A review of the suitability of duloxetine and venlafaxine for use in patients with depression in primary care with a focus on cardiovascular safety, suicide and mortality due to antidepressant overdose

Taylor, David; Lenox-Smith, Alan; Bradley, Andrew J.

doi:10.1177/2045125312472890

Cited by 29 publications

(17 citation statements)

References 48 publications

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“…Anticonvulsants for fibromyalgia syndrome (Üceyler 2017 b);Monoamine oxidase inhibitors (MAOIs) for fibromyalgia syndrome (Tort 2012);Non-steroidal anti-inflammatory drugs (NSAIDs) for fibromyalgia (Derry 2017);Analgesics and opioid agents for fibromyalgia syndrome;Sedatives and hypnotic agents for fibromyalgia syndrome;Selective serotonin reuptake inhibitors (SNRIs) for fibromyalgia syndrome (Walitt 2015);Serotonin and noradrenaline reuptake inhibitors (SNRIs) for fibromyalgia syndrome (Häuser 2013 a)Tricyclic agents for fibromyalgia syndrome. …”

Section: Notesmentioning

confidence: 99%

Serotonin and noradrenaline reuptake inhibitors (SNRIs) for fibromyalgia

Welsch

Üçeyler

Klose

et al. 2018

Cochrane Database of Systematic Reviews

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Background Fibromyalgia is a clinically defined chronic condition of unknown etiology characterized by chronic widespread pain that often co‐exists with sleep disturbances, cognitive dysfunction and fatigue. People with fibromyalgia often report high disability levels and poor quality of life. Drug therapy, for example, with serotonin and noradrenaline reuptake inhibitors (SNRIs), focuses on reducing key symptoms and improving quality of life. This review updates and extends the 2013 version of this systematic review. Objectives To assess the efficacy, tolerability and safety of serotonin and noradrenaline reuptake inhibitors (SNRIs) compared with placebo or other active drug(s) in the treatment of fibromyalgia in adults. Search methods For this update we searched CENTRAL, MEDLINE, Embase, the US National Institutes of Health and the World Health Organization (WHO) International Clinical Trials Registry Platform for published and ongoing trials and examined the reference lists of reviewed articles, to 8 August 2017. Selection criteria We selected randomized, controlled trials of any formulation of SNRIs against placebo or any other active treatment of fibromyalgia in adults. Data collection and analysis Three review authors independently extracted data, examined study quality, and assessed risk of bias. For efficacy, we calculated the number needed to treat for an additional beneficial outcome (NNTB) for pain relief of 50% or greater and of 30% or greater, patient's global impression to be much or very much improved, dropout rates due to lack of efficacy, and the standardized mean differences (SMD) for fatigue, sleep problems, health‐related quality of life, mean pain intensity, depression, anxiety, disability, sexual function, cognitive disturbances and tenderness. For tolerability we calculated number needed to treat for an additional harmful outcome (NNTH) for withdrawals due to adverse events and for nausea, insomnia and somnolence as specific adverse events. For safety we calculated NNTH for serious adverse events. We undertook meta‐analysis using a random‐effects model. We assessed the evidence using GRADE and created a 'Summary of findings' table. Main results We added eight new studies with 1979 participants for a total of 18 included studies with 7903 participants. Seven studies investigated duloxetine and nine studies investigated milnacipran against placebo. One study compared desvenlafaxine with placebo and pregabalin. One study compared duloxetine with L‐carnitine. The majority of studies were at unclear or high risk of bias in three to five domains. The quality of evidence of all comparisons of desvenlafaxine, duloxetine and milnacipran versus placebo in studies with a parallel design was low due to concerns about publication bias and indirectness, and very low for serious adverse events due to concerns about...

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Section: Notesmentioning

confidence: 99%

Serotonin and noradrenaline reuptake inhibitors (SNRIs) for fibromyalgia

Welsch

Üçeyler

Klose

et al. 2018

Cochrane Database of Systematic Reviews

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“…Case reports and case series suggest that certain secondgeneration agents, notably citalopram, venlafaxine, and bupropion, as well as selected antipsychotic medications, might be more hazardous in overdose (11)(12)(13)(14)(15)(16)(17)(18)(19). However, few reports have systematically compared the morbidity and mortality of the array of agents used to treat depression.…”

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confidence: 99%

Morbidity and Mortality Associated With Medications Used in the Treatment of Depression: An Analysis of Cases Reported to U.S. Poison Control Centers, 2000–2014

Nelson

Spyker

2017

AJP

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Objective: The authors sought to determine the relative morbidity and mortality associated with drugs used to treat depression and to examine specific clinical effects associated with serious outcomes.Method: The National Poison Data System, which receives exposure reports from regional poison centers serving the United States, Puerto Rico, and the District of Columbia, was queried for single drug exposures in individuals 12 years and older during the period 2000-2014. Medications included were antidepressants, atypical antipsychotics, anticonvulsants, lithium, and other medications used in the treatment of depression. The main outcomes were the morbidity index (the number of serious outcomes per 1,000 exposures) and the mortality index (the number of fatal outcomes per 10,000 exposures).Results: During this 15-year period, there were 962,222 single substance exposures to the 48 medications studied. Serious outcomes rose 2.26-fold and in linear fashion over the 15 years. While tricyclic and monoamine oxidase inhibitor medications were associated with high morbidity and mortality, several newer agents also appeared hazardous. Lithium, quetiapine, olanzapine, bupropion, and carbamazepine were associated with high morbidity indices. Lithium, venlafaxine, bupropion, quetiapine, olanzapine, ziprasidone, valproic acid, carbamazepine, and citalopram were associated with higher mortality indices.Conclusions: Serious outcomes after overdose or nonintentional exposures to medications used to treat depression have risen dramatically over the past 15 years. The present data suggest that the morbidity and mortality risks vary substantially among these medications. These differences become important when selecting treatments for patients with depression, especially those at increased risk for suicide.

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“…4,5) A number of reports have indicated that the medication is generally well tolerated and has significant efficacy, although a few reports have suggested inconclusive data. [6][7][8] These evaluations have been mainly focused on the socio-economical impact as well as on the induction of co-lateral health damage; however, very limited reports have been published regarding the effect of duloxetine on the genetic material, which may be a significant biomarker for future disease development. In the genotoxicity area of research we only found a report that measured genotoxicity in mice with negative results in blood and brain cells.…”

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confidence: 99%

Evaluation of Duloxetine as Micronuclei Inducer in an Acute and a Subchronic Assay in Mouse

Madrigal-Bujaidar

Álvarez-González

Morales-González

2015

Biological & Pharmaceutical Bulletin

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Duloxetine is a widely used antidepressant worldwide. In the present report, we evaluated its capacity to induce micronucleated polychromatic erythrocytes (MNPEs) and micronucleated normochromatic erythrocytes (MNNEs) in mice. Two assays were performed, one with a single chemical administration and the other with daily chemical administration. In the first, we administered the antidepressant once to groups of 5 mice by the intragastric (i.g.) route (2, 20, and 200 mg/kg) and performed the analysis at 24, 48, and 72 h postadministration. A control group administered i.g. distilled water was included in the assay, as well as another treated with the micronuclei-inducing chemical daunorubicin (2.5 mg/kg, injected intraperitoneally (i.p.)). In this assay, we found significant damage induced by duloxetine starting from the first time evaluated, showing the highest MNPE increase at the end of the assay. We observed a saturation effect as well, suggested by a decreasing relative efficiency with respect to each tested dose. In a second assay, we administered the antidepressant i.g. every day for 5 weeks (2, 6, and 12 mg/kg), and micronuclei analysis was performed at the end of each week. In this study, we also found a significant increase in both MNPEs and MNNEs which was clear by the second week of administration. Our results suggest that short-term as well as cumulative damage is produced by duloxetine. Thus, confirmation of the observed genotoxic potential in other models seems advisable, as well as caution when prescribing this antidepressant.

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A review of the suitability of duloxetine and venlafaxine for use in patients with depression in primary care with a focus on cardiovascular safety, suicide and mortality due to antidepressant overdose

Cited by 29 publications

References 48 publications

Serotonin and noradrenaline reuptake inhibitors (SNRIs) for fibromyalgia

Serotonin and noradrenaline reuptake inhibitors (SNRIs) for fibromyalgia

Morbidity and Mortality Associated With Medications Used in the Treatment of Depression: An Analysis of Cases Reported to U.S. Poison Control Centers, 2000–2014

Evaluation of Duloxetine as Micronuclei Inducer in an Acute and a Subchronic Assay in Mouse

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