Venlafaxine as single therapy associated with hypertensive encephalopathy

Abstract

IntroductionHypertensive encephalopathy with the clinicoradiological entity posterior reversible encephalopathy syndrome in the setting of venlafaxine as single therapy has not been reported earlier.Case descriptionA 46-year-old man developed hypertensive encephalopathy associated with venlafaxine as single therapy. Magnetic resonance imaging of the brain, pre and post gadolinium, carried out on day 2, displayed an increased T2 signal in the cortex on both the T2 and FLAIR images throughout the frontal and temporal lobes and in the cerebellum. Venlafaxine therapy was stopped. The patient gradually improved and he became seizure free and the blood pressure successively became normal. A magnetic resonance imaging after six weeks displayed marked regression of the abnormalities. On follow-up after 3 months, his blood pressure had been normal and he had not had any symptoms. The prescribed antiepileptic drug was discontinued as well as antihypertensive treatment. He had not experienced any new symptoms at follow-up after one year.Discussion and evaluationThe patient in this report had hypertensive encephalopathy associated with venlafaxine therapy. The imaging findings are compatible with hypertensive encephalopathy/posterior reversible encephalopathy syndrome. Venlafaxine is a drug used very frequently. Venlafaxine may infrequently induce hypertensive crisis.ConclusionHypertensive encephalopathy may rarely occur in the setting of venlafaxine as single therapy even in low to moderate doses. Patients on venlafaxine should have regular monitoring of blood pressure. Knowledge of the side effects is vital. Venlafaxine must be discontinued if significant hypertension persists.

Duloxetine-related posterior reversible encephalopathy syndrome

“…We identified only 1 case report, associated with the use of venlafaxine. [11] Patient had acute hypertensive crisis, impaired consciousness, and seizures, in keeping with the clinical manifestations in our patient. He recovered fully after withdrawal of the serotonin reuptake inhibitor and symptomatic treatment to control the seizure activity and hypertension.…”

Antidepressant Drugs Effects on Blood Pressure

“…Moreover, the incidence of hypertensive crisis is described in adults ( 53 , 103 ) but not in children and adolescents ( 111 ). Posterior reversible encephalopathy syndrome has also been described as a result of severe hypertension after starting moderate doses of venlafaxine ( 112 ). Because of a potential increase in BP, venlafaxine has also been used to treat symptomatic hypotension ( 113 ), even if its use is not approved for the treatment of orthostatic hypotension in the last 2017 American College of Cardiology/American Heart Association/Heart Rhythm Society Syncope Guidelines and 2018 European Society of Cardiology Guidelines for the diagnosis and management of syncope ( 114 , 115 ).…”

Serotonin Syndrome Presenting as a Posterior Reversible Encephalopathy Syndrome

“…There are multiple known etiologies for PRES, with hypertension being the most common amongst them [2]. Other etiologies include eclampsia, systemic lupus erythematosus, autoimmune disorders, and immunosuppressive medications [3,4,[7][8][9]. Cytotoxic medications such as cisplatin, cyclophosphamide, interferon, erythropoietin, tacrolimus, cyclosporine, and azathioprine can all induce PRES [1].…”

“…The overall prognosis of PRES is good if diagnosed and treated early. Both the symptoms and imaging findings of PRES reverse after prompt discontinuation of the offending agent and appropriate treatment [7].…”