Venlafaxine Side Effects, Usage, Dosage, and More

If you suffer from common mental health conditions like major depressive disorder, generalized anxiety disorder, and panic disorder, prescription venlafaxine may offer relief from your symptoms.

The drug is available as an extended-release antidepressant that can be taken in the form of an oral tablet once per day. It comes in strengths of 37.5 mg, 75 mg and 150 mg. 

What is venlafaxine?

Venlafaxine is a generic prescription drug that is also sold under the brand name of Effexor. Venlafaxine is an antidepressant that belongs to a class of drugs called serotonin and norepinephrine reuptake inhibitors (SNRIs). 

SNRIs act on the absorption of neurotransmitters in the brain, including serotonin and norepinephrine, and are used to treat a number of different mental health conditions.

As a result of the changes in brain chemistry, the patient’s mood and physical symptoms of their condition often improve.

The U.S. Food and Drug Administration (FDA) first approved venlafaxine for use in the United States in 1997.

While the medication was originally approved for the treatment of major depressive disorder, it has since been approved for the treatment of several other conditions.

The body converts the active ingredient of the medication, venlafaxine, into the active metabolite o-desmethylvenlafaxine. 

What conditions are treated with venlafaxine?

Since its initial approval for the treatment of major depressive disorder, also known as clinical depression, venlafaxine has been approved by the FDA for the treatment of other common mental illnesses, including generalized anxiety disorder, and panic disorder. A brief explanation of each of these conditions and their associated symptoms is provided below.

Major Depressive Disorder/Clinical Depression

Major depressive disorder, a common mental health condition that is sometimes referred to as clinical depression, is a severe form of depression that causes persistent, intense feelings of sadness. 

In order to be diagnosed with major depressive disorder, patients must experience symptoms for at least five of the following symptoms regularly for a period of two weeks:

• Sleeping and eating more or less than usual
• Feelings of worthlessness, guilt, hopelessness, or helplessness
• Difficult concentrating 
• Feeling sad, empty, or tearful
• Low energy
• Mood swings
• Loss of interest in activities that were previously enjoyed
• Suicidal thoughts or behaviors

While most people think of feelings of sadness and hopelessness when they think of depression, the condition is also associated with other mental, physical, and emotional symptoms.

Patients may experience physical changes, such as sleeping more or less than normal, eating more or less than normal, or having less energy than normal.

Changes in mood and behavior are also common, and they may be evidenced by changes to the patient’s daily habits. 

Many patients with major depressive disorder have difficulty performing routine daily tasks and may lose interest in performing activities or hobbies that they previously enjoyed. 

Major depressive disorder can become severe and commonly causes suicidal thoughts and behaviors. An estimated seven percent of American adults experience an episode of major depressive disorder each year. 

Generalized Anxiety Disorder

Anxiety is the body’s natural response to stress, but when these feelings become extreme or prolonged, they can cause an anxiety disorder.

Anxiety is the feeling we experience when we are afraid or uncertain about what is to come. 

Generalized anxiety disorder is a common type of anxiety disorder that is most frequently associated with symptoms like extreme fear or apprehension that is not rooted in an obvious cause and lasts for a period of at least six months.

These symptoms interfere with the patient’s quality of life and influence their behavior and decisions. 

Because the cause of the feelings associated with generalized anxiety disorder cannot be readily identified, most people with the condition recognize that their feelings are irrational but find themselves unable to control their anxiety.

Generalized anxiety disorder is marked by symptoms that include difficulty concentrating, increased heart rate, restlessness, rapid breathing, and difficulty falling asleep. 

Panic Disorder

A type of anxiety disorder associated with more acute symptoms is panic disorder. Panic disorder is a type of anxiety disorder that is characterized by recurrent panic attacks.

Panic attacks are episodes characterized by feelings of extreme fear and anxiety that come on suddenly and cause physical symptoms like chest pain, sweating, and racing heart rate. 

While most people will experience one or two panic attacks during their lifetime in a period of extreme distress, recurrent panic attacks are characterized as panic disorder.

If you have never experienced a panic attack, you might think you are experiencing a heart attack because of the similarity in the symptoms. Panic attacks usually do not have a clearly identifiable cause and are a terrifying experience. 

Symptoms of panic attacks include:

• Chest pain
• Trembling or shaking
• Numbness or tingling sensations
• Chills
• Headache
• Shortness of breath
• Sense of impending doom or danger
• Nausea
• Rapid, pounding heart rate
• Dizziness, lightheadedness, or faintness
• Hot flashes
• Feeling detached from reality
• Fear of loss of control 
• Sweating
• Abdominal cramping

How much does venlafaxine cost?

Like most other medications, the cost of venlafaxine varies tremendously based on whether the drug is purchased in its generic form or as the brand name Effexor.

As is usually the case, venlafaxine is much less expensive when purchased in its generic form because there are fewer marketing, research and development, and overhead costs associated with production of the medication. 

As  demonstrated in the table below, a one-month supply of Effexor XR costs about 40 times as much as a one-month supply of the same form and strength of venlafaxine HCL ER. 

Costs of a 30-Day Supply of Effexor XR and Venlafaxine HCL ER

	37.5 mg oral capsules	150 mg oral capsules
Effexor XR	$364.30	$405.70
Venlafaxine HCL ER	$8.50	$10.30

Most commercial insurance companies, Medicare, and Medicaid cover the cost of generic prescription drugs like venlafaxine. Unless the use of the brand name drug, Effexor, is medically necessary as demonstrated by a doctor, most insurance companies do not cover the cost of Effexor or provide drug coverage at a much lower rate. Patients should confirm their prescription drug coverage with their insurance.

Regardless of which type of prescription drug insurance coverage you have, if you have any at all, you can save money on the cost of both venlafaxine and Effexor when you use a pharmacy discount card to purchase your prescription.

Regardless of your insured status, you can benefit from a free pharmacy discount card. Pharmacy discount cards provide discounts on all brand-name and generic drugs that are approved by the FDA.

How do I know which dosage of venlafaxine is right for me?

The right dose of venlafaxine for you depends on a number of different factors, such as your age, what condition is being treated with the medication, and what form of the drug you are prescribed.

Your healthcare provider will help you find the right dose of the drug.  

It can take several tries before you find the right dose of an SNRI like venlafaxine.

Patients should anticipate having their dose changed several times over the course of several times before they find the dose that is best for them. 

Adults with major depressive disorder typically start taking venlafaxine at a dose of 75 mg taken by mouth once per day.

After your body has had time to adjust to the medication, you may be switched to a maintenance dose of 75 mg to 225 mg taken orally once per day depending on the condition being treated.

Patients with moderate depression are prescribed a maximum dose of 225 mg per day, while patients who are severely depressed may take up to 375 mg of venlafaxine per day.

When used to treat panic disorder, venlafaxine is used at an initial dose of 37.5 mg taken by mouth once per day for one week. After taking the medication for one week and becoming accustomed to the drug, the patient’s dose may be increased to 75 mg taken orally once per day.

The maintenance dose for venlafaxine when used to treat panic disorder is 75 mg to 225 mg taken orally once per day; the maximum dosage of venlafaxine for patients with panic disorder is 225 mg per day.

When used to treat generalized anxiety disorder in adults, venlafaxine is taken at an  initial dosage of 75 mg taken orally once per day. After adjusting to the medication, patients are typically prescribed a maintenance dose of between 75 mg and 225 mg taken orally once a day.

The maximum dose for adults with generalized anxiety disorder is 225 mg per day.

Can venlafaxine cause withdrawal symptoms?

Medications like venlafaxine, which act on the chemistry of the brain and may take up to six weeks to take full effect, are commonly associated with withdrawal symptoms. 

Because of the action of the medication on the chemistry of the brain, sudden discontinuation of the drug or abrupt reduction of your dose is likely to cause withdrawal symptoms when taking venlafaxine for more than four weeks. 

The longer you take venlafaxine, the more likely you are to experience withdrawal symptoms. However, anyone can experience withdrawal symptoms when taking venlafaxine. 

To minimize your risk of experiencing severe withdrawal symptoms, you should not stop or reduce your dose of venlafaxine without first consulting with a doctor about gradually lowering your dose. 

You should seek medical advice if you experience symptoms of venlafaxine withdrawal, including:

• Nightmares
• Irritability
• Vomiting
• Headache
• Nausea
• Dizziness
• Paresthesia (prickling or tingling sensations on the skin)

Are there any side effects associated with venlafaxine?

Side effects associated with venlafaxine can generally be classified as common and less common. Common side effects associated with venlafaxine usually do not require medical attention unless they are severe or do not go away. 

These side effects include:

• Yawning
• Trouble sleeping
• Vomiting
• Dry mouth
• Loss of appetite
• Headache
• Increased heart rate
• Irregular heartbeat
• High blood pressure
• High cholesterol
• Constipation
• Diarrhea
• Dizziness
• Blurred vision
• Nausea
• Drowsiness, tiredness or sleepiness
• Unusual dreams
• Sexual problems
• Nervousness
• Worsening sweating

It is rare, but venlafaxine can sometimes cause serious side effects that can be potentially dangerous. If you experience any of the following side effects while taking venlafaxine, seek medical attention immediately:  

• Suicidal thoughts and behaviors
• Shortness of breath or trouble breathing
• Severe itching
• Low sodium levels in the blood
• Seizures
• Abnormal bleeding
• Serotonin syndrome
• Manic episodes
• Swelling of the face, tongue, or mouth

This may not be a complete list of side effects. Consult a healthcare provider for other possible side effects associated with venlafaxine. 

Women who are breastfeeding or who are planning to breastfeed should not take venlafaxine, as it can pass into breast milk and cause withdrawal symptoms in infants.

Some patients may not be able to use venlafaxine safely, including patients who have medical conditions that include angle closure glaucoma, bleeding disorders, kidney disease, liver disease, or suicidal thoughts should not take venlafaxine or be closely monitored while taking the drug.

Potential drug interactions associated with venlafaxine include:

• Anticoagulants, such as warfarin
• Clozapine
• Methadone
• Buspirone
• Monoamine oxidase inhibitor (MAOIs) such as isocarboxazid, phenelzine, selegiline, and tranylcypromine
• Amphetamines
• Indinavir
• Nonsteroidal anti-inflammatory drugs (NSAIDS), such as ibuprofen and naproxen
• Ketoconazole
• Lithium
• Phentermine
• Amiodarone
• Sedatives
• Duloxetine
• Cimetidine
• Diuretics
• Linezolid
• Medications for migraines, including frovatriptan, naratriptan, almotriptan, zolmitriptan, eletriptan, rizatriptan, sumatriptan 
• Tranquilizers
• Ritonavir
• Tramadol
• Imipramine
• St. John’s wort
• Haloperidol
• Tryptophan
• Methylene blue
• Selective serotonin reuptake inhibitors (SSRIs), such as citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, and sertraline
• Sibutramine

This may not be a complete list of drug interactions. Consult a healthcare provider for other possible drug interactions associated with venlafaxine.

Venlafaxine is not approved for use in children, so make sure you store the drug at room temperature and out of the reach of children. 

Summary

Venlafaxine is a popular generic prescription drug that is commonly prescribed for the treatment of major depressive disorder, generalized anxiety disorder, and panic disorder in adults. 

Due to the long list of potential drug interactions associated with use of venlafaxine, patients should provide a complete list of all medications and supplements that they are taking. Venlafaxine commonly causes side effects like nausea, dry mouth, and dizziness. 

Patients can save money on the cost of venlafaxine or the brand name version of the drug, Effexor, by using a pharmacy discount card from Pharmacists.org.

References, Studies and Sources:

https://adaa.org/understanding-anxiety/generalized-anxiety-disorder-gad

https://www.health.harvard.edu/a_to_z/major-depression-a-to-z

https://www.drugs.com/dosage/venlafaxine.html