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treatment & management

Drug Profiles:
venlafaxine HCl

Effexor®, Effexor XR®

CAUTION: Federal law prohibits dispensing without prescription.

Effexor® (Venlafaxine) is an antidepressant medication. It affects chemicals in your brain that may become unbalanced and cause depression. Venlafaxine is used to relieve symptoms of depression such as feelings of sadness, worthlessness, or guilt; loss of interest in daily activities; changes in appetite; tiredness; sleeping too much; insomnia; and thoughts of death or suicide. Venlafaxine is also used to relieve symptoms of generalized anxiety disorder. It is also being prescribed by some doctors as Migraine preventive. In addition to use as a Migraine preventive, Migraineurs may find antidepressants useful for clinical (chemical) depression. Migraine and depression have a definite link — 47% of Migraineurs experience clinical depression as opposed to just 17% of the general population.

Before Using This Medicine
In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For venlafaxine, the following should be considered:

Tell your doctor if you have ever had any unusual or allergic reaction to citalopram. Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes.

Venlafaxine is in the FDA pregnancy category C. This means that it is not known whether venlafaxine will harm an unborn baby. Do not take this medication without first talking to your doctor if you are pregnant.

Venlafaxine passes into breast milk and it is not known if it will affect a nursing baby. Do not take venlafaxine without first talking to your doctor if you are breast-feeding a baby..

Studies on this medicine have been done only in adult patients, and there is no specific information comparing use of venlafaxine in children with use in other age groups.

Older adults-
In studies done to date that have included elderly people, venlafaxine did not cause different side effects or problems in older people than it did in younger adults.

Other medicines-
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking venlafaxine, it is especially important that your health care professional know if you are taking the following:

  • Buspirone (e.g., BuSpar)
  • Bromocriptine (e.g., Parlodel)
  • Certain tricyclic antidepressants (amitriptyline [e.g., Elavil], clomipramine [e.g., Anafranil], or imipramine [e.g., Tofranil])
  • Dextromethorphan (cough medicine
  • Levodopa (e.g., Sinemet)
  • Lithium (e.g., Eskalith)
  • Meperidine (e.g., Demerol)
  • Nefazodone (e.g., Serzone)
  • Pentazocine (e.g., Talwin)
  • Selective serotonin reuptake inhibitors (fluoxetine [e.g., Prozac], fluvoxamine [e.g., Luvox], paroxetine [e.g., Paxil], sertraline [e.g., Zoloft])
  • Street drugs (LSD, MDMA [e.g., ecstasy], marijuana)
  • Sumatriptan (e.g., Imitrex, Amerge, Maxalt, Zomig, Axert, Frova)
  • Tramadol (e.g., Ultram)
  • Trazodone (e.g., Desyrel)
  • Tryptophan—Using these medicines with venlafaxine may increase the chance of developing a rare, but very serious, unwanted effect known as the serotonin syndrome; symptoms of this syndrome include confusion, diarrhea, fever, poor coordination, restlessness, shivering, sweating, talking or acting with excitement you cannot control, trembling or shaking, or twitching; if you experience these symptoms contact your doctor as soon as possible
  • Moclobemide (e.g., Manerex)—Taking moclobemide and venlafaxine together or less than 3 days apart may increase the chance of developing serious unwanted effects, including the serotonin syndrome, and is not recommended
  • Monoamine oxidase (MAO) inhibitors (furazolidone [e.g., Furoxone], phenelzine [e.g., Nardil], isocarboxazid [e.g., Marplan] procarbazine [e.g., Matulane], selegiline [e.g., Eldepryl], tranylcypromine [e.g., Parnate])— Do not take venlafaxine while you are taking or within 2 weeks of taking an MAO inhibitor; if you do, you may develop confusion, agitation, restlessness, stomach or intestinal symptoms, sudden high body temperature, extremely high blood pressure, and severe convulsions; at least 14 days should be allowed between stopping treatment with an MAO inhibitor and starting treatment with venlafaxine, and at least 7 days should be allowed between stopping treatment with venlafaxine and starting treatment with an MAO inhibitor.

Other medical problems-
The presence of other medical problems may affect the use of venlafaxine. Make sure you tell your doctor if you have any other medical problems, especially:

  • Brain disease or damage, or mental retardation
  • Seizures (history of)—The risk of seizures may be increased
  • Heart disease
  • High or low blood pressure—Venlafaxine may make these conditions worse
  • Kidney disease
  • Liver disease—Higher blood levels of venlafaxine may occur, increasing the chance of side effects; your doctor may need to adjust your venlafaxine dose
  • Mania (history of)—The risk of developing mania may be increased
  • Weight loss—Venlafaxine may cause weight loss; this weight loss is usually small, but if a large weight loss occurs, it may be harmful in some patients

Proper Use of This Medicine
It is important to use this medicine properly:

  • Take this medicine only as directed by your doctor
  • You may have to take venlafaxine for 4 weeks or longer before you begin to feel better
  • Venlafaxine should be taken with food or on a full stomach to lessen the chance of stomach upset. However, if your doctor tells you to take the medicine a certain way, take it exactly as directed.
  • If you are taking the extended-release capsule dosage form, swallow the capsule whole with fluid.

The dose of venlafaxine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of venlafaxine. If your dose is different, do not change it unless your doctor tells you to do so.

The number of capsules or tablets that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on your special needs.

  • For mental depression:
    • For oral extended-release capsule dosage form:
      • Adults—At first, 75 milligrams (mg) a day, taken in one dose in the morning or evening. Your doctor may increase your dose if needed. However, the dose is usually not more than 225 mg a day.
      • Children—Use and dose must be determined by your doctor.
    • For oral tablet dosage form:
      • Adults—At first, a total of 75 mg a day, taken in smaller doses two or three times during the day. Your doctor may increase your dose if needed. However, the dose is usually not more than 375 mg a day.
      • Children up to 18 years of age—Use and dose must be determined by your doctor.
  • For anxiety:
    • For oral extended-release capsule dosage form:
      • Adults—At first, 75 mg a day, taken in one dose in the morning or evening. Your doctor may increase your dose if needed. However, the dose is usually not more than 225 mg per day.
      • Children—Use and dose must be determined by your doctor

Missed Dose-
Take the missed dose as soon as you remember. However, if it is almost time for your next regularly scheduled dose, skip the missed dose and take only the next one as directed. Do not take a double dose of this medication.

To store this medicine:

  • Keep out of the reach of children.
  • Store away from heat and direct light.
  • Do not store in the bathroom, near the kitchen sink, or in other damp places. Heat or moisture may cause the medicine to break down.
  • Do not keep outdated medicine or medicine no longer needed. Be sure that any discarded medicine is out of the reach of children.

Precautions While Using This Medicine

  • It is important that your doctor check your progress at regular visits, to allow for changes in your dose and to help reduce any side effects.
  • Tell your doctor right away if you develop any allergic reactions, such as skin rash or hives, while taking venlafaxine.
  • Do not stop taking this medicine without first checking with your doctor. Your doctor may want you to reduce gradually the amount you are taking before stopping completely. This is to decrease the chance of side effects.
  • It is not known how venlafaxine will interact with alcohol and other central nervous system (CNS) depressants (medicines that may make you drowsy or less alert). Some examples of CNS depressants are antihistamines or medicine for hay fever, other allergies, or colds; sedatives, tranquilizers, or sleeping medicine; prescription pain medicine or narcotics; barbiturates; medicine for seizures; muscle relaxants; or anesthetics, including some dental anesthetics. Check with your doctor before taking any of the above while you are using this medicine.
  • Venlafaxine may cause some people to become drowsy or have blurred vision. Make sure you know how you react to this medicine before you drive, use machines, or do anything else that could be dangerous if you are not alert or able to see clearly.
  • Dizziness, lightheadedness, or fainting may occur.

Side Effects of This Medicine
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

  • More common: Changes in vision, such as blurred vision; decrease in sexual desire or ability; headache
  • Less common: Chest pain; fast or irregular heartbeat; mood or mental changes; ringing or buzzing in ears
  • Rare: Convulsions (seizures); itching or skin rash; lightheadedness or fainting, especially when getting up suddenly from a sitting or lying position; lockjaw; menstrual changes; problems in urinating or in holding urine; swelling; talking, feeling, and acting with excitement and activity you cannot control; trouble in breathing

This medicine may also cause the following side effect that your doctor will watch for:

  • More common: High blood pressure

Other side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. However, check with your doctor if any of the following side effects continue or are bothersome:

  • More common: Abnormal dreams; anxiety or nervousness; chills; constipation; diarrhea; dizziness; drowsiness; dryness of mouth; heartburn; increased sweating; loss of appetite; nausea; stuffy or runny nose; stomach pain or gas; tingling, burning, or prickly sensations; trembling or shaking; trouble in sleeping; unusual tiredness or weakness; vomiting; weight loss
  • Less common: Change in sense of taste; muscle tension ; yawning

After you stop using this medicine, your body may need time to adjust. The length of time this takes depends on the amount of medicine you were using and how long you used it. During this period of time check with your doctor if you notice any of the following side effects:

  • Changes in dreaming; dizziness; dryness of mouth; headache; increased sweating; nausea; nervousness; trouble in sleeping; unusual tiredness or weakness

Brand Names-

U.S. and Canada: Effexor®, Effexor XR®


Information offered at this Web site by either a lay person or a health professional should not be interpreted as giving a diagnosis or a treatment recommendation. These can only be provided by a physician who has had an opportunity to interact with a patient in person and at length, with access to the patient's previous records and appropriate follow-up.