Tests

[Pipkin]

Hi all,

Been on ven for 8 years and for the first time, my GP has called me in for a blood test and an ECG. Nothing has triggered this and I haven’t been to the doctor for over a year.

This happened to anyone else?

Thanks

Pip

[venusbluejeans]

Heya Pip

My guess is that doctors or GMC policy has changed and they have say that you have to have the tests after so long on the meds.

Call your GP and asK why if you are worried why :)

Emmz xx

[Pipkin]

Hi Emmz,

Reckon you’re right that there have been some guidance changes. Either that, or he just likes poking and prodding me, and wiring me up to equipment.

Not worried though, just curious. I’ll post when I find out what they’re up to.

Pip xxx

[Carys]

Yeah, I'd be interested to know......as have been on venlafaxine for 20 years and apart from a 'yearly review' where they ring up and say 'all ok?' , have had no checks at all. I ahve to say, I have been surprised by my lack of check-ups whilst on it, and thought they were meant to check liver function and a few others things.

[Pipkin]

Thanks Cerys. I guess it could be liver function tests and I did read that ven can affect the heart rhythm so I guess that explains the ECG. I’ll let you know :D

Pip

[Carys]

I think your doctors are being really thorough and following their duties to the max.

[KK77]

Ven can increase BP and cholesterol levels. More rarely it can affect heart rhythm, so just routine tests imo.

Glad you're still waving, not drowning, old Pip :shades:

[MyNameIsTerry]

https://www.gpnotebook.co.uk/simplepage.cfm?ID=-1375338426


for patients prescribed venlafaxine, NICE suggest blood pressure should be checked on initiation and regularly during treatment, particularly during dosage titration. For patients who experience a sustained increase in blood pressure, the dose should be reduced or discontinuation considered

https://www.nice.org.uk/guidance/cg23/documents/depression-amendment-nice-guideline-draft-for-consultation2

1.5.2.34 For patients prescribed venlafaxine, blood pressure should be checked on initiation, and regularly during treatment particularly during dosage titration. Reduce the dose or consider discontinuation in patients experiencing a sustained increase in blood pressure

https://www.nottsapc.nhs.uk/media/1117/venlafaxine-higher-dose-information-sheet.pdf

Recommended monitoring 1. A baseline ECG is not required, unless clinically indicated. It should be repeated one week after any dose increase in high cardiac risk patients. 2. Blood pressure (BP) measurement should be performed before starting venlafaxine. If baseline BP is raised (systolic >140mmHg or diastolic >90mmHg) this should be managed in line with current hypertension guidelines. Hypertension should be controlled before starting venlafaxine. 3. Monitor the patient’s blood pressure 4 weeks and 8 weeks after initiation or following any subsequent dose increase and then every 3 months thereafter. 4. If there is evidence of a sustained increase in blood pressure compared with baseline the following options can be considered depending on the magnitude of the increase, patient response to treatment, history of non-response to other medication and general medical status: reduce venlafaxine dose, change antidepressant, initiate or alter antihypertensive treatment.
https://www.sussexpartnership.nhs.uk/sites/default/files/documents/antidepressant_guidelines_-_v4_final_-_jan_18_-_0418.pdf

2.4.2 Blood pressure should be monitored in patients with known hypertension. In particular, venlafaxine may have significant effect on blood pressure when used in higher doses.

Some evidence there that might answer it. There is reference to BP being dose dependent with Ven, the higher the dose the more the impact. I think I spotted something about >150mg with Ven & BP but didn't read further via Google as I'm sure you would anyway.

I've seen this sort of thing with other antidepressants and yet we don't get checked. Occasionally, someone like yourself creates a thread asking why they are. My thoughts on this is that there many be several triggers:

1) new GP who is more clued up on antidepressants.
2) current GP reads something and realises they should have been doing this.
3) local trust/CCG guidelines circulars to remind GP's.
4) other conditions e.g. a GP might being looking into diabetes or hypertension anyway and it's just best practice to consider any meds.
5) health checks based on age my spark an overall review of you.

It's like how we see people join here to ask why their GP has decided to withdraw their diazepam after donkey's years on the stuff. The negative affects of this were published decades ago and the NHS have been telling all doctors not to prescribe over x weeks for a very long time yet so many people are still out there and GP's aren't addressing the situation, perhaps until they get a reminder from someone higher up? :winks:

GP's expected to keep themselves abreast of changes. This must be very hard to do when they are so pushed. I don't believe they do this, my own practice have made mistakes with my mum that newer doctors in the local hospital picked up straight away and discontinued as well as writing to the surgery cited the treatment being years out of date.

I expect your GP is just catching up unless you are upping dosages.

They sometimes do ECG's for hell of it. When I was diagnosed with hypertension the senior nurse said it was just to catch any issues as a matter if best practice but they didn't expect anything. I had gone maybe 20 years without an ECG and the hypertension was only picked up because I took them up on the over 40's health check.

They are supposed to be checking my BP because I'm on Duloxetine. Very similar advice can be found. And the EMA says anyone with hypertension should be monitoring regularly yet I have this and they are just doing it once a year like anyone else despite the antidepressant impact. GP's and the lack of governance causes much of this, I expect.

[Pipkin]

Been away for a while but I thought I'd report back, for the sake of completeness in case anyone reads this in future.

I went for the prodding, poking and was wired up to the thingy. All was fine. It confirmed that I do have a heart and it seems to work ok. The reason was that it's a recommendation due to possible heart effects of venlafaxine but what prompted it at that time, I have no idea. It probably was a directive from somewhere.

Anyway, if you are called for similar, it's nothing to worry about.

Pip xx

[Jo79]

Good to know as I’ve been called in for bloods, blood pressure and ecg on Monday. Been on ven for a while now but recently increased to 300mg. I’m also on quetiapine and mirtazapine

[pulisa]

My son has tachycardia on 300mg ven but also has a hole in the heart. His ECG was dodgy so he's been referred for an echocardiogram to check as to whether the ven has made things worse from the last echo 2 years ago. His BP was normal but he's having a whole range of bloods done next week.

Psychiatrist didn't ask for cardiac tests. I got him to go to the GP but initially GP said that ven isn't associated with potential cardiac probs. She changed her mind after the ECG.

[KK77]

My son has tachycardia on 300mg ven but also has a hole in the heart. His ECG was dodgy so he's been referred for an echocardiogram to check as to whether the ven has made things worse from the last echo 2 years ago. His BP was normal but he's having a whole range of bloods done next week.

Psychiatrist didn't ask for cardiac tests. I got him to go to the GP but initially GP said that ven isn't associated with potential cardiac probs. She changed her mind after the ECG.

And you did absolutely the right thing, Cmrd P, as Ven IS associated with frequent negative cardiac side effects: it can raise BP, increase heart rate, and bad cholesterol levels. It certainly isn't suitable, especially at the dose your son is on, for those with pre-existing cardiac issues.

I am only stating my opinion here, but think it would be wise, depending on his mental state, to slowly reduce the Ven and get him off it completely (as you successfully did with your daughter).

He is lucky to have such a caring and informed mum as yourself, and I know you will do the right thing :D

[pulisa]

Thanks, KK. That elusive "right thing"...Will have to have strong words with the prescribing psych and get a second opinion if needed. Will need to chase up the heart echo too. I have zero confidence in the local services.

[Carnation]

Thank God, you seem to have more experience and knowledge than the pros Pulisa. I agree with KK, your son is lucky to have you as a mum. x

[pulisa]

I'm not so sure of that, carnation, but thank you! x

My "knowledge" is only a result of having to deal with a lot of crap over the years. I've just had enough now and challenge the "experts" when i feel it's justified. It's down to anger really and frustration at not being able to make things better.