venlafaxine

Adjunctive therapy • Brands: Effexor XR

Last reviewed: 2025-10-05

General information

Class: Adjunctive therapy
Common US brands: Effexor XR
Typical dose range: Initiate XR 37.5 mg once daily with food for 4–7 days, then 75 mg/day; increase by 75 mg increments at ≥7-day intervals up to 225 mg/day (300 mg off-label).
Therapeutic drug monitoring not routinely recommended.
Last reviewed: 2025-10-05

Dosing & forms

Forms/strengths: Extended-release capsules 37.5 mg, 75 mg, 150 mg; ER tablets 37.5–225 mg; legacy IR tablets 25–100 mg.
Frequency: Initiate XR 37.5 mg once daily with food for 4–7 days, then 75 mg/day; increase by 75 mg increments at ≥7-day intervals up to 225 mg/day (300 mg off-label).
Food: Take with food.
Typical range: Initiate XR 37.5 mg once daily with food for 4–7 days, then 75 mg/day; increase by 75 mg increments at ≥7-day intervals up to 225 mg/day (300 mg off-label).

Mechanism (brief)

Serotonin-norepinephrine reuptake inhibitor (SNRI).

Metabolism & Half‑life

Metabolism: CYP2D6, CYP3A4 (minor), UGT
Half‑life: Single-dose mean 5 h; Single-dose range 4–6 h; Steady-state mean 11 h; Steady-state range 9–13 h

Therapeutic Drug Monitoring (TDM)

Recommended: No

View labelExact

Monitoring highlights

Blood pressure and heart rate at baseline and after titration, with extra attention at higher doses.
Discontinuation symptoms during missed doses or tapering; plan refill timing and taper steps proactively.
Sodium in older adults or diuretic users if symptoms suggest hyponatremia (confusion, fatigue, falls).
Mood elevation or agitation in bipolar-spectrum illness; coordinate prevention plans via the bipolar disorder hub.
Medication reconciliation to avoid serotonergic combinations and to plan MAOI washouts when regimens change.

Sources

Venlafaxine hydrochloride extended-release capsules prescribing information — DailyMed (2024)
CANMAT 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder — Canadian Journal of Psychiatry (2016)
Comparative efficacy and acceptability of 21 antidepressant drugs for major depressive disorder — The Lancet (2018)
Bupropion-SR, sertraline, or venlafaxine-XR after failure of SSRIs for depression — The New England Journal of Medicine (2006)

General information

Class: Adjunctive therapy

Common US brands: Effexor XR

Typical dose range: Initiate XR 37.5 mg once daily with food for 4–7 days, then 75 mg/day; increase by 75 mg increments at ≥7-day intervals up to 225 mg/day (300 mg off-label).

Therapeutic drug monitoring not routinely recommended.

Last reviewed: 2025-10-05

Dosing & forms

Forms/strengths: Extended-release capsules 37.5 mg, 75 mg, 150 mg; ER tablets 37.5–225 mg; legacy IR tablets 25–100 mg.

Frequency: Initiate XR 37.5 mg once daily with food for 4–7 days, then 75 mg/day; increase by 75 mg increments at ≥7-day intervals up to 225 mg/day (300 mg off-label).

Food: Take with food.

Typical range: Initiate XR 37.5 mg once daily with food for 4–7 days, then 75 mg/day; increase by 75 mg increments at ≥7-day intervals up to 225 mg/day (300 mg off-label).

Monitoring highlights

Blood pressure and heart rate at baseline and after titration, with extra attention at higher doses.

Discontinuation symptoms during missed doses or tapering; plan refill timing and taper steps proactively.

Sodium in older adults or diuretic users if symptoms suggest hyponatremia (confusion, fatigue, falls).

Mood elevation or agitation in bipolar-spectrum illness; coordinate prevention plans via the bipolar disorder hub.

Medication reconciliation to avoid serotonergic combinations and to plan MAOI washouts when regimens change.