Venlafaxine

Indication

A new class of antidepressant medications, unrelated to the tricyclic antidepressants, used in the treatment of depression.

Side effects

Anxiety, somnolence, dizziness, dry mouth, nausea, abnormal ejaculation (male), impotence, headache, tremor, blurred vision, asthenia, sweating, nervousness, hypertension, and insomnia have been the most commonly reported. Changes in weight, appetite and allergic reactions have also been reported more infrequently. Other less common effects include infection, chills, chest pain, tachycardia, rash, constipation, abnormal dreams, paraesthesias, depression, urinary retention, twitching, change in taste, and tinnitus.

Interactions and precautions
1. Use with caution and at a reduced dosage in those with, liver impairment.
2. Consider overall risk-benefit in those with hypertension.
3. Do not use with alcohol.
4. Do not use with Mao inhibitors--fatal interaction can result.
5. Potential for interaction with over-the-counter cold remedies, consult you physician before use.
6. Use with cimetidine could potentiate the effects of venlafaxine. A dosage reduction (venlafaxine) may be necessary in some individuals.

Usual dose

Adults: oral, 75 mg per day in two to three dicided doses, taken with food.

Hiatal Hernia

A hernia is a condition where a part of the body protrudes through an opening into another part of the body. Most hernias are found in the abdominal area. A hiatal hernia is usually located at the opening of the diaphragm and is an anatomical abnormality of the esophagus. Then the hiatal hernia displaces the muscle band at the lower end of the esophagus (lower esophageal sphincter) and leads to gastroesophageal reflux. As a result, stomach acid flows into the esophagus leading to esophagitis. Hiatal hernia is noticed among obese persons and those who have sustained an injury to that part of the body. Women are at increased risk and so are smokers.

Heartburn is the primary complaint of patients suffering from hiatual hernia. There is belching and feeling of vomiting. Many patients feel that there is something lodged in their chest. Coughing, vomiting or physical exertion can worsen the symptoms of hiatal hernia. The symptoms worsen during pregnancy, lying down or lifting heavy objects. In some cases, a hiatal hernia may go unnoticed. Lifestyle changes like eliminating coffee, alcohol and smoking can help relieve some of the symptoms associated with hiatus hernia. Sleeping with the head at a mild elevation can help prevent stomach acid reflux at night.

A barium x-ray can help in examining the upper digestive tract and checking for any backlash of stomach contents into the esophagus. An endoscopy helps diagnose a hiatal hernia and check for any inflammation of the esophagus. Antacids can help in neutralizing stomach acid. Drugs such as ranitidine, omeprazole or cimetidine are prescribed to reduce the secretion of stomach acid. Surgery is resorted to when there is a possibility of reduced or obstructed blood supply. This is done through laparoscopy to reduce pain, scarring and chances of infection.