Deliberate long-term exceeding of recommended dose of venlafaxine by a dysthymic patient. a case report

Background

Prescription of drugs must follow established guidelines, especially concerning maximum daily dose. Nevertheless some clinicians and researchers often try high doses for optimizing results. Patients also tend to raise the doses especially of anxiolytics and analgetics

Materials and methods

We present a case report of a dysthymic patient who, by his own decision and against the doctor's recommendations, continuously receives venlafaxine at a dose almost double than the officially maximum recommended

Results

A 38 year old man who suffered of dysthymia following a head injury after a car crash, presented for treatment. He had no permanent neurological and cognitive consequences except from dizziness. Treatment started with venlafaxine, as another agent tried before proved inefficient. Following titration the psychiatrist recommended the dose of 300mgs per day by means of XR capsules. The recommended maximum daily dose of the certain drug is 325mgs. At the following visits his condition had improved but with no complete remission. During the regular once-per-month follow-up the patient announced that he had by his own decision increased the dose to 600mg daily, and he felt much better. Despite the continuous precautions given by the doctor about the maximum dose and the possible harm he insisted to his initial decision managing to obtain the extra amount by means of private purchasing. The tests he underwent for liver and renal function were normal, and the ECG showed moderate elevation of heart rate. He suffers minor side-effects like constipation and dry mouth. He continues to do so for 2 years now.

Conclusions

The above case report is presented for discussion in two topics. A. the limits of dose-related response of venlafaxine, and B. the possible altered pharmacokinetics of venlafaxine in certain patients.