Venlafaxine (Oral route)

Pronunciation:

ven-la-FAX-een

Brand Names:

Effexor
Effexor-XR

Dosage Forms:

Tablet, Extended Release
Tablet
Capsule, Extended Release

Warnings:

Oral route(Capsule, Extended Release)

Antidepressants increased the risk of suicidal thoughts and behavior in pediatric and young adult patients in short-term studies. Closely monitor all antidepressant-treated patients for clinical worsening, and emergence of suicidal thoughts and behaviors. Venlafaxine hydrochloride is not approved for use in pediatric patients .

Oral route(Tablet;Tablet, Extended Release)

Antidepressants increased the risk compared to placebo of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults in short-term studies of Major Depressive Disorder (MDD) and other psychiatric disorders. Anyone considering the use of venlafaxine hydrochloride or any other antidepressant in a child, adolescent, or young adult must balance this risk with the clinical need. Short-term studies did not show an increase in the risk of suicidality with antidepressants compared to placebo in adults beyond age 24; there was a reduction in risk with antidepressants compared to placebo in adults aged 65 and older. Depression and certain other psychiatric disorders are themselves associated with increases in the risk of suicide. Patients of all ages who are started on antidepressant therapy should be monitored appropriately and observed 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. Venlafaxine is 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, social anxiety disorder, 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 a chemical called serotonin in the brain.

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

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 might be more sensitive to the effects of this medicine which may cause hyponatremia (low levels of sodium in the blood), or age-related liver or kidney problems, which may require caution and an adjustment in the dose for patients taking venlafaxine.

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.

Bepridil
Bromopride
Cisapride
Dronedarone
Furazolidone
Iproniazid
Isocarboxazid
Levoketoconazole
Linezolid
Mesoridazine
Methylene Blue
Metoclopramide
Ozanimod
Phenelzine
Pimozide
Piperaquine
Procarbazine
Rasagiline
Safinamide
Saquinavir
Selegiline
Sparfloxacin
Terfenadine
Thioridazine
Tranylcypromine
Trifluoperazine
Ziprasidone

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.

Abciximab
Abiraterone Acetate
Aceclofenac
Acemetacin
Acenocoumarol
Adagrasib
Alfentanil
Alfuzosin
Almotriptan
Amineptine
Amiodarone
Amisulpride
Amitriptyline
Amitriptylinoxide
Amoxapine
Amoxicillin
Amphetamine
Amprenavir
Amtolmetin Guacil
Anagrelide
Anileridine
Apixaban
Apomorphine
Aprepitant
Ardeparin
Argatroban
Aripiprazole
Aripiprazole Lauroxil
Arsenic Trioxide
Asenapine
Aspirin
Astemizole
Atazanavir
Atomoxetine
Azithromycin
Bedaquiline
Bemiparin
Benzhydrocodone
Benzphetamine
Betrixaban
Bivalirudin
Boceprevir
Bromfenac
Brompheniramine
Bufexamac
Buprenorphine
Bupropion
Buserelin
Buspirone
Butorphanol
Cangrelor
Carbamazepine
Carvedilol
Celecoxib
Ceritinib
Certoparin
Chloroquine
Chlorpheniramine
Chlorpromazine
Choline Salicylate
Cilostazol
Cimetidine
Ciprofloxacin
Citalopram
Clarithromycin
Clofazimine
Clomipramine
Clonixin
Clopidogrel
Clothiapine
Clozapine
Cobicistat
Cocaine
Codeine
Conivaptan
Crizotinib
Cyclobenzaprine
Cyclosporine
Dabigatran Etexilate
Dabrafenib
Dalteparin
Danaparoid
Darunavir
Dasatinib
Degarelix
Delamanid
Delavirdine
Desipramine
Desirudin
Deslorelin
Desvenlafaxine
Deutetrabenazine
Dexfenfluramine
Dexibuprofen
Dexketoprofen
Dexmedetomidine
Dextroamphetamine
Dextromethorphan
Dibenzepin
Diclofenac
Diethylpropion
Difenoxin
Diflunisal
Dihydrocodeine
Diltiazem
Diphenoxylate
Dipyridamole
Dipyrone
Disopyramide
Dofetilide
Dolasetron
Domperidone
Donepezil
Doxepin
Doxorubicin
Doxorubicin Hydrochloride Liposome
Droperidol
Droxicam
Duloxetine
Duvelisib
Ebastine
Edoxaban
Efavirenz
Eletriptan
Eliglustat
Encainide
Encorafenib
Enoxaparin
Entacapone
Entrectinib
Epoprostenol
Eptifibatide
Eribulin
Erythromycin
Escitalopram
Ethylmorphine
Etodolac
Etofenamate
Etoricoxib
Etrasimod
Famotidine
Fedratinib
Felbamate
Felbinac
Fenfluramine
Fenoprofen
Fentanyl
Fepradinol
Feprazone
Fexinidazole
Fingolimod
Flecainide
Floctafenine
Fluconazole
Flufenamic Acid
Fluoxetine
Flurbiprofen
Fluvoxamine
Fondaparinux
Formoterol
Fosamprenavir
Fosaprepitant
Foscarnet
Fosnetupitant
Fosphenytoin
Fostemsavir
Frovatriptan
Galantamine
Gatifloxacin
Gemifloxacin
Gepirone
Givosiran
Glasdegib
Gonadorelin
Goserelin
Granisetron
Halofantrine
Haloperidol
Heparin
Histrelin
Hydrocodone
Hydromorphone
Hydroquinidine
Hydroxyamphetamine
Hydroxychloroquine
Hydroxytryptophan
Hydroxyzine
Ibuprofen
Ibutilide
Idelalisib
Iloperidone
Iloprost
Imatinib
Imipramine
Indinavir
Indomethacin
Inotuzumab Ozogamicin
Iobenguane I 123
Iobenguane I 131
Itraconazole
Ivabradine
Ivacaftor
Ivosidenib
Josamycin
Jujube
Ketobemidone
Ketoconazole
Ketoprofen
Ketorolac
Lapatinib
Larotrectinib
Lasmiditan
Lefamulin
Lenvatinib
Lepirudin
Letermovir
Leuprolide
Levofloxacin
Levomilnacipran
Levorphanol
Lisdexamfetamine
Lithium
Lofepramine
Lofexidine
Lomitapide
Lonafarnib
Lopinavir
Lorcaserin
Lornoxicam
Loxoprofen
Lumefantrine
Lumiracoxib
Macimorelin
Meclofenamate
Mefenamic Acid
Mefloquine
Melitracen
Meloxicam
Meperidine
Metaxalone
Methadone
Methamphetamine
Methotrexate
Methotrimeprazine
Methoxyphenamine
Metoprolol
Metronidazole
Mexiletine
Mibefradil
Mifepristone
Milnacipran
Mirtazapine
Mizolastine
Mobocertinib
Moricizine
Morniflumate
Morphine
Morphine Sulfate Liposome
Moxifloxacin
Nabumetone
Nadroparin
Nafarelin
Nalbuphine
Naltrexone
Naproxen
Naratriptan
Nebivolol
Nefazodone
Nelfinavir
Nepafenac
Netupitant
Nicergoline
Nicomorphine
Niflumic Acid
Nilotinib
Nimesulide
Nimesulide Beta Cyclodextrin
Norfloxacin
Nortriptyline
Octreotide
Ofloxacin
Olanzapine
Oliceridine
Ondansetron
Opipramol
Opium
Opium Alkaloids
Orlistat
Osilodrostat
Osimertinib
Oxaliplatin
Oxaprozin
Oxycodone
Oxymorphone
Oxyphenbutazone
Pacritinib
Palbociclib
Paliperidone
Palonosetron
Panobinostat
Papaveretum
Papaverine
Parecoxib
Paregoric
Parnaparin
Paroxetine
Pasireotide
Pazopanib
Pentamidine
Pentazocine
Perphenazine
Phendimetrazine
Phenindione
Phenobarbital
Phenprocoumon
Phentermine
Phenylbutazone
Piketoprofen
Pimavanserin
Pipamperone
Piritramide
Piroxicam
Pitolisant
Ponesimod
Posaconazole
Prajmaline
Pranoprofen
Prasugrel
Primidone
Probucol
Procainamide
Prochlorperazine
Proglumetacin
Promethazine
Propafenone
Propranolol
Propyphenazone
Proquazone
Protein C
Protriptyline
Quetiapine
Quinidine
Quinine
Quizartinib
Ranitidine
Ranolazine
Relugolix
Remifentanil
Reviparin
Ribociclib
Risperidone
Ritonavir
Rivaroxaban
Rizatriptan
Rofecoxib
Salicylic Acid
Salsalate
Schisandra sphenanthera
Selexipag
Selpercatinib
Sertindole
Sertraline
Setmelanotide
Sevoflurane
Sibutramine
Siponimod
Sodium Phosphate
Sodium Phosphate, Dibasic
Sodium Phosphate, Monobasic
Sodium Salicylate
Solifenacin
Sorafenib
Sotalol
Sufentanil
Sulfinpyrazone
Sulindac
Sulodexide
Sulpiride
Sultopride
Sumatriptan
Sunitinib
Tacrolimus
Tamoxifen
Tamsulosin
Tapentadol
Telaprevir
Telavancin
Telithromycin
Tenoxicam
Tetrabenazine
Tianeptine
Tiaprofenic Acid
Ticagrelor
Ticlopidine
Tilidine
Timolol
Tinzaparin
Tirofiban
Tolfenamic Acid
Tolmetin
Tolperisone
Tolterodine
Topiramate
Toremifene
Tramadol
Trazodone
Treosulfan
Treprostinil
Triclabendazole
Trimipramine
Triptorelin
Troleandomycin
Tropisetron
Tryptophan
Tucatinib
Valdecoxib
Vandetanib
Vardenafil
Vemurafenib
Verapamil
Vernakalant
Vilanterol
Vilazodone
Vinflunine
Voclosporin
Vorapaxar
Voriconazole
Vorinostat
Vortioxetine
Voxelotor
Warfarin
Yohimbine
Zolmitriptan
Zotepine
Zuclopenthixol

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
St John's Wort

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.

Using this medicine with any of the following is usually not recommended, but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use this medicine, or give you special instructions about the use of food, alcohol, or tobacco.

Ethanol
Grapefruit Juice

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, angle-closure or
Heart attack, recent or history of or
Hypercholesterolemia (high cholesterol in the blood) or
Hypertension (high blood pressure) or
Hyponatremia (low sodium in the blood) or
Interstitial lung disease, history of or
Mania, history of or
Seizures, history of or
Stroke, 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. Follow the instructions carefully. Ask your doctor if you have any questions.

Take the extended-release capsule or tablet 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 forms (extended-release capsules, extended-release tablets):
- For depression:
  - Adults—At first, 75 milligrams (mg) per day, taken as one dose in the morning or evening. Some patients may need a starting dose of 37.5 mg per day, taken for 4 to 7 days. Your doctor may adjust your dose as needed and tolerated. 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. Some patients may need a starting dose of 37.5 mg per day, taken for 4 to 7 days. Your doctor may adjust your dose as needed and tolerated. 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 for 7 days, taken as one dose in the morning or evening. Your doctor may adjust your dose as needed and tolerated. 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:

If you will be taking this medicine for a long time, it is very important that your doctor check you at regular visits. This will allow your doctor to see if the medicine is working properly and to decide if you should continue to take it.

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 14 days after you stop a MAO inhibitor and wait 7 days 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 seizures.

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

This medicine may cause some teenagers and young adults to be agitated, irritable, or display other abnormal behaviors. It may also cause some people to have suicidal thoughts and tendencies or to become more depressed. Some people may have trouble sleeping, get upset easily, have a big increase in energy, or start to act reckless. If you or your caregiver notice any of these unwanted effects, tell your doctor right away. Let the doctor know if you or anyone in your family has bipolar disorder (manic-depressive) or has tried to commit suicide.

Do not suddenly stop taking this medicine without checking first with your doctor. Your doctor may want you to gradually reduce the amount you are taking before stopping it completely. This will decrease the chance of side effects, including agitation, anxiety, blurred vision, confusion, diarrhea, dizziness, fast or irregular heartbeat, headache, irritability, nausea or vomiting, numbness or tingling feeling, restlessness, seizures, sweating, thoughts of hurting yourself or others, trouble sleeping, unusual dreams, or unusual drowsiness, tiredness, or weakness.

This medicine may cause hyponatremia (low sodium in the blood). This is more common in elderly patients, those who take diuretic medicines, or those who have a low amount 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, including NSAIDs (eg, aspirin, diclofenac, ibuprofen, naproxen, Advil®, Aleve®, Celebrex®, Voltaren®) or warfarin (Coumadin®, Jantoven®).

Tell your doctor right away if you are having chest pain or discomfort, dry cough, fever, general feeling of tiredness or weakness, skin rash, or trouble breathing with this medicine. These might be symptoms of a serious lung problem, including interstitial lung disease and eosinophilic pneumonia.

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. It is best to avoid alcohol with venlafaxine.

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.

Check with your doctor right away if you have decreased interest in sexual intercourse, delayed or inability to have and orgasm in women, inability to have or keep an erection in men, or loss in sexual ability, desire, drive, or performance. These could be symptoms of sexual dysfunction.

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 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: Change or problem with discharge of semen; decreased interest in sexual intercourse; inability to have or keep an erection; lack or loss of strength; loss in sexual ability, desire, drive, or performance; severe headache; sweating

Less common: Blurred vision; chest pain; delayed or inability to have an orgasm; fast or irregular heartbeat; mood or mental changes; ringing or buzzing in the ears; suicidal thoughts

Rare: Actions that are out of control; high fever; irritability; itching or skin rash; lightheadedness or fainting, especially when getting up suddenly from a sitting or lying position; menstrual changes; nervousness; problems with urinating or holding urine; seizures; severe muscle stiffness; talking, feeling, and acting with excitement that you cannot control; trouble breathing; unusually pale skin

Incidence not known: Agitation; bloody, black, or tarry stools; bloody stool or urine; dark urine; decreased frequency or amount of urine; diarrhea; drowsiness; fever; general feeling of tiredness or weakness; headache; increased thirst; light-colored stools; muscle cramps, spasms, or pain; nausea or vomiting; nosebleeds; overactive reflexes; poor coordination; red or purple spots on the skin; restlessness; shivering; stomach pain on the upper right side; swelling of the face, lower legs, ankles, hands, or fingers; trembling or shaking that is hard to control; twitching; unusual bruising; unusual tiredness or weakness; vomiting of blood or material that looks like coffee grounds; 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; dry mouth; heartburn; increased sweating; loss of appetite; nausea; stomach pain or gas; stuffy or runny nose; tingling, burning, or prickly sensations; trouble sleeping; vomiting; weight loss

Less common: Change in taste; muscle tension; yawning

Incidence not known: Decrease in smell; loss of sense of smell; 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: 4/24/2024

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