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NERVOUS SYSTEM › PSYCHOANALEPTICS › ANTIDEPRESSANTS › Other antidepressants
venlafaxine
N06AX16
Forms & Strengths
- Immediate‑release tablets 37.5 mg, 75 mg, 150 mg
- Extended‑release capsules 37.5 mg, 75 mg, 150 mg
- Oral solution 37.5 mg/5 mL
Adult Dosing
- MDD: start 75 mg/day (37.5 mg BID) or XR 75 mg QD; titrate to 150 mg/day; max 375 mg/day (300 mg XR)
- GAD: start 75 mg/day; may increase to 225 mg/day
- Panic disorder: start 75 mg/day; may increase to 225 mg/day
- Relapse prevention: maintain 150 mg/day
Pediatric Dosing
- MDD (12‑17 y): start 37.5 mg BID (75 mg/day); may increase to 150‑225 mg/day; max 225 mg/day
- GAD (12‑17 y): same as MDD; off‑label use
Indications
- Major depressive disorder (MDD)
- Generalized anxiety disorder (GAD)
- Social anxiety disorder (SAD)
- Panic disorder with or without agoraphobia
- Relapse prevention of depression
- Off‑label: diabetic peripheral neuropathic pain
Mechanism of Action
- Reversible inhibition of serotonin (5‑HT) reuptake
- Inhibition of norepinephrine (NE) reuptake (dose‑dependent)
- At high doses modest dopamine reuptake inhibition
Contraindications
- Known hypersensitivity to venlafaxine or its excipients
- Concomitant use of MAO inhibitors (or within 14 days of MAOI)
- Use with thioridazine (QT prolongation risk)
Adverse Reactions
- Nausea and vomiting
- Dry mouth
- Insomnia or somnolence
- Dizziness
- Sweating
- Constipation
- Sexual dysfunction (decreased libido, anorgasmia)
- Hypertension or tachycardia
- Weight gain or loss
- Serotonin syndrome (rare)
- Increased suicidal thoughts in <24 y
Drug Interactions
- MAO inhibitors → serotonin syndrome (discontinue 14 days)
- Other serotonergic drugs (SSRIs, SNRIs, TCAs, tramadol, linezolid, triptans, St. John’s wort) → risk of serotonin syndrome
- CYP2D6 inhibitors (quinidine, fluoxetine, paroxetine) ↑ venlafaxine levels
- CYP2C19 inhibitors (omeprazole, fluconazole) ↑ levels
- CYP inducers (carbamazepine, phenytoin, rifampin) ↓ levels
- NSAIDs or anticoagulants → increased bleeding risk
- Antihypertensives may have reduced efficacy
- Alcohol may increase CNS depression
Curated Content: Needs Vetting Before Put to Clinical Use