupropion and venlafaxine misuse-/abuse-/dependence- and withdrawal-ADRs were related to a respective number of 264 and 447 patients. According to the Proportional Reporting Ratio (PRR) computation, in comparison with venlafaxine bupropion resulted to be more frequently misused/abused (PRR: 1.50), but less frequently associated with both dependence (PRR: 0.92) and withdrawal (PRR: 0.77) issues. Yellow Card Scheme data suggested that paroxetine and venlafaxine, in comparison with fluoxetine and bupropion, were associated with higher number of withdrawal-related reports.Conclusions: The dopaminergic, stimulant-like, bupropion activities may be associated with its possible recreational value. Present data may confirm that the occurrence of a withdrawal syndrome may be a significant issue for venlafaxine-treated patients.

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“…The duration of symptomatology in our case (12 days) is well within what has been previously reported in the literature. 3 Given that there is some evidence that venlafaxine in breast milk could potentially attenuate SSRI-induced withdrawal symptoms 9 and the fact that the concentration of venlafaxine in human breast milk is not negligible with measurable concentrations present in the infants’ plasma, 10 it is quite possible that the duration of symptomatology in our case could have been longer had the mother discontinued her venlafaxine intake after delivery while expressing breast milk. In the eventuality that maternal venlafaxine intake was discontinued after delivery, the option of supplementing the infant with oral venlafaxine has been demonstrated in one Dutch case report 11 which noted a subsequent reduction in withdrawal symptoms.…”

Section: Discussionmentioning

confidence: 90%

“…1 Venlafaxine, a selective serotonin and norepinephrine reuptake inhibitor (SSNRI), is closely related to the popular selective serotonin reuptake inhibitors (SSRIs) and is used in up to 6% of women with live births experiencing depression during pregnancy. 2 It has been repeatedly associated with a discontinuation syndrome which may present as encephalopathy characterized by tachypnea, poor feeding, and myoclonic seizure-like activity, 3 although no adequate studies exist formally evaluating this issue nor any guidelines regarding the management of newborns with in-utero venlafaxine exposure.…”

Section: Introductionmentioning

confidence: 99%

Venlafaxine-induced encephalopathy in term newborn

Maalouli

Hilliard

2020

SAGE Open Medical Case Reports

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The use of venlafaxine, a selective serotonin and norepinephrine reuptake inhibitor, for the management of depression in women of childbearing age has been on the rise, and there have been multiple case reports in the literature tying venlafaxine in-utero exposure to a form of neonatal encephalopathy presenting as neonatal abstinence syndrome. We present the case of a 5-day-old term infant whose mother was on venlafaxine throughout her pregnancy and presented with hypothermia, poor feeding, and decreased activity level. She subsequently had a negative sepsis workup and required nasogastric tube feedings for 2 weeks with spontaneous recovery and no clinical sequelae post-discharge. This case highlights the non-trivial potential risk of venlafaxine withdrawal in exposed newborns and the need for close observation. We propose a management framework for such situations in affected infants.

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Neonatal venlafaxine discontinuation syndrome: A mini-review

Cited by 28 publications

References 9 publications

Abuse of Prescription Drugs in the Context of Novel Psychoactive Substances (NPS): A Systematic Review

Abuse of Prescription Drugs in the Context of Novel Psychoactive Substances (NPS): A Systematic Review

Is There a Potential of Misuse for Venlafaxine and Bupropion?

Venlafaxine-induced encephalopathy in term newborn

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