Medical term:

Effexor


venlafaxine hydrochloride

Co Venlafaxine, Co Venlafaxine XR, Efexor (UK), Effexor, Effexor XR, Gen-Venlafaxine XR, Novo-Venlafaxine XR, PMS-Venlafaxine XR, Ratio-Venlafaxine XR, Riva-Venlafaxine XR, Sandoz Venlafaxine XR

Pharmacologic class: Phenethylamine derivative

Therapeutic class: Antidepressant, anxiolytic

Pregnancy risk category C

Action

Inhibits neuronal serotonin and norepinephrine reuptake and slightly inhibits dopamine reuptake

Availability

Capsules (extended-release): 37.5 mg, 75 mg, 150 mg

Tablets: 25 mg, 37.5 mg, 50 mg, 75 mg, 100 mg

Tablets (extended-release): 37.5 mg, 75 mg, 150 mg, 225 mg

Indications and dosages

➣ Depression

Adults: In outpatients, 75 mg P.O. daily in two or three divided doses; may increase in increments of 75 mg/day q 4 or more days to a maximum of 225 mg/day; extended-release form can be given as a single daily dose. In hospitalized patients, 75 mg P.O. daily in two or three divided doses; may increase in increments of 75 mg/day q 4 days to a maximum of 375 mg/day given in three divided doses.

➣ Generalized anxiety disorder

Adults: Single dose of 37.5 to 75 mg (extended-release) P.O. daily; may increase in increments of 75 mg/day q 4 days to a maximum of 225 mg/day

➣ Panic disorder

Adults: 37.5 mg (extended-release) P.O. daily for 7 days; increase to 75 mg P.O. daily for 7 days; then increase by 75 mg daily at weekly intervals to a maximum of 225 mg P.O. daily

➣ Social anxiety disorder

Adults: 75 mg (extended-release capsule) P.O. daily as a single dose

Dosage adjustment

• Hepatic or renal impairment

Off-label uses

• Premenstrual dysphoric disorder

Contraindications

• Hypersensitivity to drug

• MAO inhibitor use within past 14 days

Precautions

Use cautiously in:

• cardiovascular disease; hypertension; heart failure, recent myocardial infarction, and other conditions in which increased heart rate poses a danger; hepatic or renal impairment; glaucoma; hyperthyroidism; hyponatremia; syndrome of inappropriate antidiuretic hormone secretion (SIADH)

• history of seizures, neurologic impairment, or drug abuse

• pregnant or breastfeeding patients

• children younger than age 18.

Administration

Don't give within 14 days of MAO inhibitors.

Adverse reactions

CNS: abnormal dreams, anxiety, dizziness, headache, insomnia, nervousness, abnormal thinking, agitation, confusion, depersonalization, drowsiness, emotional lability, worsening depression, twitching, tremor, asthenia, paresthesia, mania, hypomania, suicidal ideation or behavior (especially in child or adolescent)

CV: chest pain, hypertension, palpitations, tachycardia, vasodilation

EENT: visual disturbances, blurred vision, mydriasis, tinnitus, rhinitis

GI: nausea, vomiting, diarrhea, constipation, abdominal pain, dyspepsia, flatulence, dry mouth, anorexia

GU: urinary frequency or retention, sexual dysfunction, abnormal ejaculation, anorgasmia, erectile dysfunction

Metabolic: hyponatremia, SIADH

Skin: bruising, pruritus, rash, diaphoresis, photosensitivity

Other: altered taste, weight loss, chills, yawning

Interactions

Drug-drug. Cimetidine: increased venlafaxine effects

MAO inhibitors: potentially fatal reactions

Sumatriptan, trazodone: serotonin syndrome (including altered level of consciousness)

Drug-diagnostic tests. Sodium: decreased level

Drug-herbs. Chamomile, hops, kava, skullcap, valerian: increased CNS depression

S-adenosylmethionine (SAM-e), St. John's wort: increased risk of sedative or hypnotic effects

Patient monitoring

Monitor neurologic status, particularly for seizures, worsening depression, and suicidal ideation.

• Closely monitor vital signs and cardiovascular status. Stay alert for hypertension and tachycardia.

• Monitor nutritional status, hydration, and weight.

Patient teaching

• Tell patient taking extended-release capsules to swallow them whole without chewing, breaking, dividing, or dissolving.

Caution patient not to stop therapy abruptly.

Advise patient to promptly report seizures, worsening depression, or suicidal thoughts (especially in child or adolescent).

• Caution patient to avoid driving and other dangerous activities until drug effects are known.

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and herbs mentioned above.

McGraw-Hill Nurse's Drug Handbook, 7th Ed. Copyright © 2013 by The McGraw-Hill Companies, Inc. All rights reserved

venlafaxine

(ven-la-fax-een) ,

Effexor

(trade name),

Effexor XR

(trade name)

Classification

Therapeutic: antidepressants
Pharmacologic: selective serotonin norepinephrine reuptake inhibitors
Pregnancy Category: C

Indications

Major depressive disorder.Generalized anxiety disorder (Effexor XR only).Social anxiety disorder (Effexor XR only).Panic disorder (Effexor XR only).Premenstrual dysphoric disorder.

Action

Inhibits serotonin and norepinephrine reuptake in the CNS.

Therapeutic effects

Decrease in depressive symptomatology, with fewer relapses/recurrences.
Decreased anxiety.Decrease in panic attacks.

Pharmacokinetics

Absorption: 92–100% absorbed after oral administration.
Distribution: Extensive distribution into body tissues.
Metabolism and Excretion: Extensively metabolized on first pass through the liver (primarily through CYP2D6 enzyme pathway). genetic implication A small percentage of the population are poor metabolizers and will have higher blood levels with ↑ effects. One metabolite, O-desmethylvenlafaxine (ODV), has antidepressant activity; 5% of venlafaxine is excreted unchanged in urine; 30% of the active metabolite is excreted in urine.
Half-life: Venlafaxine—3–5 hr; ODV—9–11 hr (both are ↑ in hepatic/renal impairment).

Time/action profile (antidepressant action)

ROUTEONSETPEAKDURATION
POwithin 2 wk2–4 wkunknown

Contraindications/Precautions

Contraindicated in: Hypersensitivity;Concurrent use of MAO inhibitors or MAO-like drugs (linezolid or methylene blue);
Use Cautiously in: Cardiovascular disease, including hypertension;Hepatic impairment (↓ dose recommended);Impaired renal function (↓ dose recommended);History of seizures or neurologic impairment;History of mania;History of ↑ intraocular pressure or angle-closure glaucoma;History of drug abuse; Obstetric: Use only if clearly required, weighing benefit to mother versus potential harm to fetus (potential for discontinuation syndrome or toxicity in the neonate when venlafaxine is taken during the 3rd trimester); Lactation: Potential for serious adverse reactions in infant; discontinue drug or discontinue breast feeding; Pediatric: ↑ risk of suicidal thinking and behavior (suicidality) in children and adolescents with major depressive disorder and other psychiatric disorders. Observe closely for suicidality and behavior changes.

Adverse Reactions/Side Effects

Central nervous system

  • neuroleptic malignant syndrome (life-threatening)
  • seizures (life-threatening)
  • suicidal thoughts (life-threatening)
  • abnormal dreams (most frequent)
  • anxiety (most frequent)
  • dizziness (most frequent)
  • headache (most frequent)
  • insomnia (most frequent)
  • nervousness (most frequent)
  • weakness (most frequent)
  • abnormal thinking
  • agitation
  • confusion
  • depersonalization
  • drowsiness
  • emotional lability
  • worsening depression

Ear, Eye, Nose, Throat

  • rhinitis (most frequent)
  • visual disturbances (most frequent)
  • epistaxis
  • tinnitus

Cardiovascular

  • chest pain
  • hypertension
  • palpitations
  • tachycardia

Gastrointestinal

  • abdominal pain (most frequent)
  • altered taste (most frequent)
  • anorexia (most frequent)
  • constipation (most frequent)
  • diarrhea (most frequent)
  • dry mouth (most frequent)
  • dyspepsia (most frequent)
  • nausea (most frequent)
  • vomiting (most frequent)
  • weight loss (most frequent)

Genitourinary

  • sexual dysfunction (most frequent)
  • urinary frequency
  • urinary retention

Dermatologic

  • ecchymoses (most frequent)
  • itching
  • photosensitivity
  • skin rash

Neurologic

  • paresthesia (most frequent)
  • twitching

Miscellaneous

  • serotonin syndrome (life-threatening)
  • chills (most frequent)
  • bleeding
  • yawning

Interactions

Drug-Drug interaction

Concurrent use with MAO inhibitors may result in serious, potentially fatal reactions (wait at least 2 wk after stopping MAO inhibitor before initiating venlafaxine; wait at least 1 wk after stopping venlafaxine before starting MAO inhibitors).Concurrent use with MAO-inhibitor like drugs, such as linezolid or methylene blue may ↑ risk of serotonin syndrome; concurrent use contraindicated; do not start therapy in patients receiving linezolid or methylene blue ; if linezolid or methylene blue need to be started in a patient receiving venlafaxine, immediately discontinue venlafaxine and monitor for signs/symptoms of serotonin syndrome for 2 wk or until 24 hr after last dose of linezolid or methylene blue, whichever comes first (may resume venlafaxine therapy 24 hr after last dose of linezolid or methylene blue)Concurrent use with alcohol or other CNS depressants, including sedatives/hypnotics, antihistamines, and opioid analgesics in depressed patients is not recommended.Drugs that affect serotonergic neurotransmitter systems, including tricyclic antidepressants, SNRIs, fentanyl, buspirone, tramadol and triptans ↑ risk of serotonin syndromeLithium may have ↑ serotonergic effects with venlafaxine; use cautiously in patients receiving venlafaxine.↑ blood levels and may ↑ effects of desipramine and haloperidol.Cimetidine may ↑ the effects of venlafaxine (may be more pronounced in geriatric patients, those with hepatic or renal impairment, or those with pre-existing hypertension).Ketoconazole may ↑ the effects of venlafaxine.↑ risk of bleeding with NSAIDS, aspirin, clopidogrel, or warfarin.Concomitant use of kava-kava, valerian, chamomile, or hops can ↑ CNS depression.↑ risk of serotinergic side effects including serotonin syndrome with St. John’s wort and SAMe.

Route/Dosage

Major Depressive Disorder
Oral (Adults) Tablets—75 mg/day in 2–3 divided doses; may ↑ by up to 75 mg/day every 4 days, up to 225 mg/day (not to exceed 375 mg/day in 3 divided doses); Extended-release (XR) capsules—75 mg once daily (some patients may be started at 37.5 mg once daily) for 4–7 days; may ↑ by up to 75 mg/day at intervals of not less than 4 days (not to exceed 225 mg/day).
General Anxiety Disorder
Oral (Adults) Extended-release (XR) capsules—75 mg once daily (some patients may be started at 37.5 mg once daily) for 4–7 days; may ↑ by up to 75 mg/day at intervals of not less than 4 days (not to exceed 225 mg/day).
Social Anxiety Disorder
Oral (Adults) Extended-release (XR) capsules—75 mg once daily.
Panic Disorder
Oral (Adults) Extended-release (XR) capsules—37.5 mg once daily for 7 days; may then ↑ to 75 mg once daily; may then ↑ by 75 mg/day every 7 days (not to exceed 225 mg/day).

Hepatic Impairment

Oral (Adults) ↓ daily dose by 50% in patients with mild-to-moderate hepatic impairment.

Renal Impairment

Oral (Adults) CCr 10–70 mL/min—↓ daily dose by 25–50%; Hemodialysis—↓ daily dose by 50%.

Availability (generic available)

Tablets: 25 mg, 37.5 mg, 50 mg, 75 mg, 100 mg Cost: Generic — 25 mg $32.24 / 100, 37.5 mg $39.41 / 100, 75 mg $38.00 / 100
Extended-release capsules: 37.5 mg, 75 mg, 150 mg Cost: Generic — 37.5 mg $32.14 / 90, 75 mg $271.37 / 100, 150 mg $29.94 / 100

Nursing implications

Nursing assessment

  • Assess mental status and mood changes. Inform health care professional if patient demonstrates significant increase in anxiety, nervousness, or insomnia.
  • Assess suicidal tendencies, especially in early therapy. Restrict amount of drug available to patient. Risk may be increased in children, adolescents, and adults ≤24 yr.
  • Monitor BP before and periodically during therapy. Sustained hypertension may be dose-related; decrease dose or discontinue therapy if this occurs.
  • Monitor appetite and nutritional intake. Weigh weekly. Report continued weight loss. Adjust diet as tolerated to support nutritional status.
  • Assess for serotonin syndrome (mental changes [agitation, hallucinations, coma], autonomic instability [tachycardia, labile BP, hyperthermia], neuromuscular aberrations [hyper-reflexia, incoordination], and/or GI symptoms [nausea, vomiting, diarrhea]), especially in patients taking other serotonergic drugs (SSRIs, SNRIs, triptans).
  • Lab Test Considerations: Monitor CBC with differential and platelet count periodically during therapy. May cause anemia, leukocytosis, leukopenia, thrombocytopenia, basophilia, and eosinophilia.
    • May cause an ↑ in serum alkaline phosphatase, bilirubin, AST, ALT, BUN, and creatinine.
    • May also cause ↑ serum cholesterol.
    • May cause electrolyte abnormalities (hyperglycemia or hypoglycemia, hyperkalemia or hypokalemia, hyperuricemia, hyperphosphatemia or hypophosphatemia, and hyponatremia).
    • May cause false-positive immunoassay screening tests for phencyclidine (PCP) and amphetamine.

Potential Nursing Diagnoses

Ineffective coping (Indications)
Risk for injury (Side Effects)

Implementation

  • Do not confuse Effexor with Effexor XR.
  • Oral: Administer venlafaxine with food.
    • Extended-release capsules should be swallowed whole; do not crush, break, or chew.
    • Extended-release capsules may be opened and contents sprinkled on a spoonful of applesauce. Take immediately and follow with a glass of water. Do not store mixture for later use.

Patient/Family Teaching

  • Instruct patient to take venlafaxine as directed at the same time each day. Take missed doses as soon as possible unless almost time for next dose. Do not double doses or discontinue abruptly. Patients taking venlafaxine for >6 wk should have dose gradually decreased before discontinuation.
  • Advise patient, family, and caregivers to look for suicidality, especially during early therapy or dose changes. Notify health care professional immediately if thoughts about suicide or dying, attempts to commit suicide; new or worse depression or anxiety; agitation or restlessness; panic attacks; insomnia; new or worse irritability; aggressiveness; acting on dangerous impulses, mania, or other changes in mood or behavior or if symptoms of serotonin syndrome occur.
  • May cause drowsiness or dizziness. Caution patient to avoid driving or other activities requiring alertness until response to the drug is known.
  • Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and consult health care professional before taking any new medications. Caution patient to avoid taking alcohol or other CNS-depressant drugs during therapy.
  • Instruct patient to notify health care professional if signs of allergy (rash, hives) occur.
  • Instruct female patients to inform health care professional if pregnancy is planned or suspected or if breast feeding.
  • Emphasize the importance of follow-up exams to monitor progress. Encourage patient participation in psychotherapy.

Evaluation/Desired Outcomes

  • Increased sense of well-being.
    • Renewed interest in surroundings. Need for therapy should be periodically reassessed. Therapy is usually continued for several months.
  • Decreased anxiety.
Drug Guide, © 2015 Farlex and Partners

Effexor

(ĕf′ĕk-sôr′)
A trademark for the hydrochloride form of the drug venlafaxine.
The American Heritage® Medical Dictionary Copyright © 2007, 2004 by Houghton Mifflin Company. Published by Houghton Mifflin Company. All rights reserved.

Effexor®

Venlafaxine Psychiatry A mood-enhancing SSRI used for major depression, general anxiety disorder Contraindications Should not be combined with MAOIs. See Depression, Major depression, Monoamine oxidase inhibitor.
McGraw-Hill Concise Dictionary of Modern Medicine. © 2002 by The McGraw-Hill Companies, Inc.

Patient discussion about Effexor

Q. Effexor Hi! I am new to the forum. I was diagnosed eight months ago with effexor - induced mania and now have been diagnosed as Bipolar II, rapid cycling, with mixed states. I have a 30 year old history of treatment-resistant depression. No mania prior to the effexor. I also self-treat the depression with one hour of vigorous exercise daily, sunlight, healthy diet, regular sleep, and no stimulants or depressants including coffee and alcohol. I take omega 3, magnesium malate, calcium, zinc, selenium, and super b-complex supplements as well.

A. Well, I found out that goats get depressed too and it only happens when they are mineral deficient. I think the mineral deficiency that causes more health problems and especially related to the brain is Copper. Evidently it is critical to the absorption of many other minerals. If you've tried St. Johns Wort and found that it helps at all, I would suggest that it is because SJW contains lots of copper. Another really excellent source of copper is Kelp. Actually kelp is an excellent source of all the minerals, especially all the ones not yet discovered by man. **Natures Version** If you are anemic, you cannot absorb the iron without copper. Copper also helps the body to absorb calcium. I understand that there is a coating of calcium on the nerves. Unless you are eating a really old fashioned diet of mostly raw and unprocessed foods grown in remineralized soil, the food you are eating is most likely stripping more minerals from your body than adding to.

More discussions about Effexor
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