How To Take Effexor (Venlafaxine)

EFFEXOR XR (Venlafaxine)

EFFEXOR XR (Venlafaxine) is a slow release capsule and comes in 37.5, 75, and 150mg sizes.  It is a broad spectrum medication, which means it works by blocking reuptake of Serotonin (at 37.5 to 75mg) and norepinephrine (at 150mg+). Serotonin and norephinephrine are the two primary stress neuromodulators. Because Effexor XR works on both these neuromodulators, it is effective in treating anxiety and depression. When Effexor XR is taken, the brain levels of Serotonin and Norepinephrine are lowered if too high (as in anxiety), or raised if too low (as in depression).

Effexor XR has no significant drug/drug interactions and does not require dose decreases for the elderly.

HOW TO TAKE FOR ANXIETY/DEPRESSION

For mild to moderate symptoms
Week 1 37.5 mg in a.m. (after breakfast)
Week 2 75 mg in a.m.
Week 3+ 75 mg in a.m. if improving, if not, take 150 mg

For moderate to severe symptoms
Day 1 37.5mg in am
Day 2 & 3 37.5mg in am and at suppertime
Day 4+ 75mg in am and at suppertime

For severe symptoms
Day 1 37.5 mg in a.m. and at suppertime
Day 2 75 mg in a.m. and at suppertime
Day 3+ 150mg in a.m. and 75 mg at suppertime

PARTIAL DOSING

During transition, (if less than 37.5 or between 37.5 and 75mg is needed), capsules may be opened and used as a sprinkle form on any soft food. Sprinkled granules remain slow release unless bitten into.

PANIC PATIENTS NOTE: 

This step is especially important in panic disorder where initial doses as small as 9mg may be needed. It is essential to minimize side effects with panic patients because of extreme sensitivity to side effects. The dose can usually be gradually increased.

DO NOT abruptly stop the medication.  This can cause rebound symptoms such as muscle aches and nausea. When tapering the dose decrease by 37.5mg every 3 days. 

WHAT IS THE BEST DOSE TO TAKE FOR ME?

Take enough, not too much!  How much is that?  I don’t know.  Each person has to find the dose for him/her that achieves the goal of remission (completely back to normal functioning).

  • If you have some side effects but they are mild – remain on dose schedule
  • If side effects are bothering you – shift the dose time, split the dose or decrease the dose for 3-4 days, then try to go back up
  • If you have taken it for 1-2 weeks and not seeing significant benefit – increase the dose

SIDE EFFECTS

Possible side effects and suggestions for management.
Fatigue, Sluggishness First, shift the dose to evening meal. If still a problem, decrease the dose.
Delayed Orgasm Change dosing time to right after sex.
Nervousness Decrease or divide the dose, decrease caffeine intake.
Nausea Take with food, decrease dose or split dose for 3-4 days.
Sweating Take medication at suppertime, or decrease dose.  Adding Cardura (a mild blood pressure medication) may help.
Increased blood pressure This occurs occasionally in susceptible patients and is usually higher doses. Is easily managed by lowering dose, splitting dose, or adding Cardura. 

HOW DO I SWITCH FROM ANOTHER ANTIDEPRESSANT TO EFFEXOR XR?

Note: The most important rule of changeover is make only ONE change at a time. In other words don’t change the Effexor XR dose and SSRI dose both on the same day.

Use a “stagger” changeover schedule for 2½ weeks:
Days 1-4 37.5 mg Effexor XR in a.m. and current dose of SSRI in evening
Days 5-8 37.5 mg Effexor XR in a.m. and decrease SSRI by ¼ – ⅓
Days 9-12 75 mg Effexor XR in a.m. and SSRI dose not change
Days 13-16 75 mg Effexor XR in a.m. and decrease SSRI another ¼ – ⅓
2½ weeks Re-evaluate – if all is going well, discontinue current SSRI and consider going up on the Effexor XR if needed for symptoms.
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