The Effect of Venlafaxine on Electrocardiogram Intervals During Treatment for Depression in Older Adults.
The Effect of Venlafaxine on Electrocardiogram Intervals During Treatment for Depression in Older Adults.
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DOI：
10.1097/jcp.0000000000001287
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发表时间：
2020
影响因子：
2.9
通讯作者：
Mulsant BH
中科院分区：
文献类型：
--
作者：
Behlke LM;Lenze EJ;Pham V;Miller JP;Smith TW;Saade Y;Karp JF;Reynolds CF 3rd;Blumberger DM;Stefan C;Mulsant BH
文拉法辛是一种常用的抗抑郁药，具有血清素能和去甲肾上腺素能活性。人们担心它可能会延长正确的QT间期（QTc），老年人发生这种副作用的风险更高，尤其是在高剂量的药物治疗下。在这项前瞻性临床试验的二级分析中，我们测量了169名年龄≥60岁的重度抑郁症患者的QTc和其他心电图参数的变化，这些患者急性接受每日300 mg文拉法辛缓释片（XR）治疗。我们检测了文拉法辛剂量与心电图参数的关系，以及血清文拉法辛水平与心电图参数的关系。文拉法辛暴露与QTc的增加无关。文拉法辛组心率升高，PR间期缩短，QRS宽度无明显变化。从基线开始的QTc变化与文拉法辛剂量或血清浓度无关。年龄、性别、心血管合并症和抑郁缓解状态不能预测文拉法辛治疗后QTc的变化。文拉法辛治疗不延长QTc或其他心电图参数，即使在老年抑郁症患者中使用高剂量。这些结果表明文拉法辛对大多数老年患者的心脏传导没有显著影响。
Venlafaxine is a commonly used antidepressant with both serotonergic and noradrenergic activity. There are concerns it may prolong the corrected QT interval (QTc), and older adults may be at higher risk for this adverse effect, especially at higher dosages of the medication. In this secondary analysis of a prospective clinical trial, we measured changes in QTc and other ECG parameters in 169 adults aged ≥ 60 with a major depressive disorder treated acutely with venlafaxine extended release (XR) up to 300 mg daily. We examined the relationship of venlafaxine dosage and ECG parameters, as well as the relationship between serum levels of venlafaxine and ECG parameters. Venlafaxine exposure was not associated with an increase in QTc. Heart rate increased with venlafaxine treatment, while the PR interval shortened, and QRS width did not change significantly. QTc change from baseline was not associated with venlafaxine dosages or serum concentrations. Age, sex, cardiovascular comorbidities, and depression remission status did not predict changes in QTc with venlafaxine. Venlafaxine treatment did not prolong QTc or other ECG parameters, even in high dosages in older depressed adults. These findings indicate that venlafaxine does not significantly affect cardiac conduction in most older patients.