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Venlafaxine: Difference between revisions

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{{MedTemplate
{{MedTemplate
| generic           = Venlafaxine
| generic           = Venlafaxine
| brand             = Effexor
| brand             = Effexor XR, Effexor IR (discontinued in US, generic widely available)
| structure         =  
| structure         =
| classes           = SNRI, Antidepressant
| classes           = [[:Category:SNRIs|Serotonin-norepinephrine reuptake inhibitor (SNRI)]], [[:Category:Antidepressants|Antidepressant]], [[:Category:Anxiolytics|Anxiolytic]]
| mechanism          = Serotonin–norepinephrine reuptake inhibitor
| uses             = <vote slug="major-depressive-disorder-use">Major depressive disorder (FDA)</vote>, <vote slug="generalized-anxiety-disorder-use">Generalized anxiety disorder (FDA)</vote>, <vote slug="social-anxiety-disorder-use">Social anxiety disorder (FDA)</vote>, <vote slug="panic-disorder-use">Panic disorder (FDA)</vote>, <vote slug="ptsd-use">Posttraumatic stress disorder (off-label)</vote>, <vote slug="neuropathic-pain-broad-use">Neuropathic pain (off-label)</vote>, <vote slug="menopausal-vasomotor-use">Menopausal vasomotor symptoms (off-label, evidence-supported)</vote>
| uses               =  
| starting_dose     = XR 37.5 mg PO once daily for 4-7 days, then 75 mg/day; titrate by 75 mg every ≥4 days to clinical effect. IR 25-37.5 mg BID-TID
| starting_dose     =  
| preparations     = IR tablets 25, 37.5, 50, 75, 100 mg; XR capsules 37.5, 75, 150, 225 mg
| preparations       =  
| fda_max           = 225 mg/day outpatient (XR); 375 mg/day inpatient (IR divided TID); 75 mg/day in moderate hepatic impairment
| fda_max          =  
| pill_id           =
| routes             =  
| routes           = Oral
| onset             =  
| onset             = Antidepressant effect over 1-2 weeks; anxiolytic effect over 4-6 weeks
| duration           =  
| duration         = 24 hours (XR); 12 hours (IR)
| halflife           =
| halflife          = Venlafaxine 5 hours; desvenlafaxine active metabolite 11 hours<ref name="effexor-xr-label">FDA Prescribing Information, Effexor XR (venlafaxine extended-release), Wyeth/Pfizer, current revision. https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/020699s107lbl.pdf</ref>
| bioavailability    =
| bioavailability   = ~45%<ref name="effexor-xr-label" />
| pregnancy         =  
| pregnancy        = Observational signal for neonatal adaptation syndrome with late-pregnancy exposure; weigh against the risks of untreated maternal depression.{{citation needed}}
| legal              =  
| legal             = [[USLegal:Prescription only|Rx-only]] in US. Carries the antidepressant '''Boxed Warning''' for suicidality in children, adolescents, and young adults<ref name="effexor-xr-label" />
| intro              =
| mechanism        = <vote slug="venlafaxine-mech-claim">Serotonin and norepinephrine reuptake inhibitor with predominantly serotonergic activity at lower doses (37.5-150 mg); the noradrenergic effect adds at higher doses (>150 mg) and the dual-mechanism advantage really emerges then. The active metabolite desvenlafaxine (separately marketed as Pristiq) contributes meaningfully to clinical effect.</vote> '''Severe discontinuation syndrome''' is the marquee adverse-effect feature: venlafaxine's short half-life produces intense flu-like symptoms, dizziness, electric-shock sensations ("brain zaps"), and emotional dysregulation on abrupt discontinuation, worse than most other SNRIs and SSRIs. Slow taper essential. Dose-dependent '''diastolic hypertension''' at higher doses; routine BP monitoring at dose escalation. CYP2D6 substrate; CYP2D6 oxidation produces the active metabolite desvenlafaxine. PharmGKB clinical annotations for venlafaxine apply (Level 2A).<ref name="pharmgkb-venlafaxine">PharmGKB: Venlafaxine pharmacogenomics annotations. https://www.pharmgkb.org/chemical/PA451866</ref> No formal CPIC guideline covers venlafaxine; the CPIC SSRI/CYP2D6 guideline (Hicks 2015) covers sertraline, citalopram, escitalopram, fluoxetine, fluvoxamine, and paroxetine and does not extend to SNRIs.
| pharmacokinetics   =  
| pharmacodynamics  =  
| indications        =  
| dosing             =  
| effects            =  
| contraindications  =  
| interactions      =  
| pregnancy_details  =
| monitoring         =
| counseling        =
| anecdotes          =
| seealso            =
| references        =  
}}
}}


== References ==
<references />
[[Category:SNRIs]]
[[Category:Antidepressants]]
[[Category:Antidepressants]]
[[Category:Anxiolytics]]

Latest revision as of 02:23, 27 May 2026

Serotonin-norepinephrine reuptake inhibitor (SNRI), Antidepressant, Anxiolytic
Venlafaxine
Effexor XR, Effexor IR (discontinued in US, generic widely available)

Experience

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Problems

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Titration strategies

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Effects

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Summary
Classes
Serotonin-norepinephrine reuptake inhibitor (SNRI), Antidepressant, Anxiolytic
Common uses
Major depressive disorder (FDA)0, Generalized anxiety disorder (FDA)0, Social anxiety disorder (FDA)0, Panic disorder (FDA)0, Posttraumatic stress disorder (off-label)0, Neuropathic pain (off-label)0, Menopausal vasomotor symptoms (off-label, evidence-supported)0
Pharmacy
Starting dose
XR 37.5 mg PO once daily for 4-7 days, then 75 mg/day; titrate by 75 mg every ≥4 days to clinical effect. IR 25-37.5 mg BID-TID
Preparations
IR tablets 25, 37.5, 50, 75, 100 mg; XR capsules 37.5, 75, 150, 225 mg
US FDA Max
225 mg/day outpatient (XR); 375 mg/day inpatient (IR divided TID); 75 mg/day in moderate hepatic impairment
Pharmacology
Routes
Oral
Onset
Antidepressant effect over 1-2 weeks; anxiolytic effect over 4-6 weeks
Duration
24 hours (XR); 12 hours (IR)
Half-life
Venlafaxine 5 hours; desvenlafaxine active metabolite 11 hours[2]
Bioavailability
~45%[2]
Pregnancy
Observational signal for neonatal adaptation syndrome with late-pregnancy exposure; weigh against the risks of untreated maternal depression.[citation needed]
Legal status
Rx-only in US. Carries the antidepressant Boxed Warning for suicidality in children, adolescents, and young adults[2]
Purported mechanism
Serotonin and norepinephrine reuptake inhibitor with predominantly serotonergic activity at lower doses (37.5-150 mg); the noradrenergic effect adds at higher doses (>150 mg) and the dual-mechanism advantage really emerges then. The active metabolite desvenlafaxine (separately marketed as Pristiq) contributes meaningfully to clinical effect.0 Severe discontinuation syndrome is the marquee adverse-effect feature: venlafaxine's short half-life produces intense flu-like symptoms, dizziness, electric-shock sensations ("brain zaps"), and emotional dysregulation on abrupt discontinuation, worse than most other SNRIs and SSRIs. Slow taper essential. Dose-dependent diastolic hypertension at higher doses; routine BP monitoring at dose escalation. CYP2D6 substrate; CYP2D6 oxidation produces the active metabolite desvenlafaxine. PharmGKB clinical annotations for venlafaxine apply (Level 2A).[1] No formal CPIC guideline covers venlafaxine; the CPIC SSRI/CYP2D6 guideline (Hicks 2015) covers sertraline, citalopram, escitalopram, fluoxetine, fluvoxamine, and paroxetine and does not extend to SNRIs.

References

  1. ↑ PharmGKB: Venlafaxine pharmacogenomics annotations. https://www.pharmgkb.org/chemical/PA451866
  2. ↑ 2.0 2.1 2.2 FDA Prescribing Information, Effexor XR (venlafaxine extended-release), Wyeth/Pfizer, current revision. https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/020699s107lbl.pdf
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