Safety Concerns With SNRIs

Some SNRI Warnings and Precautions

Some precautions and warnings with SNRIs to be aware of include:
  • Antidepressants (including SNRIs) may increase the risk of suicidal thinking or behavior in children, teenagers, and adults (see Depression and Suicide for more information). Therefore, if you notice any changes in symptoms or new symptoms, talk to your healthcare provider immediately. Some of these symptoms may include anxiety, hostility, agitation, panic, restlessness, hallucinations, extreme hyperactivity, and suicidal thoughts or behavior (see SNRIs and Suicide for more information).
  • Before prescribing SNRIs for depression, your healthcare provider should make sure that you do not have bipolar disorder (instead of depression). Sometimes, the symptoms of bipolar disorder and depression are very similar, and SNRIs can cause problems in people with bipolar disorder.
  • Taking SNRIs with other medications that affect serotonin can increase your risk of a dangerous group of symptoms called serotonin syndrome. These other medications include other antidepressants, triptans (migraine medications), and several other medications. Contact your healthcare provider immediately if you have any possible symptoms of serotonin syndrome, including:
o Confusion
o Seeing or hearing things that are not really there (hallucinations)
o Fast heartbeat (tachycardia)
o Feeling faint
o Fever
o Sweating
o Muscle spasms
o Difficulty walking
  • SNRIs have been reported to cause liver problems, including hepatitis. SNRIs are not recommended for people who have liver problems or who drink large amounts of alcohol regularly, due to an increased risk of liver damage.
  • SNRIs can cause low blood pressure (hypotension). This may be more common if you are also taking other medications, especially high blood pressure medication. Tell your healthcare provider if you have symptoms of low blood pressure, including lightheadedness, dizziness, or fainting.
  • In studies, SNRIs were shown to slightly increase blood pressure and heart rate. Your healthcare provider should monitor your blood pressure and heart rate while you are taking an SNRI.
  • If you have a seizure disorder, there is a possibility that taking SNRIs may cause seizures. Talk to your healthcare professional before taking an SNRI if you have seizures.
  • If you are stopping SNRI use, you should be monitored by a healthcare professional for SNRI withdrawal symptoms. If you do develop any symptoms of SNRI withdrawal, such as irritability, anxiety, confusion, headache, lethargy, or insomnia, your healthcare provider may slow down the rate at which the SNRI is stopped (see SNRI Withdrawal).
  • If you are elderly or taking a diuretic, SNRIs could cause low salt levels in the blood (hyponatremia). This generally returns to "normal" when the SNRI is stopped.
  • SNRIs can make narrow angle glaucoma worse. If your glaucoma is under control, your healthcare provider should monitor your glaucoma to make sure it is not getting worse. If your glaucoma is not under control, you should not take an SNRI.
  • SNRIs are not recommended for people with severe kidney problems, such as kidney failure (renal failure).
  • SNRIs can cause anxiety, nervousness, and insomnia. Tell your healthcare provider if you experience these symptoms while taking an SNRI.
  • SNRIs can cause a loss of appetite and weight loss. Usually, weight loss is small, although it is possible to lose large amounts of weight while taking SNRIs.
  • SNRIs may affect your ability to perform complex tasks requiring mental and motor skills. Therefore, it is recommended that you become accustomed to their effect on you before becoming involved in activities requiring mental or motor concentration (such as driving a car or operating machinery). Taking SNRIs with alcohol or other medications that cause drowsiness can increase this effect.
  • SNRIs are considered pregnancy Category C medications. This means that SNRIs may not be safe to use during pregnancy. Talk to your healthcare provider about the risks and benefits of using an SNRI during pregnancy (see SNRIs and Pregnancy for more information).
  • SNRIs pass through breast milk. Therefore, if you are breastfeeding or plan to start breastfeeding, be sure to talk with your healthcare provider about using an SNRI (see SNRIs and Breastfeeding).
Alternative Therapies for Pain Management

Serotonin-Norepinephrine Reuptake Inhibitors

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