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Increased ocular pressure in two
patients with narrow angle glaucoma treated with
venlafaxine.
Aragona M, Inghilleri M.
I
Psychiatric Clinic, University La Sapienza, Rome,
Italy.
Venlafaxine blocks the specific monoamine transporters and
is devoid of significant action on muscarinic cholinergic receptors. To
our knowledge, no cases of glaucoma have been reported so far. Because
pain perception involves both serotonergic and noradrenergic mechanisms,
venlafaxine also may be useful in neuropathic pain therapy. We report on
two patients with narrow angle glaucoma affected by chronic pain. When
venlafaxine treatment was begun, their ocular pressure was steadily
around 17-18 mmHg. Venlafaxine was chosen (daily dose 75 mg) because
this drug is claimed not to bind on muscarinic cholinergic receptors.
However, 4 days later the ocular pressure of the first patient increased
to 22 mmHg, which led to suspension of the drug. The ocular pressure of
the second patient was 18.5 mmHg after a week, 21 mmHg after 2 weeks,
and 23 mmHg after 16 days. One week after suspension, ocular pressure of
the patients was 17 and 18 mmHg, respectively. Possible explanations of
this ocular effect are offered: pharmacokinetic interference on the
drugs used in glaucoma treatment, in vivo action on the muscarinic
receptor, indirect effect via dopaminergic receptors, or direct effect
on the ocular sympathetic postganglionic neurones. In any case, from a
clinical viewpoint, caution should be used when giving venlafaxine to
patients with narrow-angle glaucoma, and ocular pressure must be
monitored.
Publication Types:
PMID: 9579301 [PubMed - indexed for
MEDLINE]
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