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Venlafaxine (Oral route)

Pronunciation:

ven-la-FAX-een

Brand Names:

  • Effexor
  • Effexor-XR

Dosage Forms:

  • Capsule, Extended Release
  • Tablet, Extended Release
  • Tablet

Warnings:

Oral route(Tablet;Capsule, Extended Release;Tablet, Extended Release)

Antidepressants increased the risk of suicidal thinking and behavior in children, adolescents, and young adults in short-term studies with major depressive disorder (MDD) and other psychiatric disorders. Short-term studies did not show an increase in the risk of suicidality with antidepressants compared to placebo in adults older than 24 years, and there was a reduction in risk with antidepressants compared with placebo in adults aged 65 or older. This risk must be balanced with the clinical need. Monitor patients closely for clinical worsening, suicidality, or unusual changes in behavior. Families and caregivers should be advised of the need for close observation and communication with the prescriber. Not approved for use in pediatric patients .

Classifications:

Therapeutic—

Antidepressant

Pharmacologic—

Serotonin/Norepinephrine Reuptake Inhibitor

Uses of This Medicine:

Venlafaxine is used to treat depression. It is also used to treat general anxiety disorder (GAD), social anxiety disorder (SAD), and panic disorder.

Venlafaxine belongs to a group of medicines known as serotonin and norepinephrine reuptake inhibitors (SNRI). These medicines are thought to work by increasing the activity of the chemical called serotonin in the brain.

This medicine is available only with your doctor's prescription.

Once a medicine has been approved for marketing for a certain use, experience may show that it is also useful for other medical problems. Although this use is not included in product labeling, venlafaxine is used in certain patients with the following medical condition:

  • Hot flashes.

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 this medicine, the following should be considered:

Allergies—

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Children—

Appropriate studies performed to date have not demonstrated any benefit to using venlafaxine in children. Studies have shown that some children, teenagers, and young adults think about suicide or attempt suicide when taking the medicine. Because of this toxicity, use in children is not recommended.

Older adults—

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of venlafaxine in the elderly. However, elderly patients may be more sensitive to the effects of this medicine than younger adults, and are more likely to have hyponatremia (low sodium in the blood) and age-related liver or kidney problems, which may require caution and an adjustment in the dose for patients receiving venlafaxine.

Pregnancy—

Pregnancy CategoryExplanation
All TrimestersCAnimal studies have shown an adverse effect and there are no adequate studies in pregnant women OR no animal studies have been conducted and there are no adequate studies in pregnant women.

Breast-feeding—

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

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 this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

  • Amifampridine
  • Furazolidone
  • Iproniazid
  • Isocarboxazid
  • Linezolid
  • Methylene Blue
  • Metoclopramide
  • Moclobemide
  • Nialamide
  • Pargyline
  • Phenelzine
  • Piperaquine
  • Procarbazine
  • Rasagiline
  • Selegiline
  • Toloxatone
  • Tranylcypromine
  • Trifluoperazine

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Aceclofenac
  • Acemetacin
  • Acenocoumarol
  • Almotriptan
  • Amitriptyline
  • Amoxapine
  • Amoxicillin
  • Amtolmetin Guacil
  • Anagrelide
  • Ancrod
  • Anisindione
  • Antithrombin III Human
  • Apixaban
  • Aspirin
  • Atazanavir
  • Bivalirudin
  • Bromfenac
  • Bufexamac
  • Bupropion
  • Celecoxib
  • Choline Salicylate
  • Cilostazol
  • Clarithromycin
  • Clomipramine
  • Clonixin
  • Clopidogrel
  • Crizotinib
  • Cyclobenzaprine
  • Danaparoid
  • Defibrotide
  • Dermatan Sulfate
  • Desipramine
  • Desirudin
  • Desvenlafaxine
  • Dexfenfluramine
  • Dexibuprofen
  • Dexketoprofen
  • Dextroamphetamine
  • Dextromethorphan
  • Dibenzepin
  • Diclofenac
  • Dicumarol
  • Diflunisal
  • Dipyridamole
  • Dipyrone
  • Dothiepin
  • Doxepin
  • Duloxetine
  • Eletriptan
  • Entacapone
  • Epoprostenol
  • Eptifibatide
  • Etodolac
  • Etofenamate
  • Etoricoxib
  • Felbinac
  • Fenfluramine
  • Fenoprofen
  • Fentanyl
  • Fepradinol
  • Feprazone
  • Floctafenine
  • Flufenamic Acid
  • Fluoxetine
  • Flurbiprofen
  • Fondaparinux
  • Frovatriptan
  • Haloperidol
  • Heparin
  • Ibuprofen
  • Ibuprofen Lysine
  • Iloprost
  • Imipramine
  • Indomethacin
  • Iobenguane I 123
  • Itraconazole
  • Ivabradine
  • Jujube
  • Ketoprofen
  • Ketorolac
  • Lamifiban
  • Levomilnacipran
  • Lexipafant
  • Lorcaserin
  • Lornoxicam
  • Loxoprofen
  • Lumiracoxib
  • Meclofenamate
  • Mefenamic Acid
  • Meloxicam
  • Milnacipran
  • Mirtazapine
  • Morniflumate
  • Nabumetone
  • Naproxen
  • Naratriptan
  • Nefazodone
  • Nelfinavir
  • Nepafenac
  • Niflumic Acid
  • Nimesulide
  • Nortriptyline
  • Ondansetron
  • Oxaprozin
  • Oxyphenbutazone
  • Parecoxib
  • Pazopanib
  • Pentosan Polysulfate Sodium
  • Phenindione
  • Phenprocoumon
  • Phenylbutazone
  • Piketoprofen
  • Piroxicam
  • Pranoprofen
  • Proglumetacin
  • Propyphenazone
  • Proquazone
  • Protriptyline
  • Quetiapine
  • Ritonavir
  • Rizatriptan
  • Rofecoxib
  • Salicylic Acid
  • Salsalate
  • Saquinavir
  • Sibrafiban
  • Sibutramine
  • Sodium Salicylate
  • Sulfinpyrazone
  • Sulindac
  • Sulodexide
  • Sumatriptan
  • Tapentadol
  • Telithromycin
  • Tenoxicam
  • Tiaprofenic Acid
  • Ticlopidine
  • Tirofiban
  • Tolfenamic Acid
  • Tolmetin
  • Toremifene
  • Tramadol
  • Trazodone
  • Trimipramine
  • Valdecoxib
  • Vasopressin
  • Vemurafenib
  • Vilazodone
  • Vinflunine
  • Vortioxetine
  • Warfarin
  • Xemilofiban
  • Zolmitriptan

Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Ginkgo
  • Metoprolol
  • St John's Wort
  • Zolpidem

Other interactions—

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Other medical problems—

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

  • Bipolar disorder (mood disorder with mania and depression), or risk of or
  • Bleeding problems or
  • Glaucoma, narrow-angle or
  • Hypercholesterolemia (high cholesterol in the blood) or
  • Hypertension (high blood pressure) or
  • Hyponatremia (low sodium in the blood) or
  • Insomnia or
  • Interstitial lung disease, history of or
  • Mania, history of or
  • Seizures, history of or
  • Tachycardia (fast heart rate)—Use with caution. May make these conditions worse.
  • Kidney disease or
  • Liver disease—Use with caution. The effects may be increased because of slower removal of the medicine from the body.

Proper Use of This Medicine:

Take this medicine only as directed by your doctor to benefit your condition as much as possible. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered.

This medicine should come with a Medication Guide. It is very important that you read and understand this information. Be sure to ask your doctor about anything you do not understand.

You may have to take venlafaxine for several weeks before you begin to feel better.

Take this medicine with food either in the morning or evening at about the same time each day. If your doctor tells you to take the medicine a certain way, take it exactly as directed.

Swallow the extended-release capsule whole with fluid. Do not crush, chew, divide, or place the capsule in a liquid.

If you are unable to swallow the extended-release capsule, open it and pour the medicine on a spoonful of applesauce. Swallow the mixture of applesauce and medicine right away without chewing. Drink a glass of water so all of the medicine is swallowed.

Dosing—

The dose of this medicine 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 this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine 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 the medical problem for which you are using the medicine.

  • For oral dosage form (extended-release capsules):
    • For depression:
      • Adults—At first, 75 milligrams (mg) per day, taken as one dose in the morning or evening. Your doctor may adjust your dose as needed. However, the dose is usually not more than 225 mg per day.
      • Children—Use and dose must be determined by your doctor.
    • For generalized anxiety disorder:
      • Adults—At first, 75 milligrams (mg) per day, taken as one dose in the morning or evening. Your doctor may adjust your dose as needed. However, the dose is usually not more than 225 mg per day.
      • Children—Use and dose must be determined by your doctor.
    • For panic disorder
      • Adults—At first, 37.5 milligrams (mg) per day, taken as one dose in the morning or evening. Your doctor may adjust your dose as needed. However, the dose is usually not more than 225 mg per day.
      • Children—Use and dose must be determined by your doctor.
    • For social anxiety disorder:
      • Adults—75 milligrams (mg) per day, taken as one dose in the morning or evening.
      • Children—Use and dose must be determined by your doctor.
  • For oral dosage form (tablets):
    • For depression:
      • Adults—At first, a total of 75 milligrams (mg) per day, divided and taken 2 or 3 times during the day. Your doctor may adjust your dose as 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—

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage—

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

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.

Do not take venlafaxine with a monoamine oxidase (MAO) inhibitor (eg, isocarboxazid [Marplan®], phenelzine [Nardil®], selegiline [Eldepryl®], tranylcypromine [Parnate®]). Do not start taking venlafaxine during the 2 weeks after you stop a MAO inhibitor and wait 1 week after stopping venlafaxine before you start taking a MAO inhibitor. If you take them together or do not wait the proper amount of time, you may develop confusion, agitation, restlessness, stomach or intestinal symptoms, a sudden high body temperature, an extremely high blood pressure, or severe convulsions.

Venlafaxine may cause a serious condition called serotonin syndrome if taken together with some medicines. Do not use venlafaxine with buspirone (Buspar®), fentanyl (Abstral®, Duragesic®), linezolid (Zyvox®), lithium (Eskalith®, Lithobid®), methylene blue injection, tryptophan, St. John's wort, or some pain or migraine medicines (eg, rizatriptan, sumatriptan, tramadol, Frova®, Imitrex®, Maxalt®, Relpax®, Ultram®, Zomig®). Check with your doctor first before taking any other medicines with venlafaxine.

For some children, teenagers, and young adults, this medicine can increase thoughts of suicide. Tell your doctor right away if you start to feel more depressed and have thoughts about hurting yourself. Report any unusual thoughts or behaviors that trouble you, especially if they are new or get worse quickly. Make sure the doctor knows if you have trouble sleeping, get upset easily, have a big increase in energy, or start to act reckless. Also tell the doctor if you have sudden or strong feelings, such as feeling nervous, angry, restless, violent, or scared. Let the doctor know if you or anyone in your family has bipolar disorder (manic-depressive) or has tried to commit suicide.

Do not stop taking this medicine without checking with your doctor first. Your doctor may want you to gradually reduce the amount you are taking before stopping it completely. This is to decrease the chance of side effects, such as agitation, confusion, headache, irritability, numbness or tingling feeling, restlessness, trouble sleeping, or unusual drowsiness or weakness.

This medicine may cause hyponatremia (low sodium in the blood). This is more common in elderly patients, those who are taking diuretic medicines for high blood pressure, or those who have decreased amounts of fluid in the body due to severe diarrhea or vomiting. Check with your doctor right away if you have a headache, trouble concentrating, memory problems, confusion, weakness, or feel unsteady when standing.

Venlafaxine may increase your risk for bleeding problems. Make sure your doctor knows if you are also using other medicines that thin the blood, such as aspirin, NSAID pain or arthritis medicines (eg, diclofenac, ibuprofen, naproxen, Advil®, Aleve®, Celebrex®, Voltaren®), or warfarin (Coumadin®, Jantoven®).

Tell your doctor right away if you are having chest discomfort, a cough, or trouble breathing while being treated with this medicine. These might be symptoms of a serious lung problem.

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, allergies, or colds; sedatives, tranquilizers, or sleeping medicine; prescription pain medicine or narcotics; medicine for seizures or barbiturates; muscle relaxants; or anesthetics, including some dental anesthetics. Check with your doctor before taking any of these medicines while you are using venlafaxine.

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.

Before you have any medical tests, tell the medical doctor in charge that you are taking this medicine. The results of some tests may be affected by this medicine.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal (eg, St. John's wort) or vitamin supplements.

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 immediately if any of the following side effects occur:

More common
Changes in vision, such as blurred vision
headache
high blood pressure
Less common
Chest pain
fast or irregular heartbeat
mood or mental changes
ringing or buzzing in the ears
Rare
Convulsions (seizures)
itching or skin rash
lightheadedness or fainting, especially when getting up suddenly from a sitting or lying position
menstrual changes
problems in urinating or in holding urine
swelling
talking, feeling, and acting with excitement that you cannot control
trouble with breathing
Incidence not known
Abdominal or stomach pain
agitation
bleeding gums
blistering, peeling, or loosening of the skin
bloating of the abdomen
blood in the eye
bloody urine
bloody, black, or tarry stools
blue-green to black skin
chest pain or discomfort
confusion as to time, place, or person
cough or hoarseness
coughing up blood
dark urine
decreased awareness or responsiveness
decreased frequency or amount of urine
difficulty with swallowing
doing the opposite of what one is requested to do
dry cough
extra heartbeats
eye pain
fainting
fast, pounding, slow, or irregular heartbeat or pulse
fever with or without chills
general feeling of tiredness or weakness
hallucinations
hearing loss
high fever
hives
holding false beliefs that can not be changed by fact
hostility
increased menstrual flow or vaginal bleeding
increased thirst
indigestion
involuntary movements
irregular heartbeats
irritability
joint or muscle pain
lethargy
light-colored stools
lip smacking or puckering
loss of consciousness or coma
lower back or side pain
mimicry of speech or movements
muscle cramps or spasms
muscle pain or stiffness
muscle twitching
nosebleeds
overactive reflexes
pain, redness, or swelling in the arm or leg
painful or difficult urination
pains in the stomach, side, or abdomen, possibly radiating to the back
panic
paralysis
peculiar postures or movements, mannerisms, or grimacing
poor coordination
pounding or rapid pulse
prolonged bleeding from cuts
puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
puffing of the cheeks
rapid breathing
rapid or worm-like movements of the tongue
rapid weight gain
rash
red or dark brown urine
red skin lesions, often with a purple center
red, irritated eyes
redness in the whites of the eyes
restlessness
severe muscle stiffness
severe sleepiness
shivering
sore throat
sores, ulcers, or white spots in the mouth or on the lips
stupor
sweating
swelling of the face, lower legs, ankles, hands, or fingers
swollen or painful glands
tightness in the chest
tiredness
twitching, twisting, uncontrolled repetitive movements of the tongue, lips, face, arms, or legs
unable or unwilling to speak
uncontrolled chewing movements
uncontrolled movements of the arms and legs
unexplained bleeding or bruising
unpleasant breath odor
unusual excitement, nervousness, or restlessness
unusually pale skin
vomiting of blood or material that looks like coffee grounds
weight gain
yellow eyes or skin

Some 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. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common
Abnormal dreams
chills
constipation
decrease in sexual desire or ability
diarrhea
drowsiness
dry mouth
heartburn
increased sweating
loss of appetite
nausea
stomach pain or gas
stuffy or runny nose
tingling, burning, or prickly sensations
trembling or shaking
trouble sleeping
unusual tiredness or weakness
vomiting
weight loss
Less common
Change in taste
muscle tension
yawning
Incidence not known
Night sweats

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.


Last Updated: 4/4/2014

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