From the FDA Drug Label
If concomitant use of venlafaxine HCl with other serotonergic drugs, including triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, buspirone, tryptophan and St. John’s Wort is clinically warranted, patients should be made aware of a potential increased risk of serotonin syndrome, particularly during treatment initiation and dose increases The concomitant use of buspirone with MAOIs intended to treat depression is contraindicated. Buspirone should also not be started in a patient who is being treated with reversible MAOIs such as linezolid or intravenous methylene blue Venlafaxine HCl should be discontinued before initiating treatment with the MAOI Buspirone should be discontinued before initiating treatment with the reversible MAOI
The decision to continue or discontinue Venlafaxine and Buspar in the perioperative period should be made on a case-by-case basis, considering the potential risks and benefits.
- Key considerations:
- Risk of serotonin syndrome with concomitant use of serotonergic drugs
- Risk of sustained hypertension with venlafaxine
- Potential interactions with anesthetics and other perioperative medications
- Recommendation:
- Venlafaxine and Buspar should be discontinued prior to surgery if possible, especially if the patient will be receiving other serotonergic drugs or MAOIs during the perioperative period.
- If discontinuation is not possible, the patient should be closely monitored for signs of serotonin syndrome and sustained hypertension.
- The decision to continue or discontinue these medications should be made in consultation with the patient's psychiatrist and anesthesiologist 1 2.
From the Research
Venlafaxine and buspirone should generally be continued throughout the perioperative period to minimize the risk of withdrawal syndrome and psychiatric symptom relapse. The risk of continuing these medications is generally lower than the risk of discontinuation, especially considering the potential for venlafaxine withdrawal syndrome, which can be severe and include symptoms such as dizziness, nausea, headache, irritability, and insomnia 3, 4, 5. Buspirone has minimal withdrawal effects and few drug interactions, making it safe to continue 5.
Key Considerations
- Abrupt discontinuation of venlafaxine can cause a withdrawal syndrome, which could complicate recovery 3, 4, 5.
- Stopping antidepressants perioperatively increases the risk of psychiatric symptom relapse 5.
- Venlafaxine may theoretically interact with certain anesthetics due to its effects on serotonin and norepinephrine, but the risk of continuing it is generally lower than the risk of discontinuation 5.
- The anesthesiologist should be informed about these medications during preoperative evaluation to monitor for potential serotonin syndrome if other serotonergic medications are used.
Recommendations
- These medications should be taken up to and including the morning of surgery with a small sip of water.
- They should be resumed as soon as the patient can take oral medications postoperatively.
- In rare cases where a patient cannot take oral medications for an extended period postoperatively, alternative formulations or medications may need to be considered in consultation with psychiatry 5.