-
Major Depression including refractory cases
- Considered to be second-line agent
- Generalized Anxiety Disorder
- Obsessive Compulsive Disorder
- Post-Traumatic Stress Disorder
- Similar activity as Tricyclic Antidepressants
-
Serotonin Norepinephrine Reuptake Inhibitor
- Selective Serotonin Reuptake Inhibitor (<150 mg/day)
- Both Serotonin and Norepinephrine Reuptake Inhibitor (>150 mg/day)
- Minimally inhibits Dopamine uptake
- Venlafaxine Regular Release
- Half life: 5 to 11 hours
- Unknown safety in Lactation
- Pregnancy Category C
- Venlafaxine
- Venlafaxine regular release (Effexor)
- Available as 25, 37.5, 75, 100 mg tablets (scored)
- Start: 25 mg PO tid
- Effective dose: 150-225 mg per day divided bid to tid
- Maximum dose: 375 mg per day
- Disadvantages: More adverse effects than Effexor XR
- Advantages: May be dosed once daily since metabolites offer similar duration to Effexor XR
- Venlafaxine extended release (Effexor XR)
- Available as 37.5, 75, 150 mg (capsules)
- Start: 37.5 to 75 mg orally daily
- Maximum: 225 mg orally daily
- Indications to decrease dose by 50% (or 25% if mild organ Impairment)
- Hepatic Impairment
- Renal Impairment or Hemodialysis
- Prominent Withdrawal symptoms
- See also Antidepressant Withdrawal
- Symptoms start 1-3 days after stopping medication (mild symptoms may have onset within hours of missed pill)
- Dizziness
- Irritability
- Insomnia
- Headache
- Gastrointestinal upset
- Ataxia or Vertigo
- Paresthesias (including shock-like Sensations)
- Tachycardia
- Fever
- Effexor taper schedule
- Reduce dose 25 mg/day every 5-7 days
- Taper to 25-50 mg/day before stopping
- Effexor XR taper schedule
- Reduce dose 37.5 to 75 mg per day every 7 days
- Taper to 37.5 mg/day before stopping
- Alternatives to tapering with Effexor
- Start Sertraline (Zoloft) 50 mg orally daily on stopping Effexor
- Anticholinergic (less than Tricyclic Antidepressants)
-
Nausea or Vomiting
- May be severe and limit dosing
- Start therapy at 25 mg per day
- Increased Blood Pressure
- Only seen with total daily doses 300 mg or higher
- Less Sexual Dysfunction than Prozac, Zoloft, Paxil
- Sexual Dysfunction in 10-15% of cases
- Similar to Luvox and Celexa
- See Antidepressant Induced Sexual Dysfunction
- More stimulating (anxiogenic) than sedating
- Decreased appetite and Weight loss may occur
- Photosensitivity
- Suicidal Ideation and self harm (children)
- Ocular changes
- Increased Intraocular Pressure (Exercise caution in Glaucoma)
- Mydriasis
- Minimal Cytochrome P450 interactions
- Metabolized by CYP2D6 and CYP3A4
- Avoid with MAO Inhibitors (including Linezolid)
- Exercise caution when combining with Cimetidine or Haloperidol
- Risk of Serotonin Syndrome (as with other SNRI and with SSRI)
- Monitor closely with Triptans
- (2023) Med Lett Drugs Ther 62(1592): 25-32
- Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 38-9
- Hamilton (2020) Tarascon Pocket Pharmacopoeia
- Mishler and Lovecchio (2017) Crit Dec Emerg Med 31(11): 15-20
- (1997) Am J Psych 154:1760 [PubMed]
- Sundberg (1995) Depression Primary Care, PGM, p. 45-57