Venlafaxine: Difference between revisions
From Pharmacopedia
More actions
| [unchecked revision] | [checked revision] |
Assign pharmacological categories from List_of_CNS-active_medicines |
MDElliottMD (talk | contribs) parser-claude: Venlafaxine MedTemplate refill, Top 300 stub upgrade |
||
| Line 1: | Line 1: | ||
{{MedTemplate | {{MedTemplate | ||
| generic | | generic = Venlafaxine | ||
| brand | | brand = Effexor XR, Effexor IR (discontinued in US, generic widely available) | ||
| structure | | structure = | ||
| classes | | classes = [[:Category:SNRIs|Serotonin-norepinephrine reuptake inhibitor (SNRI)]], [[:Category:Antidepressants|Antidepressant]], [[:Category:Anxiolytics|Anxiolytic]] | ||
| | | 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 = ~45%<ref name="effexor-xr-label" /> | |||
| pregnancy = Observational signal for neonatal adaptation syndrome with late-pregnancy exposure; weigh against the risks of untreated maternal depression.{{citation needed}} | |||
| 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" /> | |||
| | | 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; CPIC PGx guidance applies<ref name="cpic-snri">CPIC Guideline for CYP2D6 and CYP2C19 Genotypes and Dosing of Selective Serotonin Reuptake Inhibitors, 2023. https://cpicpgx.org/guidelines/guideline-for-selective-serotonin-reuptake-inhibitors-and-cyp2d6-and-cyp2c19/</ref>. | ||
| | |||
| | |||
| | |||
| | |||
}} | }} | ||
== References == | |||
<references /> | |||
[[Category: | [[Category:SNRIs]] | ||
[[Category:Antidepressants]] | [[Category:Antidepressants]] | ||
[[Category:Anxiolytics]] | |||