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Venlafaxine, sold under the brand name Effexor, is a serotonin-norepinephrine reuptake inhibitor (SNRI) prescribed for major depressive disorder and several anxiety disorders. It works by increasing the levels of serotonin and norepinephrine, two key neurotransmitters involved in mood regulation. [1]
- Venlafaxine is a serotonin-norepinephrine reuptake inhibitor (SNRI) antidepressant for major depression and anxiety disorders, including generalized anxiety disorder, social anxiety disorder, and panic disorder.
- Common side effects include nausea, dizziness, insomnia (or drowsiness), dry mouth, and sexual dysfunction. Venlafaxine can also raise blood pressure in some patients.
- Venlafaxine carries a black box warning for increased suicidal thoughts in younger patients (like all antidepressants).
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What is venlafaxine (Effexor)?
Venlafaxine is an SNRI first approved by the FDA in 1993 for the treatment of major depressive disorder. It is available in immediate-release (IR) and extended-release (Effexor XR) forms. It is thought to work by increasing the levels of mood-enhancing chemicals called serotonin and norepinephrine in the brain. [1]
Medical uses of venlafaxine
Venlafaxine is FDA-approved to treat the following conditions in adults: [1][2]
- Major depressive disorder (MDD)
- Generalized anxiety disorder (GAD)
- Social anxiety disorder
- Panic disorder
Off-label uses of Effexor include: [1][2][3]
- Post-traumatic stress disorder (PTSD)
- Obsessive-compulsive disorder (OCD)
- Certain types of chronic neuropathic pain (diabetic neuropathy or fibromyalgia)
- Migraine prevention
- Menopausal hot flashes
These off-label uses should, however, be guided by evidence and utilized under close medical supervision.
How venlafaxine works
Venlafaxine increases the activity of key neurotransmitters by inhibiting the reuptake of serotonin and norepinephrine in the brain. [4] Put differently, it prevents nerve cells from reabsorbing these neurotransmitters, making more serotonin and norepinephrine available to improve communication between neurons.
At lower doses, venlafaxine mostly affects serotonin. As the dose increases, it also affects norepinephrine, which may make it more effective for some people. [1][5]
Dosage guidelines
For adults with depression or anxiety, a typical starting dose is 75 mg per day (either 75 mg once daily of the extended-release formulation or 37.5 mg twice daily of the immediate-release formulation of Effexor). [6] In some cases (especially for anxiety), doctors may start at 37.5 mg per day to minimize any possible side effects and then increase the dose gradually.
Titration
The dose is increased every few days based on the patient’s response. The usual effective dose range is 75–225 mg daily. [7] If necessary, the dose may be increased to a maximum of 225 mg/day for extended-release (or 375 mg per day in divided doses for immediate-release). [1]
Administration
Venlafaxine should be taken with food to reduce stomach upset. Extended-release capsules must be swallowed whole (not crushed or opened). If a dose is missed, take it as soon as possible unless it’s almost time for the next dose (do not double up doses). [8]
Potential side effects
Common side effects of Effexor include: [1][9]
- Nausea
- Dizziness
- Insomnia
- Drowsiness
- Dry mouth
- Sexual side effects (such as reduced libido or delayed orgasm)
- High blood pressure
These effects are usually tolerable and improve within the first couple of weeks. Taking venlafaxine with food can reduce nausea. If it leads to insomnia, morning dosing may help. For drowsiness, evening dosing may be more appropriate. [9]
More rare serious effects of venlafaxine include: [1][10]
- Serotonin syndrome (usually from interactions with other drugs that act on serotonin)
- Seizures
- Extreme confusion
- Increased body temperature
- Stiff muscles
Overall, most side effects are manageable. Patients are advised to report any severe or persistent adverse effects to their healthcare provider immediately.
Safety considerations and contraindications
Antidepressants (like venlafaxine) may increase suicidal thoughts in adolescents and young adults during the first few weeks of treatment. It’s essential that doses are closely monitored, especially in the early stages, when mood changes can be unpredictable. [11]
Contraindication
Do not take venlafaxine if you are currently on or have recently (within 2 weeks) taken a monoamine oxidase inhibitor (MAOI). Combining an SNRI with an MAOI can cause a dangerous increase in serotonin in the brain, leading to serotonin syndrome, as previously mentioned. Also, don't take venlafaxine if you have had a severe allergic reaction to venlafaxine or its active metabolite (desvenlafaxine). [12]
Cautions
Use extra caution if you have uncontrolled high blood pressure, heart disease, epilepsy, bipolar disorder, or narrow-angle glaucoma. [1][10] Doctors advise that venlafaxine should be avoided in pregnancy and breastfeeding unless absolutely necessary. [13] Talk to your doctor about your options if you are pregnant, planning to become pregnant, or breastfeeding.
Drug interactions
Combining venlafaxine with other medications that have effects on serotonin, such as other antidepressants (like selective serotonin reuptake inhibitors or SSRIs), certain migraine drugs like triptans, or the supplement St. John’s Wort, can increase the risk of serotonin syndrome. [1] Combining alcohol or sedative drugs with Effexor can enhance the effects of drowsiness and dizziness.
Venlafaxine withdrawal and discontinuation syndrome
Sudden discontinuation of venlafaxine can cause withdrawal symptoms, also known as antidepressant discontinuation syndrome. Because venlafaxine leaves the body quickly, missing even one dose can sometimes trigger uncomfortable withdrawal symptoms. [14]
Symptoms of venlafaxine withdrawal may include: [14]
- Dizziness
- Headaches
- Nausea
- Flu-like body aches
- Insomnia with vivid dreams
- “Electric shock” sensations or “brain zaps”
- Irritability
- Anxiety
While not usually dangerous, these symptoms can feel intense and overwhelming. It’s important to know they’re temporary. Abruptly stopping venlafaxine can increase the risk of withdrawal syndrome, which is often more intense than with SSRI antidepressants. [14] To avoid this, doctors recommend gradually reducing the dose when discontinuing venlafaxine. [14]
Venlafaxine overdose
An overdose of venlafaxine is a medical emergency. Taking a much higher-than-prescribed dose can lead to serious toxicity. Symptoms of overdose include: [1]
- Extreme drowsiness
- Rapid heartbeat
- Low blood pressure
- Severe nausea/vomiting
- Seizures
- Signs of serotonin syndrome (agitation, fever, and tremors)
- Heart rhythm disturbances (arrhythmia)
Statistics show that venlafaxine is more toxic in overdose than many other antidepressant medications, with potential toxicity comparable to that of older tricyclic antidepressants. [15] Getting immediate hospital care greatly improves the chances of recovery.
Misuse and addiction potential
Venlafaxine is not considered addictive. It’s not a controlled substance and does not produce a “high” or cravings, making its abuse potential low. [16] While a person’s body can become dependent on venlafaxine (meaning withdrawal symptoms will occur if stopped abruptly), this is a physical dependence due to the medication’s effect on the body, not a compulsive addiction.
There have been a few rare documented cases of venlafaxine misuse at high doses, typically in people with a history of substance use disorder. [17] Such occurrences are unusual and not representative of how the medication is generally used. When taken as prescribed under medical supervision, venlafaxine has a minimal risk of misuse or addiction.
Treatment and when to seek help
Be vigilant and seek medical advice or help in certain situations while on venlafaxine:
- Emergency symptoms: If you experience severe symptoms such as high fever, confusion, or muscle rigidity
- Worsening mood: For any new or worsening psychological symptoms (such as thoughts about suicide)
- Overdose: In the event of an overdose (or suspected overdose)
- Pregnancy: If you become pregnant while taking venlafaxine
- Taking too much: In the rare occurrence, if you find yourself taking too much of Effexor
Always follow your doctor’s guidance. Never adjust the dose or stop the medication on your own—doing so can be risky due to withdrawal effects and the return of unwanted symptoms (including suicidal thoughts in extreme cases). If you have any concerns or side effects, it’s important to consult with your healthcare provider, who can adjust the treatment plan or provide supportive measures.
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