Batusha Sopi Bujana, Yonekawa Keiko, Russmann Stefan, Bernheim Jasminka, Caselli Stefano, Schmied Christian, Hammer Helene, Lam Anna, Attenhofer Jost Christine
HerzGefässZentrum Im Park, Hirslanden Klinik Im Park, 8038 Zürich, Switzerland.
Drugsafety.ch, 8703 Küsnacht, Switzerland.
J Clin Med. 2025 Apr 18;14(8):2792. doi: 10.3390/jcm14082792.
Venlafaxine (VEN) is a serotonin and norepinephrine reuptake inhibitor (SNRI) antidepressant. Arterial hypertension (HTN), heart failure (HF), and arrhythmias are side effects of VEN. Cardiotoxicity (CTOX) as a feature of VEN-associated side-effects has only rarely been described. We conducted a search of our database for cases of VEN-associated CTOX, analyzing symptoms, echocardiographic findings, and laboratory results. We identified five patients (three females, two males) with VEN-associated CTOX, aged 51 to 87 years at presentation. VEN dose was 150 and 375 mg daily and treatment duration was 1.5 to 15 years. Presenting features were HTN in three, "hypertrophic cardiomyopathy" in two, heart failure in three, and atrial fibrillation in three patients. Symptoms and signs of CTOX were reversible in all patients after discontinuation or dose reduction of VEN, suggesting a causal relationship between VEN and CTOX. VEN-associated CTOX can occur and progress to severe cardiomyopathy or heart failure. Potential risk factors include cardiac sympathetic stimulation, high VEN dosage, and prolonged treatment duration; however, CTOX may also occur at standard doses. Therefore, patients taking VEN should be routinely monitored for signs of cardiotoxicity, including monitoring of serum concentrations of VEN.
文拉法辛（VEN）是一种5-羟色胺和去甲肾上腺素再摄取抑制剂（SNRI）类抗抑郁药。动脉高血压（HTN）、心力衰竭（HF）和心律失常是VEN的副作用。作为VEN相关副作用特征的心脏毒性（CTOX）仅有极少的描述。我们在数据库中搜索VEN相关CTOX病例，分析症状、超声心动图检查结果和实验室检查结果。我们确定了5例VEN相关CTOX患者（3例女性，2例男性），就诊时年龄为51至87岁。VEN剂量为每日150和375毫克，治疗持续时间为1.5至15年。主要表现为3例HTN、2例“肥厚型心肌病”、3例心力衰竭和3例心房颤动。在停用VEN或减少剂量后，所有患者CTOX的症状和体征均可逆，提示VEN与CTOX之间存在因果关系。VEN相关CTOX可能发生并进展为严重心肌病或心力衰竭。潜在危险因素包括心脏交感神经刺激、高VEN剂量和延长治疗持续时间；然而，CTOX也可能在标准剂量下发生。因此，服用VEN的患者应常规监测心脏毒性体征，包括监测VEN的血清浓度。
