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venlafaxine (Rx)Brand and Other Names:Effexor, Effexor XR

 
 
 

Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

tablet

  • 25mg
  • 37.5mg
  • 50mg
  • 75mg
  • 100mg

tablet, extended release

  • 37.5mg
  • 75mg
  • 150mg
  • 225mg

capsule, extended release

  • 37.5mg
  • 75mg
  • 150mg
more...

Depression

Immediate release

  • 75 mg/day PO divided q8-12hr initially; may be increased by ≤75 mg/day not faster than every 4 days
  • Moderate: Up to 225 mg/day PO divided q8-12hr
  • Severe: Up to 375 mg/day PO divided q8-12hr

Extended release

  • 37.5-75 mg PO once daily initially; may be increased by 75 mg/day every 4 days; not to exceed 225 mg/day

Generalized Anxiety

Extended release: 37.5-75 mg PO once daily initially; may be increased by 75 mg/day every 4-7 days; not to exceed 225 mg/day

Social Anxiety

Extended release: 75 mg PO once daily

Dosages >75 mg/day not shown to be more effective

Panic Disorder

Extended release: 37.5 mg PO once daily for 7 days, then 75 mg once daily; may be further increased by 75 mg/day every 7 days; not to exceed 225 mg/day

Hot Flashes Due to Hormonal Chemotherapy (Off-label)

Immediate release: 37.5 mg BID or 75 mg qDay; alternatively may titrate up beginning with 37.5 mg qDay for 1 week then 75 mg daily

Extended release: 37.5-150 mg PO once daily for 4-12 weeks

Post-traumatic Stress Disorder (Off-label)

Extended release formulation: 37.5-300 mg/day

Attention Deficit Disorder

18.75-75 mg/day; may increase to 150 mg/day after 4 weeks; doses up to 225 mg/day used

Neuropathic Pain (Off-label)

75-225 mg/day PO ; onset of relief may start in 1-2 weeks or take up to 6 weeks for full benefit

Administration

Take with food

If discontinuing therapy after ≥7 days, taper dosage

Dosing Modifications

Mild to severe renal iumpairment: Reduce dosage by 25-50%

Mild to moderate hepatic impairment: Reduce dosage by 50%

Dosage Forms & Strengths

tablet

  • 25mg
  • 37.5mg
  • 50mg
  • 75mg
  • 100mg

tablet, extended release

  • 37.5mg
  • 75mg
  • 150mg
  • 225mg

capsule, extended release

  • 37.5mg
  • 75mg
  • 150mg
more...

Anxiety (Off-label)

Children: 37.5 mg/day PO initially

Adolescents: 37.5-75 mg/day PO initially

Maintenance: Children, 75-150 mg/day; adolescents, 150-300 mg/day

Depression (Off-label)

Children: 37.5 mg/day PO initially

Adolescents: 37.5-75 mg/day PO initially

Maintenance: Children, 75-150 mg/day; adolescents, 150-300 mg/day

Attention Deficit Disorder

<40 kg: 12.5 mg/day PO initially; increase by 12.5 mg/week; not to exceed 50 mg/day divided twice daily

≥40 kg: 12.5 mg/day PO initially; increase by 25 mg/week; not to exceed 75 mg/day divided three times daily

Depression

Immediate release

25-50 mg/day PO divided q8-12hr initially; may be increased as tolerated by ≤25 mg/day no faster than every 4 days

Moderate: Up to 225 mg/day PO divided q8-12hr

Severe: Up to 375 mg/day PO divided q8-12hr

Extended release

37.5 mg PO once daily initially; may be increased by 37.5 mg/day every 4-7 days; not to exceed 225 mg/day

Generalized Anxiety

Extended release: 37.5 mg PO once daily initially; may be increased by 37.5 mg/day every 4 days; not to exceed 225 mg/day

Social Anxiety

Extended release: 37.5 mg PO once daily; may be increased by 37.5 mg/day every 4 days

Panic Disorder

Extended release: 37.5 mg PO once daily for 7 days, then 75 mg once daily; may be further increased by 37.5 mg/day every 7 days; not to exceed 225 mg/day

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Interactions

Interaction Checker

venlafaxine and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            >10%

            Headache (25-38%)

            Nausea (21-58%)

            Insomnia (15-24%)

            Asthenia (16-20%)

            Dizziness (11-24%)

            Ejaculation disorder (2-19%)

            Somnolence (12-26%)

            Dry mouth (12-22%)

            Diaphoresis (7-19%)

            Anorexia (15-17%)

            Nervousness (17-26%)

            Anorgasmia (5-13%)

            1-10%

            Weight loss (1-6%)

            Abnormal vision (4-6%)

            Hypertension (2-5%)

            Impotence (4-6%)

            Paresthesia (2-3%)

            Tremor (1-10%)

            Vasodilation (2-6%)

            Vomiting (3-8%)

            Weight gain (2%)

            Flatulence (3-4%)

            Pruritus (1%)

            Yawning (3-8%)

            Dyspepsia (5-7%)

            Twitching (1-3%)

            Mydriasis (2%)

            <1%

            Angioedema

            Agranulocytosis

            Anemia

            Anuria

            Aneurism

            Bacteremia

            Myasthenia

            Syncope

            Suicide ideation/attempt

            Postmarketing Reports

            Chills

            Dyspnea

            Interstitial lung disease

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            Warnings

            Black Box Warnings

            In short-term studies, antidepressants increased the risk of suicidal thinking and behavior in children, adolescents, and young adults (<24 years) taking antidepressants for major depressive disorders and other psychiatric illnesses

            This increase was not seen in patients aged >24 years; slight decrease in suicidal thinking was seen in adults >65 years

            Not FDA approved for children; in children and young adults; benefits of taking antidepressants must be weighed against risks

            Patients should be monitored closely for changes in behavior, clinical worsening, and suicidal tendencies; this should be done during initial 1-2 months of therapy and dosage adjustments

            Patient’s family should communicate any abrupt behavioral changes to healthcare provider

            Worsening behavior and suicidal tendencies that are not part of presenting symptoms may necessitate discontinuance of therapy

            Not FDA approved for treatment of bipolar depression

            Contraindications

            Hypersensitivity

            Coadministration with serotonergic drugs

            • Coadministration with monoamine oxidase inhibitors (MAOIs)
            • Concomitant MAOIs administration within 14 days before initiating venlafaxine or within 7 days after discontinuing venlafaxine
            • Initiation of venlafaxine in patient being treated with linezolid or IV methylene blue

            Cautions

            Risk of mydriasis; may trigger angle closure attack in patients with angle closure glaucoma with anatomically narrow angles without a patent iridectomy

            Use caution in bipolar mania, history of seizures, and cardiovascular disease

            May precipitate mania or hypomania episodes in patients with bipolar disorder; avoid monotherapy in bipolar disorder; screen patients presenting with depressive symptoms for bipolar disorder

            Use caution in hepatic or renal impairment

            Neonates exposed to serotonin-norepinephrine reuptake inhibitors (SNRIs) or selective serotonin reuptake inhibitors (SSRIs) late in 3rd trimester of pregnancy have developed complications necessitating prolonged hospitalization, respiratory support, and tube feeding

            Clinical worsening and suicidal ideation may occur despite medication in adolescents and young adults (18-24 years)

            When discontinuing, taper dosage to avoid flulike symptoms

            May cause increase in nervousness, anxiety, or insomnia

            May impair ability to operate heavy machinery; depresses CNS

            Bone fractures reported with antidepressant therapy; consider possibility if patient experiences bone pain

            May cause significant increase in serum cholesterol

            Dose-dependent anorectic effects and weight loss reported in children and adult patients

            Dose-related increase in systolic and diastolic pressure reported

            Eosinophilic pneumonia and interstitial lung disease reported

            SAIDH and hyponatremia reported SSRIs

            Potentially life-threatening serotonin syndrome with SSRIs and SNRIs when used in combination with other serotonergic agents including TCAs, buspirone tryptophan, fentanyl, tramadol, lithium, and triptans; symptoms include tremor, myoclonus, diaphoresis, nausea, vomiting, flushing, dizziness, hyperthermia with features resembling neuroleptic malignant syndrome, seizures, rigidity, autonomic instability with possible rapid fluctuations of vital signs, and mental status changes that include extreme agitation progressing to delirium and coma

            Venlafaxine in patient being treated with linezolid or IV methylene blue increases risk of serotonin syndrome; if linezolid or IV methylene blue must be administered, discontinue venlafaxine immediately and monitor for central nervous system (CNS) toxicity; therapy may be resumed 24 hours after last linezolid or methylene blue dose or after 2 weeks of monitoring, whichever comes first

            SSRIs and SNRIs may impair platelet aggregation and increase the risk of bleeding events, ranging from ecchymoses, hematomas, epistaxis, petechiae, and GI hemorrhage to life-threatening hemorrhage; concomitant use of aspirin, NSAIDs, warfarin, other anticoagulants, or other drugs known to affect platelet function may add to this risk

            Control hypertension before initiating treatment; monitor blood pressure regularly during treatment

            Risks of sustained hypertension, hyponatremia, and impeded height and weight in children

            Drug-laboratory test interactions: False-positive urine immunoassay screening tests for phencyclidine (PCP) and amphetamine have been observed during venlafaxine therapy because of lack of specificity of the screening tests

            May cause or exacerbate sexual dysfunction

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            Pregnancy & Lactation

            Pregnancy category: C

            Lactation: Enters milk; not recommended

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

            more...
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            Pharmacology

            Mechanism of Action

            "Bicyclic" antidepressant; drug is structurally unrelated to SSRIs, MAOIs, and tricyclic antidepressants (TCAs), but it and its metabolite are potent inhibitors of serotonin and norepinephrine reuptake and weak inhibitors of dopamine reuptake; it does not have MAOI activity or activity for H1 histaminergic, muscarinic cholinergic, or alpha2-adrenergic receptors

            Absorption

            Absorption: 92%

            Bioavailability: 45%

            Peak plasma time: 2-3 hr (immediate release); 5.5-9 hr (extended release)

            Concentration: Immediate release, 225-290 ng/mL; extended release, 150-260 ng/mL

            Distribution

            Protein bound: 27-30%

            Vd: Immediate release, 7.5 L/kg

            Metabolism

            Metabolized in liver by CYP2D6

            Metabolites: O-desmethylvenlafaxine

            Enzymes inhibited: CYP2D6 (weak)

            Elimination

            Half-life: 5-11 hr (prolonged in renal or hepatic dysfunction)

            Dialyzable: No

            Excretion: Urine (87%)

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            Images

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            Formulary

            FormularyPatient Discounts

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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