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Effexor (Venlafaxine Hydrochloride)

What is Effexor?

Venlafaxine, sold under the brand name Effexor, is an anti-depressant that is used to manages major depressive disorder and depression associated with bipolar disorder. This medication was the first of the Serotonin Norepinephrine Reuptake Inhibitors(SNRI). SNRIs were developed as an alternative to the adverse effects of selective serotonin reuptake inhibitors (SSRIs). Venlafaxine is also approved for management of generalized anxiety disorder and panic disorder.

How Venlafaxine Works

Venlafaxine works by making more serotonin and norepinephrine available in the body. Unlike the other SNRIs, Venlafaxine inhibits more serotonin reuptake than norepinephrine. This causes more serotonin to be available in the body.

Storage, Dosage & How to use Venlafaxine

Venlafaxine comes in 25mg, 37.5mg, 50mg, 75mg, and 100mg tablets. The tablets are pale peach colored, and shield shaped with a flat-face bevelled edge. The recommended starting dose is 75mg per day, taken in two to three doses with food. Take this medication at the same time each day. Store the medication away from moisture and heat.

If the tablet or capsule is difficult to swallow – do not chew or crush it. If you have the capsule, open it into a spoonful of apple sauce, then swallow immediately without chewing.

Depending on how the drug is tolerated and whether or not the desired effect is achieved, the dose may be increased to 150mg per day. The dosage must be increased over a period longer than four days. Maintenance doses may be 75mg to 225mg per day, depending on individual diagnoses.

Side Effects

The most common side effects are:

  • headache, dizziness, drowsiness, tiredness
  • anxiousness, nervousness, jittery
  • sleep disturbances, unusual dreams
  • tremors
  • fast heart rate, blurred vision
  • nausea, vomiting, diarrhea, constipation
  • changes in weight and appetite
  • dry mouth, yawning
  • increased perspiration
  • sexual problems

Other common side effects, not listed here, might occur. Sleep, appetite, and level of energy usually improve within one to two weeks. Contact your provider for any unusual symptoms or changes.

The most serious side effects that require emergency assistance are:

  • suicidal ideation in young patients
  • allergic reaction
  • hives, rash
  • difficulty breathing
  • swelling of the face, tongue, throat
  • serotonin syndrome

Serotonin syndrome is a dangerous-to-life side effect that requires urgent care. Read in the Interactions and Contraindications sections for the progression of symptoms caused by Serotonin syndrome.

Other possible serious side effects that require immediate medical help:

  • Nose bleeds, bleeding gums, abnormal vaginal bleeds, any bleeding that will not stop
  • Headache, confusion, problems thinking or remembering, weakness, unsteady gait
  • Blurred vision, eye pain, red eyes, seeing halos around lights
  • Cough, chest tightness, trouble breathing
  • Seizures
  • Rigid muscles, high fever, sweating, confusion, fast or uneven heart rate, tremors, feeling faint

Should any of the above serious effects occur, contact your prescribing Provider immediately. For allergic reactions, contact emergency services immediately. In the case of serotonin syndrome, contact your Provider immediately and follow their instructions.

Warnings & Precautions

Serotonin Syndrome

Some foods, herbal products, and other medications increase serotonin. Ingested while receiving Venlafaxine therapy, serotonin may increase rapidly in the body. Serotonin syndrome is a life-endangering effect of too much serotonin. Symptoms range from mild to severe, and possibly death. Before beginning Effexor treatment, inform your Prescribing Provider of all medications, supplements, and herbal products(including caffeine) that you are currently taking.

Suicide Ideation

In children, teens, and young adults, Venlafaxine may initially increase suicidal thoughts and feelings when beginning this therapy. Suicidal ideation may also increase at any time of the therapy if the dosage is altered. Observe for new or sudden mood swings, behavior, the expression of worsening depression or suicidal thoughts. Contact the prescribing Provider immediately should this occur.

Danger of Weaning Too Quickly

To stop taking Venlafaxine, you and your Provider must create a weaning program, because it is NOT safe to stop the medication in one day. Stopping the medication too quickly can cause agitation, headaches, dizziness, confusion, nightmares, nausea, vomiting, diarrhea, and tingling electric sensations. Stopping this medicine too quickly can cause a relapse of depression.

Narrow Angle Glaucoma

Do NOT take this medication if you have uncontrolled narrow-angle glaucoma.

Use of MAO Inhibitors

Do NOT use Venlafaxine within seven days before, or for 14 days after, taking an MAO inhibitor.

Known Allergies

Do NOT take this medication if you have had allergic reactions to Venlafaxine(Effexor) or to desvenlafaxine(Pristiq).

Other Medications

Before beginning Venlafaxine, tell the Provider if you are using stimulants, opioids, NSAIDs, herbal remedies, other anti-depressants or mental illness medications. Also report medications taken for Parkinson’s disease, migraine headaches, serious infections, or medications that prevent nausea and vomiting. Medications for these conditions used with Venlafaxine can cause serotonin syndrome. Serotonin syndrome is a life-endangering effect of too much serotonin. Symptoms range from mild to severe, and possibly death.

Pregnancy

Newborns of mothers taking Venlafaxine late in the third trimester may require prolonged hospitalization, respiratory support, and tube feedings after birth.

Breast Feeding

Do not breast feed when receiving Venlafaxine therapy.

Hypertension

Venlafaxine may increase blood pressure. High blood pressure typically has no noticeable symptoms. Monitor blood pressure vigilantly, especially when beginning use of this therapy. Discuss changes with the Provider to manage hypertension.

Other

Be aware that this drug can cause false results on drug-screening urine lab tests.

Also, avoid activities such as driving or managing heavy equipment and machinery, until your body adjusts to the medication. Reaction time may be impaired.

Interactions

Venlafaxine is not advised with certain health conditions. Discuss the benefits and risks of receiving Venlafaxine therapy with your prescribing Provider, if you have any of the following:

  • narrow angle glaucoma
  • liver disease
  • kidney disease
  • bipolar disorder
  • chronic pain
  • heart disease
  • hypertension
  • high cholesterol
  • diabetes
  • thyroid disorder
  • seizures
  • bleeding problems
  • low levels of sodium

A number of medications given for these conditions can also interfere with the safe and effective use of Venlafaxine. Review all of your medications with the healthcare provider. The following are known to have adverse interactions with Venlafaxine:

  • Anti-inflammatory drugs(NSAIDs)
  • Alcohol
  • MAO Inhibitors ­­­­­­­­­­­­­

Also, be aware that any stimulant can increase the effect of venlafaxine causing dangerous symptoms to escalate.

Contraindications

Using any medication or product that increases uptake of serotonin

Symptoms may begin with diarrhea, shivering, increased anxiety, agitation, restlessness, insomnia, headaches, rigid muscles, mild fever, and goosebumps.

Signs of serotonin syndrome worsening begin with increasing the heart rate and blood pressure. The patient’s pupils may become dilated. There will be a loss of muscle coordination, twitching, heavy perspiration, and confusion.

Severe serotonin syndrome symptoms include high fever, seizures, irregular heartbeat with unconsciousness, and eventually death, if untreated.

Frequently Asked Questions

No. Any nonsteroidal anti-inflammatory drugs (NSAIDs) taken while using Venlafaxine can cause gastro-intestinal bleeding. Studies show the chance of stomach bleeds increase by 75% when receiving Venlafaxine therapy while taking a NSAID.

Discuss how to gradually reduce your dosage over time with your Provider. Stopping too fast can cause uncomfortable adverse effects. The benefits gained from receiving Venlafaxine therapy may be lost if the drug is stopped too quickly.

Dilated pupils may be a sign of Serotonin syndrome. Consider your caffeine drink intake and other stimulating foods or herbs recently ingested. Contact your clinic and discuss this symptom with the nurse or Provider. Continue to observe your symptoms. Serotonin syndrome can rapidly escalate and require emergency treatment.

Venlafaxine interferes with coagulation. Call your provider and discuss whether Venlafaxine is the right choice for you, and whether the dosage should be lowered.

Possibly. Contact the Provider immediately and share these symptoms. Be sure to remind the provider of your age. Elderly patients sometimes need a different type of medication. You may need a lower dose or to be gradually weaned off the Venlafaxine.

Discuss management of your condition to control the cholesterol and triglyceride levels. Also discuss other medications that might be a better fit for you.

No. Venlafaxine moves through the mother’s milk, so the baby will receive high doses of the drug by breastfeeding. Discuss the benefits and risks of using antidepressants during breastfeeding with your provider. Also ask about other therapeutic options, including other antidepressant drugs, which might be safer to use.

Yes. St. John’s Wort increases serotonin levels and could lead to serotonin syndrome, a dangerous condition that requires immediate attention. St. John’s Wort should be weaned from your system prior to beginning Venlafaxine. Contact your prescribing Provider to discuss how to manage the switch from one to the other.

If you are taking Venlafaxine as instructed, the medication can take three to six weeks to become effective. Review the Medication insert that comes with Venlafaxine to confirm you are following instructions for how to take the medicine and be patient for another two weeks.

The duration for taking Venlafaxine varies depending on the reason for taking it. Generally, people take Venlafaxine at least six months. However, those who have severe depression or drug-resistant depression may be on an open-ended care plan for using this form of therapy. Some clinicians advise to remain on this medication for six months to a year after your condition returns to balance.

Venlafaxine is not addictive.

Venlafaxine is also used, off label, for migraine therapy. When there is also moodiness or other symptoms of depression, Venlafaxine reduces both the frequency of headaches and improves the mood.

Of the most commonly used antidepressants, Venlafaxine is one of the lowest risk for severe side effects when used with heart medications. Talk to your Provider about the risks and benefits of treating depression in heart disease.

No. Double dosing can lead to too much serotonin and potential serotonin syndrome. If you missed the full day of three doses, inform your Provider. Record any unusual or new symptoms should any occur. If only one or two of the three doses was missed, there is likely not a relapse of  symptoms. However, keep records of the dose missed and any associated new symptoms.

No. Alcohol and any other nonprescribed drugs used while on Venlafaxine therapy will increase side effects, especially sedation. The benefits achieved from Venlafaxine will likely be reduced as well.