Friday, December 10, 2021

non-SSRI toxicity

 Q; 44 years old female is admitted to ICU with seizures and Bupropion overdose. Hemodialysis is indicated? 

A) Yes 

B) No

Answer: B

The objective of this question is to highlight the fact that hemodialysis has no role in serotonin-norepinephrine reuptake inhibitors (SNRIs) and nonselective serotonin reuptake inhibitors (non-SSRIs). 

It includes venlafaxine (Effexor), desvenlafaxine (Pristiq), duloxetine (Cymbalta), milnacipran (Savella), mirtazapine (Remeron), and bupropion (Wellbutrin, Zyban).

This is due to their large volume of distribution.



1. Mandrioli R, Protti M, Mercolini L. New-Generation, Non-SSRI Antidepressants: Therapeutic Drug Monitoring and Pharmacological Interactions. Part 1: SNRIs, SMSs, SARIs. Curr Med Chem. 2018;25(7):772-792. doi: 10.2174/0929867324666170712165042. PMID: 28707591.

2. Protti M, Mandrioli R, Marasca C, Cavalli A, Serretti A, Mercolini L. New-generation, non-SSRI antidepressants: Drug-drug interactions and therapeutic drug monitoring. Part 2: NaSSAs, NRIs, SNDRIs, MASSAs, NDRIs, and others. Med Res Rev. 2020 Sep;40(5):1794-1832. doi: 10.1002/med.21671. Epub 2020 Apr 13. PMID: 32285503.

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