Heart failure worsening and exacerbation after venlafaxine and duloxetine therapy.
OBJECTIVE
To report 2 cases of worsened heart failure (HF) after the introduction of venlafaxine or duloxetine therapy in patients with previously stable disease.


METHODS
Two patients, a 39-year-old female and a 68-year-old male, both diagnosed with HF of left ventricular systolic dysfunction, had worsening symptoms in the presence of the serotonin and norepinephrine reuptake inhibitors (SNRIs) venlafaxine 75 mg twice daily and/or duloxetine 30-60 mg/day. Both patients developed tachycardia, which remitted after the discontinuation of these agents. The woman was rechallenged with duloxetine 60 mg daily after her HF worsened with venlafaxine, only to have the tachycardia and HF symptoms return. Other iatrogenic causes and metabolic disturbances (eg, anemia) were ruled out.


CONCLUSIONS
Increased levels of norepinephrine secondary to reuptake inhibition may be potentially deleterious in patients with chronic HF of left ventricular dysfunction owing to the "progressive HF model" and neurohormonal compensatory responses. Use of the Naranjo probability scale showed a probable relationship between venlafaxine/duloxetine use and these adverse outcomes. Venlafaxine and duloxetine were discontinued.


CONCLUSIONS
Use of drugs that increase serum norepinephrine levels, such as the SNRIs, may be potentially deleterious in individuals with unstable or advanced HF. These medications should be avoided or used with caution and monitored regularly in this patient population.
Colucci
Vincent J
VJ
Skaggs School of Pharmacy, College of Health Professions and Biomedical Sciences, The University of Montana, Missoula, MT 59812, USA. Vincent.colucci@umontana.edu
Berry
Bradley D
BD
D000328:Adult; D000368:Aged; D003511:Cyclohexanols / Q000009:adverse effects*; D000068736:Duloxetine Hydrochloride; D005260:Female; D006333:Heart Failure / Q000139:chemically induced* / Q000503:physiopathology; D006801:Humans; D008297:Male; D009638:Norepinephrine / Q000378:metabolism; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects*; D013610:Tachycardia / Q000139:chemically induced; D013876:Thiophenes / Q000009:adverse effects*; D000069470:Venlafaxine Hydrochloride; D018487:Ventricular Dysfunction, Left / Q000209:etiology / Q000503:physiopathology
D003511:Cyclohexanols; D000068736:Duloxetine Hydrochloride; D009638:Norepinephrine; D017367:Selective Serotonin Reuptake Inhibitors; D013876:Thiophenes; D000069470:Venlafaxine Hydrochloride