Venlafaxine XR
EFFEXOR XR
Pronunciation: VEN-la-fax-een
“Vanilla e-Faxing”
1980s rapper Vanilla Ice
Blood pressure cuff → may increase blood pressure
Blue cloud → serotonin reuptake inhibitor (SRI)
What it isVenlafaxine extended-release (EFFEXOR XR, 1997) inhibits serotonin and norepinephrine reuptake; depression and several anxiety disorders.
Why this oneUnlike the IR tablets, its label includes GAD, SAD, panic—more approved anxiety indications than most antidepressants.
What limits itAbrupt interruption causes prominent discontinuation symptoms; monitor blood pressure and avoid stacking serotonergic drugs.
FDA-approved for
- depression (1997)
- generalized anxiety disorder (1999)
- social anxiety disorder (2003)
- panic disorder (2005)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Major Depressive Disorder (MDD) | Adults | 37.5-75 mg QD | 75 mg QD | 225 mg QD |
| Generalized Anxiety Disorder (GAD) | Adults | 37.5-75 mg QD | 75 mg QD | 225 mg QD |
| Social Anxiety Disorder (SAD) | Adults | 75 mg QD | 75 mg QD | 75 mg QD |
| Panic Disorder (PD) | Adults | 37.5 mg QD | 75 mg QD | 225 mg QD |
Titration Increase in increments up to 75 mg/day at intervals of not less than 4 days (not less than 7 days for panic disorder)
Renal Reduce total daily dose 25-50% (mild-moderate); 50% or more for severe impairment or hemodialysis
Hepatic Reduce total daily dose 50% (mild-moderate); more than 50% for severe impairment or cirrhosis
Instructions
- Take once daily with food at approximately the same time each day
- Swallow capsules whole; do not divide, crush, chew, or dissolve (or sprinkle contents on applesauce and swallow immediately without chewing)
- Taper gradually when discontinuing (reduce ~75 mg at 1-week intervals) — do not stop abruptly
- Allow ≥14 days after stopping an MAOI before starting, and ≥7 days after stopping before starting an MAOI
Available strengths
- ER cap 37.5, 75, 150 mg
Contraindications
- Concomitant use of MAOIs, or within 14 days of stopping an MAOI, because of the risk of serotonin syndrome
- Life-threatening serotonin syndrome requires combination with an MAOI; SRI overdose or SRI+SRI combination causes non-life-threatening serotonin toxicity.
Cautions
- Serotonin syndrome (increased with other serotonergic drugs; can occur alone)
- Elevated blood pressure — control hypertension before starting; monitor
- Increased bleeding risk with NSAIDs/aspirin/anticoagulants
- Angle-closure glaucoma; activation of mania/hypomania (screen for bipolar disorder)
- Discontinuation syndrome; seizures; hyponatremia/SIADH; interstitial lung disease/eosinophilic pneumonia; sexual dysfunction
Adverse reactions
- Nausea
- Somnolence
- Dry mouth
- Sweating
- Abnormal ejaculation
- Anorexia
- Constipation
- Dizziness
- Insomnia
Pregnancy No established increased risk of major birth defects; possible increased preeclampsia and postpartum hemorrhage; monitor neonates for poor adaptation/discontinuation syndrome (third-trimester exposure)
Lactation Venlafaxine and active metabolite present in human milk; no adverse reactions seen in breastfed infants in studies
Cost
| Strength | #/mo | generic $/mo | CostPlus | |
|---|---|---|---|---|
| 37.5 mg | ER cap | 30 qd | $2.37 | offered |
| 75 mg | ER cap | 30 qd | $2.40 | offered |
| 150 mg | ER cap | 30 qd | $3.57 | offered |
Other forms: Venlafaxine (EFFEXOR)
⚠ BOXED WARNING
- Suicidal thoughts and behaviors in patients under 25
Classes and tags
Clinical profile
Serotonin and MAOI
Provisional washout figures
Elevating mechanismSRI
Exposure dependenceTherapeutic exposure; severe toxicity requires meaningful MAO-A inhibition
Evidence confidenceHigh
InterpretationClinically significant SRI. A second SRI generally represents therapeutic duplication/additive adverse effects, not the classic life-threatening interaction.
Active metabolites
Open Venlafaxine XR in the interactive console ↗
Memory aids: interaction avatars
