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EFFEXOR XR
Anxiety/OCD
Mood disorders
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Drug Name:

EFFEXOR XR Rx

Generic Name and Formulations:
Venlafaxine (as HCl) 37.5mg, 75mg, 150mg; ext-rel caps.

Company:
Pfizer Inc.

Therapeutic Use:

Indications for EFFEXOR XR:

Generalized anxiety disorder (GAD). Social anxiety disorder (SAD). Panic disorder (PD).

Adult:

Take with food. Swallow whole or sprinkle contents on spoonful of applesauce; do not chew. GAD: Initially 75mg once daily; may start at 37.5mg once daily for 4–7 days before increasing to 75mg/day; may increase by increments of up to 75mg/day at intervals of at least 4 days. SAD: 75mg once daily. PD: Initially 37.5mg once daily for 7 days, then may increase to 75mg/day; then may increase in increments of up to 75mg/day at intervals of at least 7 days. For GAD or PD: usual max 225mg/day. Mild-to-moderate hepatic impairment: reduce by 50%. Renal impairment: reduce by 25–50%; reduce dose by 50% in hemodialysis (hold dose until end of treatment). Withdraw gradually (reduce by 75mg/day at 1-week intervals).

Children:

Not established.

Pharmacological Class:

SNRI.

Contraindications:

During or within 14 days of MAOIs (see Interactions). Concomitant linezolid or IV methylene blue.

Warnings/Precautions:

Increased risk of suicidal thinking and behavior in children, adolescents, and young adults; monitor for clinical worsening or unusual changes. Screen for bipolar disorder. Monitor for emergence of serotonin syndrome; discontinue if occurs. Pre-existing hypertension, cardio- or cerebrovascular disease. Monitor BP before and during treatment; consider dose reduction or discontinuation if elevated BP persists. Heart disease (eg, recent MI, heart failure). Increased risk of bleeding. Angle-closure glaucoma. History of mania/hypomania, seizure disorders. Renal or hepatic dysfunction. Avoid abrupt disruption. Reevaluate periodically. Write ℞ for smallest practical amount. Elderly. Labor & delivery. Pregnancy (Cat.C) (avoid in 3rd trimester; see full labeling for effects on neonate). Nursing mothers: not recommended.

Interactions:

See Contraindications. Allow at least 14 days after MAOI discontinuance before starting venlafaxine; allow at least 7 days after venlafaxine discontinuance before starting an MAOI. Increased risk of serotonin syndrome with concomitant other serotonergic drugs (eg, triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone, St. John's Wort) or with drugs that impair serotonin metabolism (eg, MAOIs, linezolid, IV methylene blue). Avoid alcohol. Concomitant weight loss agents (eg, phentermine), serotonin precursors (tryptophan supplements): not recommended. Caution with other CNS drugs, cimetidine, haloperidol, diuretics, metoprolol, drugs that inhibit CYP2D6, CYP3A4. Increased risk of bleeding with NSAIDs, aspirin, warfarin, or others that affect coagulation. False (+) urine immunoassay screening tests for PCP and amphetamine.

Adverse Reactions:

Nausea, somnolence, dry mouth, sweating, abnormal ejaculation, anorexia, constipation, erectile dysfunction, decreased libido, weight changes, dizziness, insomnia, headache, nervousness, asthenia, vasodilation, abnormal dreams or vision, tremor, yawn, ecchymosis; hyponatremia/SIADH (esp in elderly); rare: interstitial lung disease, eosinophilic pneumonia.

Metabolism:

Hepatic (CYP2D6).

Elimination:

Renal.

Generic Availability:

YES

How Supplied:

Caps—15, 30, 90

Indications for EFFEXOR XR:

Major depressive disorder.

Adult:

Take with food. Swallow whole or sprinkle contents on spoonful of applesauce; do not chew. Transferring from immediate-release: give total daily dose on once-daily basis. Initially 75mg once daily; may start at 37.5mg once daily for 4–7 days before increasing to 75mg/day; may increase by increments of up to 75mg/day at intervals of at least 4 days; usual max 225mg/day. Mild-to-moderate hepatic impairment: reduce by 50%. Renal impairment: reduce by 25–50%; reduce dose by 50% in hemodialysis (hold dose until end of treatment). Withdraw gradually (reduce by 75mg/day at 1-week intervals).

Children:

Not established.

See Also:

EFFEXOR

Pharmacological Class:

SNRI.

Contraindications:

During or within 14 days of MAOIs (see Interactions). Concomitant linezolid or IV methylene blue.

Warnings/Precautions:

Increased risk of suicidal thinking and behavior in children, adolescents, and young adults; monitor for clinical worsening or unusual changes. Screen for bipolar disorder. Monitor for emergence of serotonin syndrome; discontinue if occurs. Pre-existing hypertension, cardio- or cerebrovascular disease. Monitor BP before and during treatment; consider dose reduction or discontinuation if elevated BP persists. Heart disease (eg, recent MI, heart failure). Increased risk of bleeding. Angle-closure glaucoma. History of mania/hypomania, seizure disorders. Renal or hepatic dysfunction. Avoid abrupt disruption. Reevaluate periodically. Write ℞ for smallest practical amount. Elderly. Labor & delivery. Pregnancy (Cat.C) (avoid in 3rd trimester; see full labeling for effects on neonate). Nursing mothers: not recommended.

Interactions:

See Contraindications. Allow at least 14 days after MAOI discontinuance before starting venlafaxine; allow at least 7 days after venlafaxine discontinuance before starting an MAOI. Increased risk of serotonin syndrome with concomitant other serotonergic drugs (eg, triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone, St. John's Wort) or with drugs that impair serotonin metabolism (eg, MAOIs, linezolid, IV methylene blue). Avoid alcohol. Concomitant weight loss agents (eg, phentermine), serotonin precursors (tryptophan supplements): not recommended. Caution with other CNS drugs, cimetidine, haloperidol, diuretics, metoprolol, drugs that inhibit CYP2D6, CYP3A4. Increased risk of bleeding with NSAIDs, aspirin, warfarin, or others that affect coagulation. False (+) urine immunoassay screening tests for PCP and amphetamine.

Adverse Reactions:

Nausea, somnolence, dry mouth, sweating, abnormal ejaculation, anorexia, constipation, erectile dysfunction, decreased libido, weight changes, dizziness, insomnia, headache, nervousness, asthenia, vasodilation, abnormal dreams or vision, tremor, yawn, ecchymosis; hyponatremia/SIADH (esp in elderly); rare: interstitial lung disease, eosinophilic pneumonia.

Metabolism:

Hepatic (CYP2D6).

Elimination:

Renal.

Generic Availability:

YES

How Supplied:

Caps—15, 30, 90; Tabs 25mg, 37.5mg—60; 50mg, 75mg—30; 100mg—20

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