venlafaxine hydrochloride

(vin lah facks' in)

Effexor, Effexor XR

Pregnancy Category C

Drug class
Antidepressant

Therapeutic actions
Potentiates the neurotransmitter activity in the CNS; inhibits serontonin, norepinephrine,
and dopamine reuptake leading to prolonged stimulation at neuroreceptors.

Indications
• Treatment of depression
• ER form: Treatment of generalized anxiety disorder
• Prevention of major depressive disorder relapse
• Treatment of social anxiety disorder

Contraindications and cautions

• Contraindicated with allergy to venlafaxine, use of MAOIs within last 14 days.
• Use cautiously with pregnancy, lactation.

Available forms
Tablets—25, 37.5, 50, 75, 100 mg; ER capsules—37.5, 75, 150 mg

Dosages
ADULTS
• Depression: Starting dose, 75 mg/day PO in 2 to 3 divided doses (or once a day,
ER capsule) taken with food. May be increased slowly up to 225 mg/day to
achieve desired effect.
• Transfer to or from MAOI: At least 14 days should elapse from the
discontinuation of the MAOI and the starting of venlafaxine; allow at least 7 days
to elapse from the stopping of venlafaxine to the starting of an MAOI.
• Generalized anxiety disorder: 75–225 mg/day PO should be taken on a daily
basis, not as needed.
• Prevention of major depressive disorder relapse: 75–225 mg/day PO or 75–
150 mg/day PO extended-release capsule.
• Social anxiety disorder: 75 mg/day PO as a single dose; range 75–225 mg/day.
PEDIATRIC PATIENTS
Safety and efficacy not established.
PATIENTS WITH RENAL OR HEPATIC IMPAIRMENT
For patients with creatinine clearance of 10–70 mL/min, reduce dosage by 25%. For
patients on dialysis, reduce dosage by 50% (give after dialysis completion on dialysis
days). For patients with hepatic impairment, reduce total daily dose by 50%, and increase
very slowly to achieve desired effect.
Pharmacokinetics
Route Onset Duration
Oral Slow 48 hr

Metabolism: Hepatic; T1/2: 1.3–2 hr

Distribution: Crosses placenta; may enter breast milk
Excretion: Urine

Adverse effects
• CNS: Somnolence, dizziness, insomnia, nervousness, anxiety, tremor, dreams
• CV: Vasodilation, hypertension, tachycardia
• Dermatologic: Sweating, rash, pruritus
• GI: Nausea, constipation, anorexia, diarrhea, vomiting, dyspepsia, dry mouth,
flatulence
• GU: Abnormal ejaculation, impotence, urinary frequency
• Other: Headache, asthenia, infection, chills, chest pain

Interactions
Drug-drug
• Increased serum levels and risk of toxicity with MAOIs (within last 14 days),
cimetidine
• Serotonin syndrome may occur if combined with trazodone
• Increased sedation with alcohol
Drug-alternative therapy
• Increased sedation and hypnotic effects with St. John's wort

Nursing considerations
Assessment
• History: Allergy to venlafaxine; use of MAOIs within last 14 days; pregnancy,
lactation
• Physical: Skin color, temperature, lesions; reflexes, gait, sensation, cranial nerve
evaluation; mucous membranes, abdominal exam, normal output; P, BP,
peripheral perfusion

Interventions
• Give with food to decrease GI effects.
• Advise patient to use contraceptives.

Teaching points
• Take with food to decrease GI upset.
• Avoid alcohol while using this drug.
• This drug cannot be taken during pregnancy; use birth control. If you become
pregnant, consult with your health care provider.
 • These side effects may occur: Loss of appetite, nausea, vomiting, dry mouth (use
frequent mouth care, eat frequent small meals, suck sugarless lozenges);
constipation (request bowel program); dizziness, drowsiness, tremor (avoid
driving or operating dangerous machinery).
• Report rash, hives, increased depression, pregnancy.

Adverse effects in Italic are most common; those in Bold are life-threatening.