Formulary
Venlafaxine: Indications, Dosing, Side Effects and Interactions
A serotonin and noradrenaline re-uptake inhibitor.
MedNext Academy | 4 min read
Venlafaxine: Indications, Dosing, Side Effects and Interactions
A serotonin and noradrenaline re-uptake inhibitor.
Drug action
A serotonin and noradrenaline re-uptake inhibitor.
Indications and dose
**Major depression**
- **Adult** (By Mouth Using Immediate-Release Medicines): 75 mg daily in 2 divided doses, then increased if necessary up to 375 mg daily in 2 divided doses, dose to be increased if necessary at intervals of at least 2 weeks, faster dose titration may be necessary in some patients.
- **Adult** (By Mouth Using Modified-Release Medicines): 75 mg once daily, increased if necessary up to 375 mg once daily, dose to be increased if necessary at intervals of at least 2 weeks, faster dose titration may be necessary in some patients.
**Generalised anxiety disorder**
- **Adult** (By Mouth Using Modified-Release Medicines): 75 mg once daily, increased if necessary up to 225 mg once daily, dose to be increased at intervals of at least 2 weeks.
**Social anxiety disorder**
- **Adult** (By Mouth Using Modified-Release Medicines): 75 mg once daily, there is no evidence of greater efficacy at higher doses, increased if necessary up to 225 mg once daily, dose to be increased if necessary at intervals of at least 2 weeks.
**Panic disorder**
- **Adult** (By Mouth Using Modified-Release Medicines): Initially 37.5 mg once daily for 7 days, increased to 75 mg once daily, increased if necessary up to 225 mg once daily, dose to be increased at intervals of at least 2 weeks.
**Menopausal symptoms, particularly hot flushes, in women with breast cancer**
- **Adult** (By Mouth Using Modified-Release Medicines): 37.5 mg once daily for one week, then increased if necessary to 75 mg once daily.
Cautions
Conditions associated with high risk of cardiac arrhythmia; diabetes; heart disease (monitor blood pressure); history of bleeding disorders; history of epilepsy; history or family history of mania; susceptibility to angle-closure glaucoma
Contraindications
Uncontrolled hypertension
Side effects
Common or very common Anxiety; appetite decreased; arrhythmias; asthenia; chills; confusion; constipation; depersonalisation; diarrhoea; dizziness; dry mouth; dyspnoea; headache; hot flush; hypertension; menstrual cycle irregularities; movement disorders; muscle tone increased; mydriasis; nausea; palpitations; paraesthesia; sedation; sexual dysfunction; skin reactions; sleep disorders; sweat changes; taste altered; tinnitus; tremor; urinary disorders; vision disorders; vomiting; weight changes; yawning Uncommon Alopecia; angioedema; apathy; behaviour abnormal; derealisation; haemorrhage; hallucination; hypotension; mood altered; photosensitivity reaction; syncope Rare or very rare Agranulocytosis; angle closure glaucoma; bone marrow disorders; delirium; hepatitis; hyponatraemia; interstitial lung disease; neuroleptic malignant syndrome; neutropenia; pancreatitis; pulmonary eosinophilia; QT interval prolongation; rhabdomyolysis; seizure; serotonin syndrome; severe cutaneous adverse reactions (SCARs); SIADH; thrombocytopenia Frequency not known Suicidal behaviours; vertigo; withdrawal syndrome Side-effects, further information Symptoms of sexual dysfunction may persist after treatment has stopped.
Interactions
**Severe interactions:**
- Severe adverse reactions have been reported in patients who have recently been discontinued from an MAOI and started on venlafaxine, or have recently had venlafaxine therapy discontinued prior to...
- Serotonin syndrome As with other serotonergic agents, serotonin syndrome, a potentially life-threatening condition, may occur with venlafaxine treatment, particularly with concomitant use of other...
- Relevant classes include: class Ia and III antiarrhythmics (e.g., quinidine, amiodarone, sotalol, dofetilide) some antipsychotics (e.g., thioridazine) some macrolides (e.g., erythromycin) ...
- Risperidone Venlafaxine increased the risperidone AUC by 50%, but did not significantly alter the pharmacokinetic profile of the total active moiety (risperidone plus 9-hydroxyrisperidone).
**Other interactions (32):**
- Venlafaxine must be discontinued for at least 7 days before starting treatment with an irreversible non-selective MAOI (see sections 4.3 and 4.4).
- Reversible, selective MAO-A inhibitor (moclobemide) Due to the risk of serotonin syndrome, the combination of venlafaxine with a reversible and selective MAOI, such as moclobemide, is not recommended.
- Following treatment with a reversible MAO-inhibitor, a shorter withdrawal period than 14 days may be used before initiation of venlafaxine treatment.
- It is recommended that venlafaxine should be discontinued for at least 7 days before starting treatment with a reversible MAOI (see section 4.4).
- Reversible, non-selective MAOI (linezolid) The antibiotic linezolid is a weak reversible and non-selective MAOI and should not be given to patients treated with venlafaxine (see section 4.4).
- John's Wort [ Hypericum perforatum ], opioids [e.g., fentanyl and its analogues, tramadol, dextromethorphan, tapentadol, pethidine, methadone, pentazocine, buprenorphine and buprenorphine/naloxone...
Pregnancy
Avoid unless potential benefit outweighs risk-toxicity in animal studies. Risk of withdrawal effects in neonate.
Breast feeding
Present in milk-avoid.
Hepatic impairment
Manufacturer advises caution (inter-individual variability in clearance; limited information available in severe impairment). Dose adjustments Manufacturer advises consider dose reduction of 50% in mild to moderate impairment and of more than 50% in severe impairment.
Renal impairment
Use with caution (inter-individual variability in clearance). M Dose adjustments Use half normal dose if eGFR less than 30 mL/minute/1.73 m 2 ; M see Prescribing in renal impairment .
Medicinal forms
Solution,Tablet,Tablet,Capsule,Solution
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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