Generic Name and Formulations:
Venlafaxine (as HCl) 25mg, 37.5mg, 50mg, 75mg, 100mg; scored tabs.
Major depressive disorder.
Take with food. ≥18yrs: Initially 75mg/day in 2–3 divided doses; may increase at 4-day intervals in 75mg/day increments to 150mg/day; max 375mg/day, in 3 divided doses. Hepatic impairment: reduce by at least 50%. Mild-to-moderate renal impairment: reduce by at least 25%; hemodialysis: reduce by 50% (hold dose until end of dialysis treatment). Withdraw gradually (over 2 weeks).
<18yrs: not established.
Serotonin and norepinephrine reuptake inhibitor.
MAOIs (see Interactions). Concomitant linezolid or IV methylene blue.
Increased risk of suicidal thinking and behavior in children, adolescents, and young adults. Monitor BP; reduce dose or discontinue if elevated BP persists. Heart disease (eg, recent MI, heart failure). Hypercholesterolemia (consider monitoring in long-term use). Renal or hepatic dysfunction. Increased intraocular pressure. Diseases that affect metabolism or hemodynamic response (eg, hyperthyroidism). Mania. Seizure disorders. Reevaluate periodically.Write ℞ for smallest practical amount. Elderly. Labor & delivery. Pregnancy (Cat.C) (avoid 3rd trimester; see literature for effects on neonate). Nursing mothers: not recommended.
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. Risk of serotonin syndrome with concomitant serotonergic drugs (eg, triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone, St. John's Wort) and 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. False (+) urine immunoassay screening tests for PCP and amphetamine.
GI upset, dizziness, somnolence, insomnia, sexual dysfunction, sweating, dry mouth, nervousness, asthenia, tremor, vasodilation, hypertension, abnormal dreams or vision, yawn, paresthesia, agitation, ecchymosis, anorexia, weight changes; hyponatremia/SIADH (esp in elderly); rare: interstitial lung disease; eosinophilic pneumonia.
Caps—15, 30, 90; Tabs 25mg, 37.5mg—60; 50mg, 75mg—30; 100mg—20