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Correction of Venlafaxine- and Duloxetine-Induced Transaminase Elevations with Desvenlafaxine in a Patient with Gilbert's Syndrome

Published online by Cambridge University Press:  07 November 2014

S. Shalom Feinberg
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Abstract

Recent reviews have questioned whether the serotonin-norepinephrine reuptake inhibitor (SNRI) desvenlafaxine succinate offers any practical clinical advantages over existing SNRIs. The following case is one instance where it appears that this SNRI offers unique safety and benefit. Presented is a case report of a patient with Gilbert's syndrome, longstanding social phobia, and more recent depressive disorder not otherwise specified, who was found to have elevated liver transaminases when prescribed both duloxetine and venlafaxine. The patient subsequently responded to desvenlafaxine but without liver abnormalities. In this patient with Gilbert's Syndrome, desvenlafaxine's lack of metabolism through the cytochrome P450 (CYP) 2D6 pathway may explain the avoidance of these abnormalities and thus suggests a possible therapeutic role for this SNRI in similarly susceptible patients.

Type
Case Report
Information
CNS Spectrums , Volume 15 , Issue 1 , January 2010 , pp. 53 - 55
Copyright
Copyright © Cambridge University Press 2010

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References

REFERENCES

1.Effexor, Pristiq vs.. The Carlat Psychiatry Report. 2008; 6: 1–6.Google Scholar
2.Desvenlafaxine for Depression. The Medical Letter. 2008; 50: 37–39.Google Scholar
3.Desvenlafaxine, (Pristiq). Biological Therapies in Psychiatry. 2008; 31: 21–22.Google Scholar
4.Patroneva, A, Connolly, SM, Fatato, P, et al. An assessment of drug-drug interactions: the effect of desvenlafaxine and duloxetine on the pharmacokinetics of the CYP2D6 probe desipramine in healthy subjects. Drug Metab Dispos. 2008; 36: 2484–491.CrossRefGoogle ScholarPubMed
5.Amchin, J, Ereshefsky, L, Zarycranski, W, Taylor, K, Albano, D, Klockowski, PM. Effect of venlafaxine versus fluoxetine on metabolism of dextromethorphan, a CYP2D6 probe. J Clin Pharmacol. 2001; 41: 443–451.CrossRefGoogle ScholarPubMed
6.Bosma, PJ. Inherited disorders of bilirubin metabolism. J Hepatol. 2003; 38: 107–117.CrossRefGoogle ScholarPubMed
7.Burchell, B, Hume, R. Molecular genetic basis of Gilbert's syndrome. J Gastroenterol Hepatol. 1999; 14: 960–966.CrossRefGoogle ScholarPubMed
8.Desanty, KP, Amabile, CM. Antidepressant-induced liver injury. Ann Pharmacother. 2007; 41: 1201–1211.CrossRefGoogle ScholarPubMed
9. Dear Healthcare Professional Letter. Cymbalta (duloxetine hydrochloride) Indianapolis, IN: Eli Lilly and Co., October 2005. Available at: www.fda.gov/downloads/Safety/MedwaTCH/safetyinformation/safety/alertsforhumanmedicalproducts/UCM164428.pdf. Accessed August 27, 2009.Google Scholar
10. Effexor XR [package insert]. Philadelphia, PA: Wyeth Pharmaceuticals Inc; 2008 (Revised).Google Scholar
11.Rudolph, RL, Derivan, AT. The safety and tolerability of venlafaxine hydrochloride: analysis of the clinical trials database. J Clin Psychopharmacol. 1996; 16(3 suppl 2): 54S–61S.CrossRefGoogle ScholarPubMed
12. Pristiq [package insert]. Philadelphia, PA: Wyeth Pharmaceuticals, Inc. 2008.Google Scholar
13.Clayton, AH, Kornstein, SG, Rosas, G, et al. An Integrated Analysis of the Safety and Tolerability of Desvenlafaxine Comparedwith Placebo in the Treatment of Major Depressive Disorder. CNS Spectr. 2009; 14: 183–195.CrossRefGoogle Scholar
14.Preskorn, SH, Nichols, AI, Paul, J, Patroneva, AL, Helzner, EC, Guico-Pabia, CJ. Effect of desvenlafaxine on the cytochrome P450 2D6 enzyme system. J Psychiatr Pract. 2008; 14: 368–378.CrossRefGoogle ScholarPubMed
15.Bleibel, W, Kim, S, D'Silva, K, Lemmer, ER. Drug Induced Liver Injury: review Article. Dig Dis Sci. 2007; 52: 2463–2471.CrossRefGoogle ScholarPubMed
16.Schatzberg, AF, Nemeroff, CB, eds. Textbook of Psychopharmacology. Third edition. Washington, DC: American Psychiatric Publishing; 2004.Google Scholar