Venlafaxine
EFFEXOR
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.
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 ↗
| 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
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.
⚠ BOXED WARNING
- Suicidal thoughts and behaviors in patients under 25
Cost, est. cash$300–$2,500/month
Generic entryLong generic
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityHypertension and discontinuation are common concerns; overdose can cause seizures, serotonin toxicity and cardiotoxicity.
Active metabolites
Mechanism of action: Venlafaxine ballicule
Open Venlafaxine in the interactive console ↗
Memory aids: mascots and interaction avatars
1980s rapper Vanilla Ice
Blood pressure cuff → may increase blood pressure
Blue cloud → serotonin reuptake inhibitor (SRI)
