ECG? Before starting.

[BikerMatt]

I've been tapering off seroxat and my psychiatrist wants me to start venlafaxine 75XR which I've collected from the chemist. I haven't started taking them yet, but I've read you should have an ECG before starting. I haven't been offered one. Did anybody that takes them have an ECG first?
Thanks

[MyNameIsTerry]

I've been on Duloxetine, another SNRI, and I've read about regular checks in the US but it's never been mentioned by my GP.

Is it because of the long QT issue? That one has links to other SSRI's so I guess is possible that if you were ok on one they see it as not being a problem?

[BikerMatt]

I've been on Duloxetine, another SNRI, and I've read about regular checks in the US but it's never been mentioned by my GP.

Is it because of the long QT issue? That one has links to other SSRI's so I guess is possible that if you were ok on one they see it as not being a problem?

Terry sorry whats QT? I've also had my mirtazapine upped from 15 to 45 over the last two months.

[MyNameIsTerry]

It's an inherited electrical problem with the heart, a specific form of arrhythmia.

Some of these meds have been found to increase risk to this underlying condition so doctors check first. I was just wondering if what you read mentioned testing for this first hence the ECG?

[nicola1980]

Hi I take ven and never had an ECG beforehand, I have had one whilst on it but not because I was taking ven. Good luck with it XX

[MyNameIsTerry]

http://www.drugs.com/pro/venlafaxine.html

ECG Changes
In an analysis of ECGs obtained in 769 patients treated with Venlafaxine hydrochloride and 450 patients treated with placebo in controlled clinical trials, the only statistically significant difference observed was for heart rate, i.e., a mean increase from baseline of 4 beats per minute for Venlafaxine hydrochloride. In a flexible-dose study, with doses in the range of 200 to 375 mg/day and mean dose greater than 300 mg/day, the mean change in heart rate was 8.5 beats per minute compared with 1.7 beats per minute for placebo (see PRECAUTIONS, General, Use in Patients with Concomitant Illness).

Use in Patients with Concomitant Illness
Clinical experience with Venlafaxine hydrochloride in patients with concomitant systemic illness is limited. Caution is advised in administering Venlafaxine hydrochloride to patients with diseases or conditions that could affect hemodynamic responses or metabolism.

Venlafaxine hydrochloride has not been evaluated or used to any appreciable extent in patients with a recent history of myocardial infarction or unstable heart disease. Patients with these diagnoses were systematically excluded from many clinical studies during the product's premarketing testing. Evaluation of the electrocardiograms for 769 patients who received Venlafaxine hydrochloride in 4- to 6-week double-blind placebo-controlled trials, however, showed that the incidence of trial-emergent conduction abnormalities did not differ from that with placebo. The mean heart rate in Venlafaxine hydrochloride-*treated patients was increased relative to baseline by about 4 beats per minute.

The electrocardiograms for 357 patients who received Venlafaxine hydrochloride extended-release capsules and 285 patients who received placebo in 8- to 12-week double-blind, placebo-controlled trials were analyzed. The mean change from baseline in corrected QT interval (QTc) for Venlafaxine hydrochloride extended-release capsules-treated patients was increased relative to that for placebo-treated patients (increase of 4.7 msec for Venlafaxine hydrochloride extended-release capsules and decrease of 1.9 msec for placebo). In these same trials, the mean change from baseline in heart rate for Venlafaxine hydrochloride extended-release capsule-treated patients was significantly higher than that for placebo (a mean increase of 4 beats per minute for Venlafaxine hydrochloride extended-release capsules and 1 beat per minute for placebo). In a flexible-dose study, with Venlafaxine hydrochloride doses in the range of 200 to 375 mg/day and mean dose greater than 300 mg/day, Venlafaxine hydrochloride-treated patients had a mean increase in heart rate of 8.5 beats per minute compared with 1.7 beats per minute in the placebo group.

As increases in heart rate were observed, caution should be exercised in patients whose underlying medical conditions might be compromised by increases in heart rate (e.g., patients with hyperthyroidism, heart failure, or recent myocardial infarction), particularly when using doses of Venlafaxine hydrochloride above 200 mg/day.

In patients with renal impairment (GFR=10 to 70 mL/min) or cirrhosis of the liver, the clearances of Venlafaxine and its active metabolite were decreased, thus prolonging the elimination half-lives of these substances. A lower dose may be necessary (see DOSAGE AND ADMINISTRATION). Venlafaxine hydrochloride, like all antidepressants, should be used with caution in such patients.

The Patient Information Leaflet (PIL) is also on the bottom of that webpage and I can't say I spotted the need for ECG. Where did you find out about the need for it?

I know with mine there should be ongoing liver tests because it has been associated with liver disease BUT only due to heavy drinkers. So, maybe this is about NHS guidelines differing to other countries?

[pulisa]

My daughter had to have an ECG before starting ven but this was at the psychiatrist's request, not the GP. There does appear to be an increasing awareness of potential cardiac problems with SSRIs and SNRIs