Effexor XR Fact Sheet
Medication Name (brand):
Effexor XR
Medication Name (clinical):
venlafaxine
Manufacturer:
Wyeth; patent expires 2008. IR version available as generic.
Indications:
Major Depression
- Generalized Anxiety Disorder
- Social Anxiety Disorder
- Panic Disorder
Mechanism:
Serotonin and Norepinephrine Reuptake Inhibitor
Dosing:
XR formulation supplied in 37.5 mg, 75 mg, and 150 mg capsules; IR (immediate release) formulation supplied in 25 mg, 37.5 mg, 50 mg, 75 mg, and 100 mg tablets.
- "Magic dose" to aim for: 150 mg, which is the dose at which norepinephrine reuptake inhibition kicks in.
- Give patient two things: 1) "starter pack" (one week each of 37.5 mg and 75 mg) and 2) a prescription for 150 mg Q PM.
- Evening dosing works well for most patients, taking advantage of initial sedative effects.
- Geriatric patients tend to tolerate same dosing schedule as younger patients.
Side Effects:
Most common are nausea, dizziness, fatigue, sexual dysfunction.
- Treatment-emergent BP elevation is possible at higher doses, uncommon with doses below 300 mg.
- Black Box Warning: In clinical trials, SSRIs and SNRIs increased the risk of suicidality in children (from 2% to 4%). No actual suicides occurred in these trials.
- Pregnancy Risk Category C
Drug-drug Interactions:
Only significant interactions are that Wellbutrin and Benadryl can increase Effexor serum levels.
Pearls:
Effexor may be more effective than SSRIs in bringing about complete remission of depressive symptoms, though more recent studies are calling this into question.
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