venlafaxine

Adjunctive therapy

Brands: Effexor XR

Last reviewed 2025-10-05

Reviewed by PsychMed Editorial Team.

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Quick answers

What is venlafaxine?
Venlafaxine (Effexor XR) is an SNRI with dose-dependent norepinephrine activity, commonly selected for comorbid anxiety or pain syndromes in serious mental illness.
What is Effexor XR?
Effexor XR is a brand name for venlafaxine.
What is Effexor XR (venlafaxine) used for?
Label indications include: Major depressive disorder; generalized anxiety disorder; social anxiety disorder; panic disorder.
What drug class is Effexor XR (venlafaxine)?
Serotonin-norepinephrine reuptake inhibitor (SNRI).
What strengths does Effexor XR (venlafaxine) come in?
Extended-release capsules 37.5 mg, 75 mg, 150 mg; ER tablets 37.5–225 mg; legacy IR tablets 25–100 mg.

Snapshot

Class: Adjunctive therapy
Common US brands: Effexor XR
Therapeutic drug monitoring not routinely recommended.
Last reviewed: 2025-10-05

Label indications

Major depressive disorder; generalized anxiety disorder; social anxiety disorder; panic disorder.

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Clinical Highlights

Venlafaxine (Effexor XR) is an SNRI with dose-dependent norepinephrine activity, commonly selected for comorbid anxiety or pain syndromes in serious mental illness. Lower doses behave more like an SSRI, while higher doses add more noradrenergic effects—monitor blood pressure and activation as doses rise.

Extended-release formulations dominate due to once-daily dosing and improved tolerability compared with immediate-release tablets.
Monitor blood pressure and withdrawal risk; counsel on adherence and gradual tapering to avoid discontinuation syndrome.
The compare view and the venlafaxine evidence feed can support a quick look at blood pressure, discontinuation, and sexual side effects relative to other SNRIs when reassessing treatment-resistant depression plans.
Symptom improvement is usually gradual: early side effects (nausea, sleep changes, sweating) may occur in the first days, while mood and anxiety benefits often take several weeks at a therapeutic dose.
Because discontinuation symptoms can be severe, missed doses matter; refill planning and predictable tapers are often higher value than frequent dose “stop-start” changes.
Major depressive disorder (FDA 1993)
Generalized anxiety disorder (FDA 1999)
Social anxiety disorder (FDA 2003)

Dosing & Formulations

Extended-release capsules 37.5 mg, 75 mg, 150 mg; ER tablets 37.5–225 mg; legacy IR tablets 25–100 mg. 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).

Reduce total daily dose 25–50% in renal or hepatic impairment.
Taper gradually over several weeks to prevent discontinuation symptoms.

Monitoring & Risks

Boxed warning: Antidepressants increase suicidality risk in children, adolescents, and young adults; monitor closely. Nausea: Most common early effect; taking with food or at bedtime may help.

Insomnia or somnolence: Mixed activating/sedating profile—adjust dosing time accordingly.
Sweating: Often dose-related; monitor at higher doses.
Blood pressure elevation: Check BP at baseline and after titrations, especially ≥225 mg/day.
Sexual dysfunction: Discuss proactively to support adherence.
Hyponatremia can occur, especially in older adults or diuretic users; check sodium when confusion, fatigue, or falls emerge.

Drug Interactions

CYP2D6/3A4 substrates—strong inhibitors (fluoxetine, paroxetine, ritonavir) can raise concentrations; monitor for hypertension or adverse effects. Contraindicated with MAOIs; observe 7-day washout before starting an MAOI.

Additive bleeding risk with NSAIDs, antiplatelets, anticoagulants.

Practice Notes

Encourage once-daily dosing with food to reduce GI upset. Consider desvenlafaxine if CYP2D6 interactions limit dosing.

Screen for bipolar spectrum symptoms—venlafaxine can precipitate mania/hypomania; coordinate care with the bipolar disorder hub when mood elevation emerges.
If discontinuation symptoms occur during tapering, slower reductions over longer intervals are often better tolerated than larger dose drops.

References

Venlafaxine Hydrochloride Extended Release Capsules Prescribing Information — DailyMed (2024)
CANMAT 2024 Clinical Guidelines for Major Depressive Disorder — Canadian Journal of Psychiatry (2024)
Comparative efficacy and acceptability of 21 antidepressant drugs for major depressive disorder — The Lancet (2018)Meta-analysisdepressionefficacy