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Venlafaxine is prescribed for the treatment of depression that is, a continuing depression that interferes with daily functioning. The symptoms usually include changes in appetite, sleep habits, and mind/body coordination, decreased sex drive, increased fatigue, feelings of guilt or worthlessness, difficulty concentrating, slowed thinking, and suicidal thoughts.

Venlafaxine XR is also prescribed to relieve abnormal anxiety (generalized anxiety disorder and social anxiety disorder). Generalized anxiety disorder is marked by persistent anxiety for a period of at least 6 months, accompanied by at least 3 of these 6 symptoms: restlessness, fatigue, poor concentration, irritability, muscle tension, and sleep disturbances.

Social anxiety disorder is marked by a persistent fear (avoidance, anxiousness, or distress) of social situations, exposure to unfamiliar people, or possible scrutiny by others. Social anxiety is considered abnormal if it causes someone to alter an otherwise normal routine or interferes with daily functioning. The disorder can also cause panic attacks.

Venlafaxine must be taken 2 or 3 times daily. The extended-release form, Venlafaxine XR, permits once-a-day dosing.

Brand name: Effexor

Generic name: Venlafaxine

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Most important fact about Venlafaxine

Serious, sometimes fatal reactions have occurred when Venlafaxine is used in combination with other drugs known as MAO inhibitors, including the antidepressants Nardil and Parnate. Never take Venlafaxine with one of these drugs; and do not begin therapy with Venlafaxine within 14 days of discontinuing treatment with one of them. Also, allow at least 7 days between the last dose of Venlafaxine and the first dose of an MAO inhibitor.

How should you take Venlafaxine ?

Take Venlafaxine with food, exactly as prescribed. It may take several weeks before you begin to feel better. Your doctor should check your progress periodically.

Take Venlafaxine XR once at the same time each day. Swallow the capsule whole with water. Do not divide, crush, or chew it. However, if you have trouble swallowing pills, you may take Venlafaxine XR by carefully opening the capsule and sprinkling the entire contents on a spoonful of applesauce, followed by a glass of water.

If you miss a dose of Venlafaxine

It is not necessary to make it up. Skip the missed dose and continue with your next scheduled dose. Do not take 2 doses at once.

Storage instructions for Venlafaxine

Store in a tightly closed container at room temperature. Protect from excessive heat and moisture.

What side effects may occur when taking Venlafaxine ?

Side effects of Venlafaxine cannot be anticipated. If any develop or change in intensity, tell your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking Venlafaxine.

Side effects of Venlafaxine may include:

Abnormal ejaculation/orgasm, anxiety, blurred vision, constipation, dizziness, dry mouth, impotence, insomnia, nausea, nervousness, sleepiness, sweating, tremor, vomiting, weakness, weight loss

Side effects of Venlafaxine XR may include:

Abnormal dreams, abnormal ejaculation, constipation, dizziness, dry mouth, headache, insomnia, nausea, nervousness, sleepiness, sweating, weakness, weight loss

Why should Venlafaxine not be prescribed ?

Never take Venlafaxine while taking other drugs known as MAO inhibitors. (See "Most important fact about this drug.") Also avoid this drug if it has ever given you an allergic reaction.

Special warnings about Venlafaxine

In clinical studies, antidepressants increased the risk of suicidal thinking and behavior in children and adolescents with depression and other psychiatric disorders. Anyone considering the use of Venlafaxine or any other antidepressant in a child or adolescent must balance this risk with the clinical need. Venlafaxine has not been studied in children or adolescents and is not approved for treating anyone less than 18 years old.

Additionally, the progression of major depression is associated with a worsening of symptoms and/or the emergence of suicidal thinking or behavior in both adults and children, whether or not they are taking antidepressants. Individuals being treated with Venlafaxine and their caregivers should watch for any change in symptoms or any new symptoms that appear suddenly especially agitation, anxiety, hostility, panic, restlessness, extreme hyperactivity, and suicidal thinking or behavior and report them to the doctor immediately. Be especially observant at the beginning of treatment or whenever there is a change in dose.

Your doctor will prescribe Venlafaxine with caution if you have high blood pressure, heart, liver, or kidney disease or a history of seizures or mania (extreme agitation or excitability). You should discuss all of your medical problems with your doctor before taking Venlafaxine.

Venlafaxine sometimes causes an increase in blood pressure. If this happens, your doctor may need to reduce your dose or discontinue Venlafaxine.

Venlafaxine also tends to increase the heart rate, especially at higher doses. Use Venlafaxine with caution if you've recently had a heart attack, suffer from heart failure, or have an overactive thyroid gland.

Venlafaxine may also cause cholesterol levels to rise in some patients who take it for 3 months or longer. This effect is more common among patients taking higher doses of Venlafaxine.

Antidepressants such as Venlafaxine may cause fluid retention, especially if you are an older adult.

Venlafaxine may cause you to feel drowsy or less alert and may affect your judgment. Therefore, avoid driving or operating dangerous machinery or participating in any hazardous activity that requires full mental alertness until you know how this drug affects you.

Your doctor will check you regularly if you have glaucoma (high pressure in the eye), or you are at risk of developing it.

If you have ever been addicted to drugs, tell your doctor before you start taking Venlafaxine.

If you develop a skin rash or hives while taking Venlafaxine, notify your doctor. Venlafaxine may also cause bleeding or bruising of the skin.

Do not stop taking Venlafaxine without consulting your doctor. If you stop suddenly, you may have withdrawal symptoms, even though Venlafaxine does not seem to be habit-forming. Your doctor will have you taper off gradually.

Possible food and drug interactions when taking Venlafaxine

Combining Venlafaxine with MAO inhibitors could cause a fatal reaction. (See "Most important fact about this drug.")

Although Venlafaxine does not interact with alcohol, the manufacturer recommends avoiding alcohol while taking Venlafaxine.

If you have high blood pressure or liver disease, or are elderly, check with your doctor before combining Venlafaxine with cimetidine (Tagamet).

You should consult your doctor before combining Venlafaxine with other drugs that affect the central nervous system, including lithium, migraine medications such as Imitrex, narcotic painkillers, sleep aids, weight-loss products such as phentermine, tranquilizers, antipsychotic medicines such as Haldol, and other antidepressants such as Celexa, Prozac, Tofranil, and Zoloft.

Venlafaxine has been found to reduce blood levels of the HIV drug Crixivan. It's best to check with your doctor before combining Venlafaxine with any other drug or herbal product.

Special information on Venlafaxine if you are pregnant or breastfeeding

The effects of Venlafaxine during pregnancy have not been adequately studied. If you are pregnant or are planning to become pregnant, tell your doctor immediately. Venlafaxine should be used during pregnancy only if clearly needed.

If Venlafaxine is taken shortly before delivery, the baby may suffer withdrawal symptoms. It's also known that Venlafaxine appears in breast milk and could cause serious side effects in a nursing infant. You'll need to choose between nursing your baby or continuing your treatment with Venlafaxine.

Recommended dosage of Venlafaxine

Venlafaxine

The usual starting dose is 75 milligrams a day, divided into 2 or 3 smaller doses, and taken with food. If needed, your doctor may gradually increase your daily dose in steps of no more than 75 milligrams at a time up to a maximum of 375 milligrams per day.

If you have kidney or liver disease or are taking other medications, your doctor will adjust your dosage accordingly.

Venlafaxine XR

For both depression and anxiety, the usual starting dose is 75 milligrams once daily taken with food, although some people begin with a dose of 37.5 milligrams for the first 4 to 7 days. Your doctor may gradually increase the dose, in steps of no more than 75 milligrams, up to a maximum of 225 milligrams daily. As with regular Venlafaxine, the doctor will make adjustments in your dosage if you have kidney or liver disease.

Overdosage with Venlafaxine

An overdose of Venlafaxine, combined with other drugs or alcohol, can be fatal.

If you suspect an overdose of Venlafaxine, seek medical attention immediately.

Symptoms of Venlafaxine overdose include:

Sleepiness, vertigo, rapid or slow heartbeat, low blood pressure, seizures, coma

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