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Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs) for Chronic Pain

Examples

Generic NameBrand Name
desvenlafaxinePristiq
duloxetineCymbalta
milnacipranSavella
venlafaxineEffexor

How It Works

SNRIs work to increase the activity of brain chemicals called serotonin and norepinephrine. Doctors do not know exactly how this improves chronic pain symptoms.

Why It Is Used

Serotonin and norepinephrine reuptake inhibitors (SNRIs) are used to treat certain types of chronic pain, especially nerve pain. They may be used to treat:

How Well It Works

SNRIs can help some people who have chronic pain. They seem to work best for people who have chronic nerve pain and people who also have symptoms of depression.1

Side Effects

All medicines have side effects. But many people don't feel the side effects, or they are able to deal with them. Ask your pharmacist about the side effects of each medicine you take. Side effects are also listed in the information that comes with your medicine.

Here are some important things to think about:

  • Usually the benefits of the medicine are more important than any minor side effects.
  • Side effects may go away after you take the medicine for a while.
  • If side effects still bother you and you wonder if you should keep taking the medicine, call your doctor. He or she may be able to lower your dose or change your medicine. Do not suddenly quit taking your medicine unless your doctor tells you to.

Call911or other emergency services right away if you have:

  • Trouble breathing.
  • Swelling of your face, lips, tongue, or throat.

Desvenlafaxine and venlafaxine

Call your doctor right away if you have:

  • Hives.
  • Thoughts of suicide.
  • Agitation and restlessness.
  • Seizures.
  • Blurry vision.
  • Headache.

Duloxetine

Call your doctor right away if you have:

  • Hives.
  • Thoughts of suicide.
  • Agitation and restlessness.
  • Dark urine or light-colored stool.
  • Nausea and vomiting.
  • Yellow eyes and skin (jaundice).
  • Upper right abdominal pain camera.gif.

Common side effects of these medicines include:

  • Constipation.
  • Cough.
  • Decrease in sexual desire or ability.
  • Dizziness.
  • Dry mouth.
  • Increased sweating.
  • Headache.
  • Nausea and loss of appetite.
  • Sleep problems.
  • Weight loss.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

Never suddenly stop taking SNRIs. The use of any antidepressant should be tapered off slowly and only under the supervision of a doctor. Abruptly stopping antidepressant medicines can cause negative side effects or a relapse of your condition.

SNRIs are started at low doses, and the dose is increased gradually to reduce the severity of side effects. You may need regular blood tests to check the amount of the medicine in your blood. Too much of this type of medicine in the bloodstream can be dangerous.

Be sure to tell your doctor about all the medicines you are currently taking. Duloxetine and milnacipran can interact poorly with monoamine oxidase (MAO) inhibitors (taken for depression and other mental health conditions). Examples of MAO inhibitors include phenelzine, selegiline, and tranylcypromine.

Duloxetine can affect blood sugar levels in people who have diabetes. If you notice that the results of your blood sugar tests are different than you expect, or if you have any questions, talk with your doctor.

Taking medicine

Medicine is one of the many tools your doctor has to treat a health problem. Taking medicine as your doctor suggests will improve your health and may prevent future problems. If you don't take your medicines properly, you may be putting your health (and perhaps your life) at risk.

There are many reasons why people have trouble taking their medicine. But in most cases, there is something you can do. For suggestions on how to work around common problems, see the topic Taking Medicines as Prescribed.

Advice for women

If you are pregnant, breast-feeding, or planning to get pregnant, do not use any medicines unless your doctor tells you to. Some medicines can harm your baby. This includes prescription and over-the-counter medicines, vitamins, herbs, and supplements. And make sure that all your doctors know that you are pregnant, breast-feeding, or planning to get pregnant.

Checkups

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.

Citations

  1. Drugs for pain (2010). Treatment Guidelines From The Medical Letter, 8(92): 25–34.

ByHealthwise Staff
Primary Medical ReviewerAnne C. Poinier, MD - Internal Medicine
Specialist Medical ReviewerNancy Greenwald, MD - Physical Medicine and Rehabilitation
Current as ofMarch 12, 2014

WebMD Medical Reference from Healthwise

Last Updated: March 12, 2014
This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.

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