Venlafaxine

EFFEXOR

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Pronunciation: VEN-la-fax-een (e-FEK-sor)

Venlafaxine ballicule: receptor binding, kinetics and half-life diagram — Mechanism of action: Venlafaxine ballicule

Venlafaxine EFFEXOR mascot mnemonic cartoon — Visual mnemonic: Venlafaxine mascot
**“Vanilla e-Faxing”**
1980s rapper Vanilla Ice
Blood pressure cuff → may increase blood pressure
Blue cloud → serotonin reuptake inhibitor (SRI)

What it isSNRI; depression and generalized anxiety.

Why this oneDose-dependent noradrenergic effect gives a second mechanism when an SSRI has failed.

What limits itRaises blood pressure at higher doses, and has the sharpest discontinuation syndrome of the class because of its short half-life.

Venlafaxine molecular structure (skeletal formula) — Molecular structure: Venlafaxine

FDA-approved for

depression (1993)
GAD (1999)
social anxiety disorder (2003)
panic disorder (2005)

Off-label

menopausal hot flashes
neuropathic pain

FDA label

Read the full label on DailyMed ↗

BOXED WARNING Suicidality: increased risk of suicidal thinking/behavior in children, adolescents, and young adults. Not approved in pediatric patients.

FDA dosing	Population	Start	Target	Max
Major depressive disorder	Adults	75 mg/day divided BID–TID (with food)	Up to 225 mg/day	375 mg/day (severely depressed inpatients)

Titration Increase by up to 75 mg/day at intervals of no less than 4 days.

Renal Reduce total daily dose by 25% (mild–moderate, GFR 10–70); by 50% for hemodialysis.

Hepatic Reduce total daily dose by 50% (mild–moderate impairment); may need greater reduction in cirrhosis.

Instructions

Take with food
Administer in divided doses (2–3 times daily)
Taper gradually rather than abruptly stopping

Available strengths

tab 25, 37.5, 50, 75, 100 mg

Contraindications

MAOIs (for psychiatric disorders) concomitantly, within 7 days after stopping venlafaxine, or within 14 days of stopping an MAOI; do not start in patients treated with linezolid or IV methylene blue

Cautions

Serotonin syndrome
Increased blood pressure
Increased heart rate
Discontinuation symptoms
Activation of mania/hypomania

Adverse reactions

Nausea
Somnolence
Dry mouth
Dizziness
Sweating
Nervousness/anxiety
Constipation
Anorexia
Abnormal ejaculation/impotence
Tremor

Pregnancy No clear malformation risk; third-trimester exposure can cause neonatal complications (SSRI/SNRI class).

Lactation Undefined.

Cost

Venlafaxine (EFFEXOR)

What pharmacies pay · NADAC 9/30/26

Strength		#/mo	generic $/mo	CostPlus
25 mg	tab	60 BID	$4.34	offered
37.5 mg	tab	60 BID	$4.29	offered
50 mg	tab	60 BID	$5.36	offered
75 mg	tab	60 BID	$5.10	offered
100 mg	tab	60 BID	$6.60	offered

Other forms: Venlafaxine XR (EFFEXOR XR)

Generic entryLong generic

⚠ BOXED WARNING

Suicidal thoughts and behaviors in patients under 25

Classes and tags

Clinical profile

Therapeutic safety burden2 / 4

Overdose danger3 / 4

Weight-gain liability0 / 4

Sedation liability1 / 4

QT / Torsades1 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk2 / 4

Legacy pregnancy categoryC

Defining liabilityHypertension and discontinuation are common concerns; overdose can cause seizures, serotonin toxicity and cardiotoxicity.

Serotonin and MAOI

Provisional washout figures

SRI significance3 / 4

MAO-A inhibition0 / 4

Serotonin release0 / 4

Elevating mechanismSRI

Non-elevating actionNone recorded

Exposure dependenceTherapeutic exposure; severe toxicity requires meaningful MAO-A inhibition

Washout BEFORE an MAOI7 days

Evidence confidenceHigh

InterpretationClinically significant SRI. A second SRI generally represents therapeutic duplication/additive adverse effects, not the classic life-threatening interaction.

Active metabolites

Desvenlafaxine

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Memory aids: interaction avatars

Box: minimal PK interactions

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