From the Guidelines
Venlafaxine is not absolutely contraindicated in patients with glaucoma, but it should be used with caution, particularly in those with narrow-angle glaucoma, due to the potential risk of mydriasis and acute angle-closure attack. The primary concern with venlafaxine in glaucoma patients is its potential to cause pupil dilation, which may exacerbate the condition in anatomically predisposed individuals 1.
Key Considerations
- Patients with narrow-angle glaucoma are at higher risk of complications and should exercise particular caution when taking venlafaxine.
- For patients with controlled open-angle glaucoma, venlafaxine generally poses less risk.
- Regular monitoring of intraocular pressure is advisable, especially during the initial treatment period and dose adjustments.
- Patients should be educated about reporting any eye pain, visual changes, or headaches immediately.
Mechanism and Precautions
The mechanism behind this caution relates to venlafaxine's noradrenergic effects, which can influence pupil dilation and potentially impact intraocular pressure in susceptible individuals. As noted in the study on neuropathic pain management, venlafaxine should be prescribed with caution in patients with certain comorbidities, including cardiac disease, but there is no specific mention of glaucoma as a contraindication 1. However, given the potential risks, a cautious approach is recommended.
Clinical Implications
In clinical practice, the decision to prescribe venlafaxine to a patient with glaucoma should be made on a case-by-case basis, considering the individual's specific condition, the severity of their glaucoma, and the potential benefits and risks of the medication. Close monitoring and patient education are crucial to minimize potential complications.
From the FDA Drug Label
Who should not take venlafaxine HCl? Do not take venlafaxine HCl if you: • have uncontrolled narrow-angle glaucoma
Venlafaxine (Effexor) is contraindicated in patients with uncontrolled narrow-angle glaucoma 2.
From the Research
Venlafaxine and Glaucoma
- Venlafaxine, an antidepressant medication, has been reported to increase ocular pressure in patients with narrow angle glaucoma 3.
- A study published in 1998 described two patients with narrow angle glaucoma who experienced increased ocular pressure after starting venlafaxine treatment, suggesting that caution should be used when prescribing venlafaxine to patients with this condition 3.
- Another study published in 2014 reported a case of bilateral acute angle-closure glaucoma associated with the use of duloxetine, another serotonin norepinephrine reuptake inhibitor (SNRI), and noted that there have been previous reports of acute angle-closure glaucoma associated with venlafaxine 4.
Mechanism and Risk
- The mechanism by which venlafaxine may increase the risk of glaucoma is not fully understood, but it may be related to its effects on muscarinic cholinergic receptors, dopaminergic receptors, or ocular sympathetic postganglionic neurons 3.
- A review of literature published in 2021 suggested that selective serotonin and noradrenaline reuptake inhibitors, including venlafaxine, may not be associated with an increased risk of glaucoma, but recommended that clinicians be aware of the possible risk and monitor patients closely 5.
- A systematic review and meta-analysis published in 2018 found that the use of SSRIs was not associated with a higher risk of glaucoma, and that antidepressant treatment may be associated with lower intraocular pressure and higher pupillary diameter 6.
Clinical Implications
- Patients with glaucoma or glaucoma risk factors should be closely monitored when taking venlafaxine or other SNRIs 3, 4, 5.
- Clinicians should be aware of the possible risk of glaucoma associated with venlafaxine and other psychotropic medications, and consider ophthalmological consultations before starting treatment in patients with glaucomatous risk factors 5, 7.