section name header

Pronunciation

ven-la-FAX-een

Classifications

Therapeutic Classification: antidepressants, antianxiety agents

Pharmacologic Classification: selective serotonin and norepinephrine reuptake inhibitors-SSNRIs

Indications

REMS


Action

  • Inhibits serotonin and norepinephrine reuptake in the CNS.
Therapeutic effects:
  • Decrease in depressive symptomatology, with fewer relapses/recurrences.
  • Decreased anxiety.Decrease in panic attacks.

Pharmacokinetics

Absorption: 92–100% absorbed after oral administration.

Distribution: Extensive distribution into body tissues.

Metabolism/Excretion: Extensively metabolized on first pass through the liver (primarily through the CYP2D6 isoenzyme); the CYP2D6 isoenzyme exhibits genetic polymorphism (7% of population may be poor metabolizers and may have significantly venlafaxine concentrations and an risk of adverse effects). One metabolite, O-desmethylvenlafaxine (ODV), has antidepressant activity. 5% of venlafaxine is excreted unchanged in urine; 30% of the active metabolite is excreted in urine.

Half-Life: Venlafaxine: 3–5 hr; ODV: 9–11 hr (both are in hepatic/renal impairment).

Time/Action Profile

(antidepressant action)

ROUTEONSETPEAKDURATION
POwithin 2 wk2–4 wkunknown





Contraind./Precautions

Contraindicated in:

Use Cautiously in:

Adv. Reactions/Side Effects

CV: chest pain, hypertension, palpitations, tachycardia

Derm: ecchymoses, itching, photosensitivity, skin rash

EENT: rhinitis, visual disturbances, epistaxis, tinnitus

GI: abdominal pain, altered taste, anorexia, constipation, diarrhea, dry mouth, dyspepsia, nausea, vomiting, weight loss

GU: libido, delayed/absent orgasm, ejaculatory delay/failure, erectile dysfunction, urinary frequency, urinary retention

Hemat: BLEEDING

Neuro: abnormal dreams, anxiety, dizziness, headache, insomnia, nervousness, paresthesia, weakness, abnormal thinking, agitation, confusion, depersonalization, drowsiness, emotional lability, NEUROLEPTIC MALIGNANT SYNDROME, SEIZURES, SUICIDAL THOUGHTS, twitching, worsening depression

Misc: chills, discontinuation syndrome, SEROTONIN SYNDROME, yawning

Interactions

Drug-drug:

Drug-Natural Products:

Route/Dosage

Major Depressive Disorder

Renal Impairment

Hepatic Impairment

General Anxiety Disorder

Renal Impairment

Hepatic Impairment

Social Anxiety Disorder

Renal Impairment

Hepatic Impairment

Panic Disorder

Hepatic Impairment

Renal Impairment

Availability

(Generic available)

Assessment

Lab Test Considerations:

Implementation

Patient/Family Teaching

Evaluation/Desired Outcomes

US Brand Names

Effexor, Effexor XR

Pill Image

venlafaxine_195-8941.jpg