VenlafaxineVenlafaxine Hydrochloride

About Venlafaxine

Labeled uses differ by form, all in adults: immediate-release tablets for major depressive disorder; Effexor XR capsules for depression, generalized anxiety, social anxiety and panic disorder; hydrochloride extended-release tablets for depression and social anxiety; and the besylate tablet for depression and generalized anxiety. Immediate-release tablets start at 75 mg a day in two or three doses with food and usually go no higher than 225 mg, though more severely depressed patients may take up to 375 mg in three doses. Capsules and hydrochloride tablets are taken once a day with food, usually from 75 mg (or 37.5 mg for four to seven days, and for a week in panic disorder) up to 225 mg; 75 mg is the recommended dose for social anxiety. The besylate 112.5 mg tablet is used only after at least four days on 75 mg or more of another extended-release form, up to 225 mg. Liver or kidney impairment calls for a lower dose.

The boxed warning says antidepressants increased the risk of suicidal thoughts and behaviors in children and young adults in short-term studies, so everyone taking it is watched closely; it is not approved for children. It must not be taken with an MAO inhibitor, including linezolid or intravenous methylene blue, or within 14 days of stopping one, and an MAO inhibitor waits 7 days after venlafaxine stops; anyone allergic to venlafaxine or desvenlafaxine must avoid it. It can cause sustained high blood pressure, so existing high blood pressure is controlled first and checked regularly. Other warnings cover serotonin syndrome, bleeding, angle-closure glaucoma, mania, seizures, low sodium, a rare lung inflammation, weight and height changes in children, and sexual problems. Nausea, sleepiness, dry mouth, sweating, abnormal ejaculation, loss of appetite and constipation are common, and cholesterol can rise.

Stopping suddenly can cause dizziness, nausea, headache, insomnia, nightmares, anxiety and electric shock sensations, and some people need several months to come off it. Capsules are swallowed whole or opened and the whole contents sprinkled on a spoonful of applesauce; extended-release tablets are swallowed whole, never divided, crushed, chewed or placed in water. The Effexor tablet brand has been discontinued, while Effexor XR is still sold. Venlafaxine can make urine screens falsely positive for phencyclidine (PCP) or amphetamine. Use in the month before delivery has been linked to heavy bleeding after birth, babies exposed late in pregnancy have needed prolonged hospital care, and venlafaxine passes into breast milk.

Taking Venlafaxine

How to take it

Immediate-release tablets two or three times a day with food; capsules and extended-release tablets once a day with food, in the morning or evening at about the same time. If a capsule is opened onto applesauce, swallow the mixture at once, then drink water. Do not stop it on your own.

If you miss a dose

Take it as soon as you remember, unless it is almost time for the next dose; then skip the missed dose. Do not take a double dose, and with extended-release capsules take no more than one dose a day.

Storage

At room temperature in the original, tightly closed container, away from excess heat and moisture (not in the bathroom), out of reach of children.

Interactions to know about

Never with an MAO inhibitor, within 14 days after stopping one, or within 7 days before starting one. Triptans, other antidepressants, tramadol, lithium, buspirone and St. John’s wort add to serotonin syndrome risk; aspirin, NSAIDs and blood thinners add to bleeding risk; CYP3A blockers raise its levels; weight-loss medicines such as phentermine are not recommended with it; and the label advises avoiding alcohol.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Venlafaxine differs from pharmacy to pharmacy

Generic capsules have many makers, and a prescription that names Effexor XR and blocks substitution is priced as a brand. Doses above 150 mg take more than one capsule, and immediate-release tablets are taken two or three times a day, so the count depends on the form written.

Hydrochloride extended-release tablets have fewer makers than the capsules, the besylate tablet has one, and neither can be swapped for capsules at the counter.

Ways to pay less for Venlafaxine without insurance

• Ask for generic venlafaxine, and make sure the prescription does not name a brand only.
• If extended-release tablets are prescribed, ask the prescriber whether generic extended-release capsules would suit you.
• Ask for quotes on your daily dose as one capsule and as smaller ones, and for a ninety-day supply once your dose is settled.
• Compare more than one pharmacy, and refill early enough never to run out.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Venlafaxine

1. 1.Is my prescription for capsules, hydrochloride tablets or the besylate tablet, and can any of them be swapped?
2. 2.How often should my blood pressure be checked?
3. 3.Do any of my pain, migraine, weight-loss or blood-thinning medicines interact with it?
4. 4.How slowly should my dose be lowered if I need to stop?

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