Venlafaxine (Effexor)
SNRI antidepressant
- Major Depression2
- Social Anxiety2
- Generalized anxiety2
- Panic Disorder2
- PTSD2
- High WD risk
- Menopausal symptoms (hot flashes)
- Migraine prevention
Features
Dosing
75mg-375mg. Below 150 acts as SSRI, above that acts as SNRI (raising blood pressure and manic risk). Approved for depression, GAD, panic, social anxiety disorder. May help ADHD a little.
Menopausal hot flashes: 75 mg daily
INTERACTIONS: Lower 50% with strong CYP2D6 inhibitors (asenapine, bupropion, cannabidiol, duloxetine, and non-pram SSRIs: fluoxetine, paroxetine, sertraline ≥ 150 mg/day).
Management
Less favorable among SNRIs due to WD risks and weight gain.
TOLERABILITY: Nausea, sexual dysfunction, weight gain, sleep disruption, restless legs.
RISKS: Osteopenia in post-menopausal women. Hypertension at higher dose. Hyponatremia. Serotonin syndrome.
EMR Text
Depression
Venlafaxine use based on FDA approval in major depressive disorder.
Venlafaxine side effects, including mania and hypertension, reviewed with patient.
Anxiety Disorders
Venlafaxine use based on FDA approval in anxiety disorders (social anxiety disorder, generalized anxiety disorder, and panic disorder).
Venlafaxine side effects, including mania and hypertension, reviewed with patient.
PTSD
Venlafaxine use based on controlled trials in PTSD (Davidson J et al, Arch Gen Psychiatry. 2006;63(10):1158-1165).
Venlafaxine side effects, including mania and hypertension, reviewed with patient.
Menopausal hot flashes
Venlafaxine use based on controlled trials in postmenopausal symptoms (Caan B et al, Menopause. 2015;22(6):607-615).
Venlafaxine side effects, including mania and hypertension, reviewed with patient.