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 About Medication

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About_Medications

Effexor® (venlafaxine)

Effexor®

  • Tablets (immediate release): 25 mg, 37.5 mg, 50 mg, 75 mg, 100 mg 

Effexor XR®

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

Venlafaxine

  • Tablets (extended release): 37.5, 75 mg, 150 mg, 225 mg 
  • Tablets (immediate release): 25 mg, 37.5 mg, 50 mg 75, mg 100 mg 

Generic name: venlafaxine (ven la FAX een)

Medication Class: Serotonin-norepinephrine reuptake inhibitor (SNRI) antidepressant

All FDA black box warnings are at the end of this fact sheet.  Please review before taking this medication.

What is Effexor® and what does it treat?

Venlafaxine is an antidepressant medication that works in the brain.  It is approved for the treatment of major depressive disorder (MDD), generalized anxiety disorder (GAD), panic disorder, and social anxiety disorder (social phobia).

Symptoms of depression include:

  • Depressed mood - feeling sad, empty, or tearful 
  • Feeling worthless, guilty, hopeless, and helpless 
  • Loss of interest or pleasure in your usual activities 
  • Sleep and eat more or less than usual (for most people it is less) 
  • Low energy, trouble concentrating, or thoughts of death (suicidal thinking) 
  • Psychomotor agitation (‘nervous energy’) 
  • Psychomotor retardation (feeling like you are moving and thinking in slow motion) 
  • Suicidal thoughts or behaviors 

Generalized Anxiety Disorder (GAD) occurs when a person experiences excessive anxiety or worry for at least six months.  Other symptoms include

  • Restlessness 
  • Fatigue (low energy, feeling tired all the time) 
  • Difficulty concentrating 
  • Irritability 
  • Muscle tension 
  • Sleep disturbance (difficulty falling asleep or waking up in the middle of the night) 

Panic Disorder occurs when a person experiences unexpected and repeated episodes of intense fear.  These episodes have physical symptoms including chest pain, shortness of breath, heart palpitations, sweating, dizziness, and nausea. Fear of future episodes is also part of panic disorder.

Social phobia/social anxiety disorder is a fear of situations where one may feel as if they are being judged by others.  Symptoms include:

  • Blushing 
  • Difficulty talking 
  • Nausea 
  • Sweating 
  • Shaking 

What is the most important information I should know about Effexor®?

Do not stop taking venlafaxine, even when you feel better.  Only your healthcare provider can determine the length of treatment that is right for you.

Missing doses of venlafaxine may increase your risk for relapse in your symptoms.

Stopping venlafaxine abruptly may result in one or more of the following withdrawal symptoms: irritability, nausea, feeling dizzy, vomiting, nightmares, headache, and/or paresthesias (prickling, tingling sensation on the skin).

Depression is also a part of bipolar illness.  People with bipolar disorder who take antidepressants may be at risk for "switching" from depression into mania.  Symptoms of mania include "high" or irritable mood, very high self esteem, decreased need for sleep, pressure to keep talking, racing thoughts, being easily distracted, frequently involved in activities with a large risk for bad consequences (for example, excessive buying sprees).

Medical attention should be sought if serotonin syndrome is suspected.  Please refer to serious side effects for signs/symptoms.

Are there specific concerns about Effexor® and pregnancy?

If you are planning on becoming pregnant, notify your healthcare provider to best manage your medications.  People living with MDD who wish to become pregnant face important decisions. Untreated MDD has risks to the fetus, as well as the mother.  It is important to discuss the risks and benefits of treatment with your doctor and caregivers.  For women who take antidepressant medications during weeks 13 through the end of their pregnancy (second and third trimesters), there is a risk that the baby can be born before it is fully developed (before 37 weeks).

Caution is advised with breastfeeding since venlafaxine does pass into breast milk.

What should I discuss with my healthcare provider before taking Effexor®?

  • Symptoms of your condition that bother you the most 
  • If you have thoughts of suicide or harming yourself 
  • Medications you have taken in the past for your condition, whether they were effective or caused any adverse effects 
  • If you experience side effects from your medications, discuss them with your provider.  Some side effects may pass with time, but others may require changes in the medication.   
  • Any other psychiatric or medical problems you have, including a history of bipolar disorder 
  • All other medications you are currently taking (including over the counter products, herbal and nutritional supplements) and any medication allergies you have 
  • Other non-medication treatment you are receiving, such as talk therapy or substance abuse treatment.  Your provider can explain how these different treatments work with the medication. 
  • If you are pregnant, plan to become pregnant, or are breast-feeding 
  • If you drink alcohol or use drugs 

How should I take Effexor®?

Venlafaxine immediate release tablets are usually taken 2 or 3 times per day with or without food.  The extended release tablets and capsules one time per day with or without food.

Typically patients begin at a low dose of medicine and the dose is increased slowly over several weeks.  

The dose usually ranges from 37.5 mg to 300 mg.  Only your healthcare provider can determine the correct dose for you.

Extended release tablets: swallow whole; do not chew, crush, or break

Extended release capsules: swallow whole or sprinkle onto food, such as applesauce or pudding and eat immediately.  

Consider using a calendar, pillbox, alarm clock, or cell phone alert to help you remember to take your medication.  You may also ask a family member or friend to remind you or check in with you to be sure you are taking your medication.

What happens if I miss a dose of Effexor®?

If you miss a dose of venlafaxine, take it as soon as you remember, unless it is closer to the time of your next dose.  Discuss this with your healthcare provider.  Do not double your next dose or take more than what is prescribed.

What should I avoid while taking Effexor®?

Avoid drinking alcohol or using illegal drugs while you are taking antidepressant medications.  They may decrease the benefits (e.g., worsen your condition) and increase adverse effects (e.g., sedation) of the medication.  

What happens if I overdose with Effexor®?

If an overdose occurs, call your doctor or 911.  You may need urgent medical care.  You may also contact the poison control center at 1-800-222-1222.

A specific treatment to reverse the effects of venlafaxine does not exist.

What are the possible side effects of Effexor®?

Common Side Effects

  • Headache, nausea, diarrhea, dry mouth, increased sweating 
  • Feeling nervous, restless, fatigued, sleepy or having trouble sleeping (insomnia) 

These will often improve over the first week or two as you continue to take the medication.

  • Sexual side effects, such as problems with orgasm or ejaculatory delay 
  • Increased blood pressure 

These often do not improve over time.

Rare Side Effects

Increased heart rate, low blood pressure, increased salivation, irregular menstrual cycle, increased frequency of urination, changes in taste, increased bleeding (e.g., gums may bleed more easily), low sodium (symptoms of low sodium levels may include headache, weakness, difficulty concentrating and remembering), teeth grinding, difficulty urinating

Serious Side Effects

Serotonin syndrome (symptoms may include shivering, diarrhea, confusion, severe muscle tightness, fever, seizures, and death), gastrointestinal bleeding

Are there any risks of taking Effexor® for long periods of time?

To date, there are no known problems associated with long term use of venlafaxine.  It is a safe and effective medication when used as directed.

What other medications may interact with Effexor®?

Venlafaxine should not be taken with or within 2 weeks of taking monoamine oxidase inhibitors (MAOIs).  These include phenelzine (Nardil®), tranylcypromine (Parnate®), isocarboxazid (Marplan®), rasagiline (Azilect®), and selegeline (Emsam®).

Although rare, there is an increased risk of serotonin syndrome when venlafaxine is used with other medications that increase serotonin, such as other antidepressants, migraine medications called “triptans” (e.g., Imitrex®), some pain medications (e.g., tramadol (Ultram®), and the antibiotic linezolid (Zyvox®).

Venlafaxine may increase the effects of other medications that can cause bleeding (e.g., ibuprofen (Advil®, Motrin®), warfarin (Coumadin®) and aspirin).

How long does it take for Effexor® to work?

Sleep, energy, or appetite may show some improvement within the first 1-2 weeks.  Improvement in these physical symptoms can be an important early signal that the medication is working.  Depressed mood and lack of interest in activities may need up to 6-8 weeks to fully improve.

Provided by the College of Psychiatric and Neurologic Pharmacists

(January 2013)

Summary of Black Box Warnings

Suicidal Thoughts or Actions in Children and Adults

  • Depression and certain other psychiatric disorders are themselves associated with increases in the risk of suicide.   
  • Patients with major depressive disorder (MDD), both adult and pediatric, may experience worsening of their depression and/or the emergence of suicidal ideation and behavior (suicidality) or unusual changes in behavior, whether or not they are taking antidepressant medications.  This risk may persist until significant remission occurs. 
  • In short-term studies, antidepressants increased the risk of suicidality in children, adolescents, and young adults when compared to placebo.  Short-term studies did not show an increase in the risk of suicidality with antidepressants compared to placebo in adults beyond age 24.  Adults age 65 and older taking antidepressants have a decreased risk of suicidality.   
  • Patients, their families, and caregivers should be alert to the emergence of anxiety, restlessness, irritability, aggressiveness and insomnia.  If these symptoms emerge, they should be reported to the patient’s prescriber or healthcare professional.   
  • All patients being treated with antidepressants for any indication should watch for and notify their healthcare provider for worsening symptoms, suicidality and unusual changes in behavior, especially during the first few months of treatment. 


Related Resources

Antidepressants and Kids
A new review concludes that the benefits of antidepressant medications for children and teens appear to be much greater than the risks.

Partnership for Prescription Assistance
A new toll-free number and Web site provide help to those who lack prescription coverage or cannot afford their medications.

FDA Requires "Black Box" Warning on Antidepressants
NAMI applauds the FDA for calling for close monitoring of youth living with depression and for providing better information about medications for treating depression in youth. However, the FDA's actions may also have unintended negative consequences.


More...

Online Discussion

Living with Major Depression
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Related Links

Food and Drug Administration Consumer Information on Effexor

Food and Drug Administration Label Insert for Effexor

YourPharmacyBenefit.org
Information to help you make good use of the pharmacy benefits that are part of your health insurance.



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