노인환자에서 Venlafaxine 투여와 관련된 저나트륨혈증 발생 증례보고 1예

유지인,최영민 대한정신약물학회 2008 대한정신약물학회지 Vol.19 No.1

Recent studies have indicated that hyponatremia can be associated with antidepressants, and venlafaxine is a widely used serotonin norepinephrine reuptake inhibitor (SNRI) that has been reported to induce this electrolyte abnormality.1 A 76-year-old female patient was observed to have hyponatremia after an increase in the dosage of venlafaxine from 37.5 mg to 75 mg a day. Her electrolyte level normalized after the venlafaxine therapy was discontinued, but the abnormality recurred after therapy was resumed. A few case reports of hyponatremia associated with venlafaxine can be found in the literature. While the present case is consistent with previous reports, it is still remarkable due to the rapid development of the hyponatremia, which was 2 days in this patient versus several weeks in the other reported cases. Therefore, special attention is required for the use of venlafaxine, especially in elderly psychiatric patients and patients with a previous brain lesion. Venlafaxine이 저나트륨혈증의 발생에 영향을 끼칠 수 있음을 보고한다. 환자는 입원 3일째 venlafaxine 75 mg/day 투약 중 첫 번째 저나트륨혈증 소견을 보였고, 입원 27일째 venlafaxine 37.5 mg/day를 재투약하였을 때에도 두 번째 저나트륨혈증 소견을 보였다. 이후 venlafa-xine을 중단함으로써 저나트륨혈증은 정상 소견을 보였다. 이상을 볼 때 비록 venlafaxine에서의 저나트륨혈증이 흔한 부작용은 아닐지라도, venlafaxine 투여 전에 전해질상태를 신중히 살펴보는 것이 필요하다고 생각된다. 특히 약물에 민감한 노인 환자와, 여러 약물을 같이 복약하는 경우, 이전에 뇌에 병변이 있는 경우는 이의 투여가 더 신중해야 할 것이며, 투약 중에도 지속적인 전해질 상태에 관한 추적검사 및 이를 반영할 전신 상태 및 진정작용 등의 증상을 주의 깊게 살펴보는 것이 중요할 것으로 생각된다.

Venlafaxine-Induced Mania After Nortriptyline-Induced Hypomania in Unipolar Depression

Beang-Jin Chae(채병진) 대한생물치료정신의학회 2008 생물치료정신의학 Vol.14 No.1

Venlafaxine은 세로토닌 수용체나 아드레날린 수용체 차단을 통해 효과를 나타내는 항우울제이다. 저자는 33세의 우울증을 앓고 있는 여성에서 venlafaxine에 의한 조증을 경험하여 보고하고자 한다. 이 여성은 nortriptyline에 의한 경조증의 과거력과 자살의 가족력이 있었다. Venlafaxine으로 치료한지 51일째부터 조증으로 전환되었고, 이후venlafaxine을 중단한후 25일째부터 조증 증상이 소실되었다. 이 증례는 양극성 성향을 가진 단극성 우울증 환자에서 venlafaxine을 사용시 조증이나 경조증으로는 전환을 일으킬 수도 있음을 시사한다. Venlafaxine is an effective antidepressant medication which acts through the blockage of serotonergic or noradrenergic receptors. I present a case of venlafaxine induced mania in a unipolar depressed 33 year old woman. She had a history of nortriptyline induced hypomania and a family history of suicide. 51 days after beginning venlafaxine, she began developing manic switch. Twenty five days after stopping venlafaxine, manic symptoms disappeared. This case suggests that venlafaxine may be associated with a switch to mania or hypomania in unipolar depressive patient with bipolarity.

The Effects of Venlafaxine and Dexamethasone on the Expression of HSP70 in Rat C6 Glioma Cells

유재학,Jun-Seok Lee,양병환,최미란,채영규,김석현,노성원 대한신경정신의학회 2010 PSYCHIATRY INVESTIGATION Vol.7 No.1

Objective: The present study aimed to determine the intracellular action of the antidepressant, venlafaxine, in C6 glioma cells using heat shock protein 70 (HSP70) immunocytochemistry and HSP70 Western blots; HSP70 is known to be associated with stress and depression. Methods: The extent of HSP70 expression was measured after rat C6 glioma cells were treated with 1) dexamethasone only, 2) venlafaxine only, 3) simultaneous venlafaxine and dexamethasone, or 4) dexamethasone after venlafaxine pretreatment. Dexamethasone (10 μM, 6 hours) did not affect the level of HSP70 expression relative to control. Results: Short-term (1 hour) venlafaxine treatment significantly increased the level of HSP 70 expression. Simultaneous long-term (72 hours) venlafaxine and dexamethasone treatment significantly reduced the level of HSP70 expression. Dexamethasone treatment administered following long-term (24 and 72 hours) pretreatment with venlafaxine also significantly reduced the level of HSP70 expression. Conclusion: Short-term treatment with venlafaxine increases the expression of HSP70, but prolonged treatment with dexamethasone suppresses the venlafaxine-induced expression of HSP70. These findings suggest that HSP70 and dexamethasone play a significant role in the pathophysiology of depression.

Venlafaxine의 안면홍조 증상개선효과에 대한 최근 연구 고찰

이유정 한국임상약학회 2010 한국임상약학회지 Vol.20 No.2

안면홍조는 폐경기 초기 많은 여성들에게 나타나는 증상이다. 정확한 원인은 밝혀지지 않았지만 혈중 에스트로겐 수 치가 낮아졌을 때 안면홍조 증상이 나타나기 때문에 에스트로겐을 기본으로 한 호르몬 요법이 수년간 안면홍조 증상 치료의 중심이었다. 그러나 호르몬 요법이 유방암, 뇌졸중 등의 발생 위험도를 증가시킨다는 연구 결과가 발표된 이 후 많은 보건의료인들은 호르몬 요법 대신 사용 가능한 다른 치료제에 관심을 보이고 있다. 본 연구는 venlafaxine 의 안면홍조 증상 치료효과에 대한 최신 지견을 얻고자, 1990년부터 2010년 7월까지 MEDLINE에 등재된 논문을 Hot flashes와 Venlafaxine이라는 MeSH terms로 검색하여 추출한 자료 중에서 대조군이 사용된 무작위 배정 및 이 중맹검 임상연구 사례만을 선별하여 임상적 유용성을 평가하였다. 현재 venlafaxine은 안면홍조 증상 치료제로 허가된 의약품은 아니지만 최근 여러 국가에서 시행된 연구들은 venlafaxine이 효과적인 안면홍조 증상 치료제일 수 있다는 결과를 보여주고 있다.

Profiling of Proteins Regulated by Venlafaxine during Neural Differentiation of Human Cells

도미숙,한달무리,오동훈,김석현,최미란,채영규 대한신경정신의학회 2015 PSYCHIATRY INVESTIGATION Vol.12 No.1

ObjectiveaaAntidepressants are known to positively influence several factors in patients with depressive disorders, resulting in increased neurogenesis and subsequent relief of depressive disorders. To study the effects of venlafaxine during neural differentiation at the cellular level, we looked at its effect on protein expression and regulation mechanisms during neural differentiation. MethodsaaAfter exposing NCCIT cell-derived EBs to venlafaxine during differentiation (1 day and 7 days), changes in protein expression were analyzed by 2-DE and MALDI-TOF MS analysis. Gene levels of proteins regulated by venlafaxine were analyzed by real-time RT-PCR. ResultsaaTreatment with venlafaxine decreased expression of prolyl 4-hydroxylase (P4HB), ubiquitin-conjugating enzyme E2K (HIP2) and plastin 3 (T-plastin), and up-regulated expression of growth factor beta-3 (TGF-β3), dihydropyrimidinase-like 3 (DPYSL3), and pyruvate kinase (PKM) after differentiation for 1 and 7 days. In cells exposed to venlafaxine, the mRNA expression patterns of HIP2 and PKM, which function as negative and positive regulators of differentiation and neuronal survival, respectively, were consistent with the observed changes in protein expression. ConclusionaaOur findings may contribute to improve understanding of molecular mechanism of venlafaxine.

우울증 치료 시 항우울제 선택에 관한 비용-효과 분석

박정애 ( Jeong Ae Park ),최상은 ( Sang Eun Choi ) 한국보건경제정책학회 2010 보건경제와 정책연구 Vol.16 No.2

우울증은 사회적 부담이 상당히 큰 질환으로 WHO는 오는 2020년에 이르면 질병부담이 두번째로 높은 질환이 될 것으로 예측하고 있다. 우리나라의 자살로 인한 사망률은 OECD국가 중 가장 높은 것으로 보고되며, 이러한 자살의 원인 중 60%를 차지하는 것이 우울증이다. 이에 본 연구에서는 중등도 및 중증 우울증 환자를 대상으로 국내 시장점유율이 높은 항우울제 4개성분 (venlafaxine, paroxetine, escitalopram, mirtazapine)에 대한 비용-효과 분석을 통하여, 우울증 치료 시 보다 합리적이고 비용 효과적인 약제를 선택할 수 있도록 기초자료를 제공하고자 한다. 결정수형모형을 이용하여 6개월간의 증가된 질보정생존연수(QALY)를 측정하였으며, 비용에는 직접의료비용과 간접비용이 포함되었다. 기본 분석 결과, escitalopram> venlafaxine> mirtazapine> paroxetine> 순으로 escitalopram이 가장 효과적인 것으로 나타났으며, 비용은 escitalopram이 가장 적고 venlafaxine< mirtazapine< paroxetine 순으로 높아졌다. 점진적 비용-효과비(ICER)를 구한 결과, escitalopram은 나머지 3개 약제에 비해 효과는 좋으면서 비용은 더 적어 가장 비용 효과적인 것으로 나타났다. 이러한 결과는 효과 및 비용 등의 주요변수에 대한 민감도 분석에서도 달라지지 않았으며, escitalopram의 비용-효과성에 가장 크게 영향을 미치는 요인은 저렴한 약제비와 낮은 부작용발생률임을 알 수 있었다. The economic burden of depression is known to be high and was estimated 2,015.3 billion won in Korea. The purpose of this analysis was to evaluate the cost-effectiveness of first-line therapies (escitalopram, paroxetine, venlafaxine, mirtazapine) for the treatment of major depressive disorder (MDD) in Korea. A decision analytic model with a 6 month treatment goal was used to estimate the effectiveness, cost and cost-effectiveness of antidepressants from the societal perspective. Clinical outcome was measured using quality-adjusted life years(QALY) based on remission rates(HAM≤D 7 or MADRS≤10) and adverse drug reaction(ADR) rates. Sensitivity analysis was conducted to examine the impact of uncertainty upon variation of the major parameters. The expected effectiveness of treatment was 0.3700 QALY for escitalopram, followed by 0.3684 for venlafaxine, 0.3675 QALY for mirtazapine and 0.3557 QALY for paroxetine. The total cost of treatment was 6,621,107 won for escitalopram, 6,799,101 won for venlafaxine, 6,830,130 won for mirtazapine and 7,801,911 won for paroxetine. The most effective and the least expensive alternative, escitalopram was dominant compared with other three antidepressants. Sensitivity analyses indicated that the results of the study were robust to the assumptions underpinning the model. This analysis suggests that first-line treatment of MDD with escitalopram is the most cost-effective alternative compared with mirtazapine, venlafaxine, paroxetine in the Korea National Health Insurance context. The observed dominance reported in the current study stems from better clinical outcomes and cost savings demonstrated by escitalopram over the 3 comparators.

Oromucosal delivery of venlafaxine by linseed mucilage based gel: in vitro and in vivo evaluation in rabbits

Pankaj Padmakar Nerkar,Surendra Ganeshlal Gattani 대한약학회 2013 Archives of Pharmacal Research Vol.36 No.7

Linseed is the crop that is used as a foodstuff inEuropean and Asian countries. The objective of the presentwork was to extract mucilage from linseed, utilize it asmucoadhesive gelling agent along with synthetic polymersand administration of venlafaxine by buccal route in the gelform. Buccal administration of venlafaxine will avoid firstpass metabolism, which will increase the bioavailability ofthe drug. Linseed mucilage based buccal mucoadhesive gelpreparations in combination with chitosan, carbopol 934P,carboxy methylcellulose and polyvinyl pyrrolidone wereformulated and the viscosity, gel strength, percentagemucoadhesion and in vitro diffusion of the formulation wasevaluated. Formulation (F2) was subjected to in vivoanalysis in rabbits. Formulation F2, which contained linseedmucilage (2 %) and chitosan (0.5 %), showed thehighest percentage of mucoadhesion, gel strength andsustained drug diffusion. The bioavailability by the oralroute and buccal route were compared with that of theintravenous route. The bioavailability of venlafaxine in theformulation F2 was 63.08 ± 1.28 % by buccal route,which was higher than by the oral route (39.21 ± 6.18 %). Based on these results, the combination of linseed mucilageand chitosan can be used to form a buccal mucoadhesivegel and increase the bioavailability of venlafaxine.

CASE REPORT : A Case of Venlafaxine-Induced Interstitial Lung Disease

( Serim Oh ),( Seung Ick Cha ),( Hyera Kim ),( Min Jung Kim ),( Sun Ha Choi ),( Hye Won Seo ),( Tae In Park ) 대한결핵 및 호흡기학회 2014 Tuberculosis and Respiratory Diseases Vol.77 No.2

A patient treated with venlafaxine for major depression developed an interstitial lung disease (ILD) with the characteristic clinical, radiological and pathological features of chronic hypersensitivity pneumonitis. A high resolution computed tomography scan demonstrated ground glass opacity, mosaic perfusion with air-trapping and traction bronchiectasis in both lungs. The pathological findings were consistent with a nonspecific interstitial pneumonia pattern. Clinical and radiological improvements were noted after the discontinuation of venlafaxine and the administration of a corticosteroid. This report provides further evidence that the anti-depressant venlafaxine can cause ILD.

Dose Dependent Course of Hyperprolactinemic and Normoprolactinemic Galactorrhea Induced by Venlafaxine

Mehmet Akif Camkurt,Gizem Gülpamuk,Ebru Fındiklı,Rengin Elve 대한정신약물학회 2017 CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE Vol.15 No.2

Venlafaxine is a serotonergic and noradrenergic reuptake inhibitor which is used for the treatment of depression. We report a case of galactorrhea in a patient with major depressive disorder after starting treatment with venlafaxine. In particular, we discuss the course of hyper and normoprolactinemic galactorrhea. We managed this side effect initially by dose reduction and further by switching to essitalopram. Physicians should be aware of endocrinologic side effects such as galactorrhea during the serotonin and noradrenaline reuptake inhibitor treatment.

A Case of Venlafaxine-Induced Interstitial Lung Disease

오세림,차승익,김혜라,김민정,최선하,서혜원,박태인 대한결핵및호흡기학회 2014 Tuberculosis and Respiratory Diseases Vol.77 No.2

A patient treated with venlafaxine for major depression developed an interstitial lung disease (ILD) with the characteristic clinical, radiological and pathological features of chronic hypersensitivity pneumonitis. A high resolution computed tomography scan demonstrated ground glass opacity, mosaic perfusion with air-trapping and traction bronchiectasis in both lungs. The pathological findings were consistent with a nonspecific interstitial pneumonia pattern. Clinical and radiological improvements were noted after the discontinuation of venlafaxine and the administration of a corticosteroid. This report provides further evidence that the anti-depressant venlafaxine can cause ILD.