Adult Dosing
Major depressive disorder
Immediate release
- 37.5-75 mg PO daily
- Initial: 37.5 mg PO bid
- Titrate: Increase by 75 mg/day q4 days
- MAX: 375 mg/day
- Info: To D/C, taper over 2 weeks
- Give with food; do not crush/cut/chew
Extended release (ER)
- 75-225 mg ER PO daily
- Initial: 37.5-75 mg PO daily
- Titrate: Increase by 75 mg/day at an interval of not less than every 4 days
- Max: 225 mg/day
- Info: To D/C, decrease by 75 mg/week or more slowly
- Give with food; do not crush/cut/chew
Generalized anxiety disorder
- 75-225 mg ER PO daily
- Start 37.5-75 mg ER PO daily; then increase by 75 mg/day at an interval of not less than every 4 days
- Info: To D/C, decrease by 75 mg/week or more slowly
- Give with food; do not crush/cut/chew
- Max 225 mg/day
Panic disorder
- 75-225 mg ER PO daily
- Start 37.5 mg ER PO daily for 7 days, then 75 mg PO daily for 7 days. Further increases of 75 mg/day may be given at an interval of not less than every 7 days
- Max 225 mg/day
- Info: To D/C, decrease by 75 mg/week or more slowly
- Give with food; do not crush/cut/chew
Social anxiety disorder
- 75 mg ER PO daily (no increased efficacy at doses >75 mg/day)
Obsessive-compulsive disorder [Non-FDA Approved]
Pediatric Dosing
- Safety and efficacy in pediatric patients has not been established
[Outline]
Renal Dose Adjustment (Based on CrCl)
- 10-70 mL/min: Reduce total daily dose by 25-50%
- Hemodialysis: Reduce dose by 50% and withhold drug until after dialysis
Hepatic Dose Adjustment
- Moderate impairment: Reduce dose by 50%
- Severe impairment: Dose adjustments not defined
See Supplemental Patient Information
- Increased risk of suicidality; observe patients for worsening of depression, emergence of suicidality, or unusual behavior, particularly early in therapy and at the time of dose changes [US Black Box warning]
- Serious adverse events, have occurred in patients who have recently been discontinued from a MAO inhibitor and started on venlafaxine, or who have recently discontinued venlafaxine prior to initiation of an MAO inhibitor
- Neuroleptic Malignant Syndrome manifesting with hyperpyrexia, muscle rigidity, altered mental status and autonomic instability has occurred with SNRIs and SSRIs alone, but particularly with concomitant use of serotonergic drugs (including triptans), with drugs which impair metabolism of serotonin (including MAOIs), or with antipsychotics or other dopamine antagonists
- Treatment with concomitant MAOIs, serotonergic or antidopaminergic agents is not recommended
- Dose-dependent increases in systolic and diastolic blood pressure have occurred; reduce dose or discontinue if elevated BP persists
- Use in 3rd trimester of pregnancy has been associated with respiratory, gastrointestinal and feeding problems in the neonate
- May worsen psychosis or precipitate a shift to mania or hypomania in patients with bipolar disorder; venlafaxine is not FDA approved for the treatment of bipolar depression
- May increase the risks associated with electroconvulsive therapy; consider discontinuing, when possible, prior to ECT treatment
- May impair performance of skilled tasks eg. driving or operating machinery
- Avoid abrupt withdrawal. Withdraw gradually over at least 1-2 wks and monitor for withdrawal symptoms
- When discontinuing treatment, decrease dose qwk, by no greater than 75 mg/day
- Discontinue MAO inhibitor at least 14 days before starting venlafaxine
- Discontinue venlafaxine at least 7 days before starting a MAO inhibitor
- Measure CrCl and lipid profile at baseline; blood pressure periodically
Cautions: Use cautiously in
- Renal impairment (refer dose adjustment section)
- Hepatic impairment (refer dose adjustment section)
- Co-administration of aspirin, NSAIDs, warfarin, or other anticoagulants (risk of bleeding)
- Hx of seizure disorder
- Narrow-angle Glaucoma
- Increased IOP
- Cerebrovascular disease
- Cardiovascular disease
- Hypertension
- Recent MI
- Hyponatremia
- Hypovolemia
- Hyperthyroidism
- History of manic disorder
- History of bleeding disorders
- History of hyperlipidemia
- Geriatric population
Supplemental Patient Information
- Advise caregivers to monitor patients for the emergence of agitation, irritability, unusual changes in behavior, and emergence of suicidality, and to report such symptoms immediately to health care providers
Pregnancy Category:C
Breastfeeding: Venlafaxine and its metabolite are excreted in breast milk. Breastfed infants, especially newborn or preterm infants, should be monitored for excessive sedation and adequate weight gain. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 1 September 2010). Use not recommended as per manufacturer's data.
US Trade Name(s)
US Availability
venlafaxine (generic)
- TABS: 25, 37.5, 50, 75, 100 mg
- Extended Release TABS: 37.5, 75, 150, 225 mg
- Extended Release CAPS: 37.5, 75, 150 mg
Effexor XR
- Extended Release CAPS: 37.5, 75, 150 mg
Canadian Trade Name(s)
Canadian Availability
venlafaxine (generic)
Effexor XR
UK Trade Name(s)
- Bonilux XL
- Depefex XL
- Efexor XL
- Foraven XL
- Politid XL
- Tifaxin XL
- Venaxx XL
- Venlalic XL
- Winfex XL
UK Availability
venlafaxine (generic)
Bonilux XL, Depefex XL, Efexor XL, Foraven XL, Politid XL, Tifaxin XL, Venaxx XL, Winfex XL
Venlalic XL
Australian Trade Name(s)
Australian Availability
Efexor-XR
[Outline]
Pricing data from www.DrugStore.com in U.S.A.
- Effexor XR 37.5 MG CP24 [Bottle] (WYETH)
30 mg = $148.99
90 mg = $430.97 - Effexor XR 150 MG CP24 [Bottle] (WYETH)
30 mg = $179.99
90 mg = $515.97 - Effexor XR 75 MG CP24 [Bottle] (WYETH)
90 mg = $470.99
180 mg = $935.96
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
