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Effexor XR Fact Sheet

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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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