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venlafaxine
Effexor XR · Effexor (IR)
SNRI⚠ Unverified beta content
At a glance
- Class
- Serotonin-norepinephrine reuptake inhibitor
- Black box
- ⚠ Suicidal thoughts and behaviors
- Key monitoring
- Blood pressure & heart rate — Per provider; report sustained elevation
- Suicidality / mood
- Usual adult dose
- MDD (XR): 75–225 mg/day
- Call provider / escalate if
- Thoughts of suicide or self-harm • Severe headache, chest pain, very high blood pressure readings • Serotonin syndrome signs (agitation, fever, sweating, tremor, stiffness, diarrhea)
Built-in explanation — generated offline from this app’s structured data (no AI, no network). Still unverified beta content.
What it is
- venlafaxine (Effexor XR, Effexor (IR)) — serotonin-norepinephrine reuptake inhibitor.
- Used for: Major depressive disorder; Generalized anxiety disorder; Social anxiety disorder; Panic disorder.
Usual adult dosing
- MDD (XR): 75–225 mg/day (Start 37.5–75 mg once daily; increase in ≤75 mg steps at ≥4-day intervals.)
- Max (XR, outpatient): 225 mg/day
- IR tablets: Divided BID–TID; up to 375 mg/day in severe, monitored cases
Boxed warning
- Suicidal thoughts and behaviors: antidepressants increase the risk in children, adolescents and young adults (to age 24). Monitor closely, especially at start and with dose changes.
Monitor
- Blood pressure & heart rate — Per provider; report sustained elevation [Baseline, after dose increases, and periodically]
- Suicidality / mood [Every contact; closely early]
Nursing priorities
- Baseline mood, suicidal ideation (ask directly), sleep, appetite, anxiety.
- Screen for history of mania/bipolar disorder.
- Assess suicidal ideation each contact, especially early and after dose changes; follow facility safety protocols.
- Benefit often delayed 4–6 weeks; reinforce adherence.
- Do not stop abruptly.
Major interactions
- MAOIs / linezolid / methylene blue: Serotonin syndrome – contraindicated; allow washout per label.
- Other serotonergic drugs (triptans, tramadol, fentanyl, St John’s wort, other antidepressants): Increased risk of serotonin syndrome.
Key teaching
- Take it every day as prescribed, even when you feel better. Full effect can take several weeks.
- Do not stop suddenly; ask your provider about slowly lowering the dose.
- Report any new or worse thoughts of hurting yourself, or big changes in mood or behavior, right away.
Optional: AI explanation
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Boxed warning
- Suicidal thoughts and behaviors: antidepressants increase the risk in children, adolescents and young adults (to age 24). Monitor closely, especially at start and with dose changes.
Other serious warnings
- Sustained hypertension (dose-related)
- Serotonin syndrome
- Bleeding risk
- Hyponatremia/SIADH
- Activation of mania
- Seizures
- Angle-closure glaucoma
- Severe discontinuation syndrome (short half-life)
- Overdose toxicity is higher than with SSRIs (QT, seizures)
Sources: FDA label (DailyMed): EFFEXOR XR (VENLAFAXINE HYDROCHLORIDE) CAPSULE,
- Blood pressure & heart rateTarget: Per provider; report sustained elevationWhen: Baseline, after dose increases, and periodically
- Suicidality / moodWhen: Every contact; closely early
- SodiumWhen: If at risk or symptomatic
- Lipids (cholesterol)Label notes possible serum cholesterol elevation with long-term use
Sources: FDA label (DailyMed): EFFEXOR XR (VENLAFAXINE HYDROCHLORIDE) CAPSULE,
Assessment
- Baseline mood, suicidal ideation (ask directly), sleep, appetite, anxiety.
- Screen for history of mania/bipolar disorder.
- Medication/supplement list for interactions.
- Baseline blood pressure and heart rate; control hypertension before starting.
- Sodium if older adult or on diuretics.
Interventions
- Assess suicidal ideation each contact, especially early and after dose changes; follow facility safety protocols.
- Benefit often delayed 4–6 weeks; reinforce adherence.
- Do not stop abruptly.
- Take blood pressure regularly, especially after titration; report sustained elevations.
- Give XR capsule with food; swallow whole (may be opened onto applesauce per label).
- Taper gradually (e.g., over weeks) – missed doses can cause withdrawal within a day or two.
Sources: General nursing drug reference conventions (e.g., Davis Drug Guide / L
- Thoughts of suicide or self-harm
- Severe headache, chest pain, very high blood pressure readings
- Serotonin syndrome signs (agitation, fever, sweating, tremor, stiffness, diarrhea)
- Unusual bleeding
- Confusion/weakness (low sodium)
- Seizure
- Manic symptoms
- Severe withdrawal symptoms after missed doses
Sources: FDA label (DailyMed): EFFEXOR XR (VENLAFAXINE HYDROCHLORIDE) CAPSULE, · General nursing drug reference conventions (e.g., Davis Drug Guide / L
- Nausea
- Headache
- Dizziness
- Insomnia / somnolence
- Sweating
- Dry mouth
- Constipation
- Sexual dysfunction
- Increase in blood pressure / heart rate (dose-related)
Sources: FDA label (DailyMed): EFFEXOR XR (VENLAFAXINE HYDROCHLORIDE) CAPSULE,
- MAOIs / linezolid / methylene blue MajorSerotonin syndrome – contraindicated; allow washout per label.
- Other serotonergic drugs (triptans, tramadol, fentanyl, St John’s wort, other antidepressants) MajorIncreased risk of serotonin syndrome.
- NSAIDs / anticoagulants / antiplateletsBleeding risk.
- CYP2D6 inhibitors (e.g., fluoxetine, paroxetine, bupropion) / CYP3A4 inhibitorsMay raise venlafaxine levels.
Sources: FDA label (DailyMed): EFFEXOR XR (VENLAFAXINE HYDROCHLORIDE) CAPSULE,
- Take it every day as prescribed, even when you feel better. Full effect can take several weeks.
- Do not stop suddenly; ask your provider about slowly lowering the dose.
- Report any new or worse thoughts of hurting yourself, or big changes in mood or behavior, right away.
- Check with your pharmacist before taking new medicines, supplements or herbal products.
- Avoid or limit alcohol.
- Missing doses can cause dizziness, “brain zaps,” nausea, and irritability – take it at the same time each day.
- Your blood pressure may go up; keep your appointments for blood pressure checks.
Sources: General nursing drug reference conventions (e.g., Davis Drug Guide / L
Indications
- Major depressive disorder
- Generalized anxiety disorder
- Social anxiety disorder
- Panic disorder
Dosing
- MDD (XR): 75–225 mg/dayStart 37.5–75 mg once daily; increase in ≤75 mg steps at ≥4-day intervals.
- Max (XR, outpatient): 225 mg/day
- IR tablets: Divided BID–TID; up to 375 mg/day in severe, monitored cases
Sources: FDA label (DailyMed): EFFEXOR XR (VENLAFAXINE HYDROCHLORIDE) CAPSULE,
Prescriber-oriented details; limited in this beta.
renal Adjustment
- Reduce total daily dose (label: ~25–50%) in renal impairment/dialysis.
hepatic Adjustment
- Reduce dose ~50% in mild–moderate hepatic impairment (label).
discontinuation
- Taper gradually; short half-life makes withdrawal common.
Sources: FDA label (DailyMed): EFFEXOR XR (VENLAFAXINE HYDROCHLORIDE) CAPSULE,
- Verified
- No – unverified beta
- Last reviewed
- 2026-10-29 (drafted; not clinician-reviewed)
- FDA label (DailyMed): EFFEXOR XR (VENLAFAXINE HYDROCHLORIDE) CAPSULE, EXTENDED RELEASE [VIATRIS SPECIALTY LLC]
- General nursing drug reference conventions (e.g., Davis Drug Guide / Lexicomp nursing) - summarized from standard practice; NOT line-by-line verified