title: Venlafaxine-induced orthostatic hypotension in a geriatric patient.
abstract: Venlafaxine is not usually associated with risk of orthostatic hypotension. A 65-year-old US Caucasian female taking 225 mg/day of venlafaxine extended-release developed symptomatic orthostatic hypotension. The systolic and diastolic blood pressure dropped by 25 and 18 mm Hg, respectively, from supine position to standing position within 3 minutes. The patient was otherwise healthy and the orthostatic hypotension resolved with venlafaxine discontinuation. This was a probable venlafaxine adverse drug reaction according to the Naranjo scale. This case contributes to the scarce literature that indicates that clinicians need to be aware that occasionally venlafaxine can induce clinically significant orthostatic hypotension, particularly in geriatric patients. Our patient did not have orthostatic hypotension when she was taking venlafaxine at 60 years of age in higher venlafaxine doses (300 mg/day) but developed this adverse drug reaction when venlafaxine was restarted at the geriatric age. This case indicates that a history of prior tolerance to venlafaxine does not guarantee tolerance after 65 years of age. If a clinician decides to use venlafaxine in geriatric patients, the clinician should warn the patient about the risk of orthostatic hypotension and consider very slow titration and low doses.
authors: Department of Psychiatry, College of Medicine, University of Kentucky, Lexington, KY 40509, USA.
authors: Vidyashree
authors: V
authors: Chikkaramanjegowda
authors: Jose
authors: J
authors: de Leon
references: J Clin Psychiatry. 1995 Dec;56(12):574-9
references: 8530334
references: Clin Pharmacol Ther. 1981 Aug;30(2):239-45
references: 7249508
references: Curr Drug Metab. 2011 Sep;12(7):611-20
references: 21495972
references: Am J Geriatr Psychiatry. 2006 Sep;14(9):796-802
references: 16943176
references: Pharmacotherapy. 2003 Dec;23(12):1668-72
references: 14695048
references: Pharmacopsychiatry. 2012 Sep;45(6):229-35
references: 22426847
references: Clin Auton Res. 2011 Apr;21(2):69-72
references: 21431947
references: Indian J Psychiatry. 2001 Oct;43(4):371-3
references: 21407896
references: J Clin Psychiatry. 1998 Oct;59(10):502-8
references: 9818630
references: Neurology. 1996 May;46(5):1470
references: 8628505
references: J Clin Psychiatry. 2003;64 Suppl 13:5-12
references: 14552650
references: Curr Drug Metab. 2011 Sep;12(7):601-10
references: 21495970