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.

#toxicology

References:

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.