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The Risk of Fatal Arrhythmias in Post-Myocardial Infarction Depression in Association With Venlafaxine - PubMed

  • ️Sat Jan 01 2022

Review

. 2022 Sep 13;14(9):e29107.

doi: 10.7759/cureus.29107. eCollection 2022 Sep.

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Review

The Risk of Fatal Arrhythmias in Post-Myocardial Infarction Depression in Association With Venlafaxine

Sai Dheeraj Gutlapalli et al. Cureus. 2022.

Abstract

Venlafaxine is a second line anti-depressant and the most commonly used in the treatment of selective serotonin reuptake inhibitor nonresponders in major depression; due to its effects on the noradrenergic and serotonergic systems as a serotonin and norepinephrine reuptake inhibitor, there has been considerable apprehension regarding its use in patients with cardiovascular diseases, particularly post-myocardial infarction depression, some of the feared adverse effects include QT prolongation, arrhythmias including torsades de pointes and sudden cardiac death. We tried to resolve the facts regarding the risks associated with venlafaxine use in cardiac patients. We have reviewed all the relevant information up to May 2022 regarding the risks of venlafaxine use in cardiovascular disease, particularly with a focus on post-myocardial infarction depression, and gathered around 350 articles in our research and narrowed it down to 49 articles. The database used was PubMed and the keywords used were venlafaxine, arrhythmia, major depression, post-myocardial infarction, and ventricular tachycardia. We carefully screened all relevant articles and found articles supporting and refuting the effects of venlafaxine in increasing cardiovascular morbidity and mortality. We have concluded that there is a significant variability due to confounding factors affecting individual cases. Overall there is no increased arrhythmia risk in comparison with other anti-depressants except in high-risk cases such as with pre-existing cardiovascular disease, certain genotypes, and other co-morbidities. Any patient with a high risk of arrhythmias due to any etiology should receive a screening electrocardiogram before venlafaxine prescription for baseline QT interval and periodically while on therapy to check for changes. We encourage further research, including randomized clinical trials and post-marketing surveillance regarding the use of venlafaxine in high-risk cases such as patients with multiple co-morbidities, elderly patients, or patients with certain genotypes.

Keywords: arrhythmia; depression; post-myocardial infarction; snri; venlafaxine.

Copyright © 2022, Gutlapalli et al.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. The multi-directional web of causation.
Figure 2
Figure 2. List of the factors increasing the risk for QT prolongation.
Figure 3
Figure 3. The most common cardiovascular side effects of venlafaxine.

Heart Rate (HR); Blood Pressure (BP)

Figure 4
Figure 4. Factors associated with an increased risk of venlafaxine toxicity.

Long QT Syndrome (LQTS)

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