Venlafaxine: Wikis

  
  

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1 : 1 mixture (racemate)
Systematic (IUPAC) name
(RS)-1-[2-dimethylamino-1-(4-methoxyphenyl)-ethyl]cyclohexanol
Identifiers
CAS number 93413-69-5
ATC code N06AX16
PubChem 5656
DrugBank APRD00125
ChemSpider 56641
Chemical data
Formula C17H27NO2 
Mol. mass 277.402 g/mol
SMILES eMolecules & PubChem
Pharmacokinetic data
Bioavailability 45%
Protein binding 27%
Metabolism Hepatic
Half life 5 ± 2 h (parent compound); 11 ± 2 h (active metabolite)
Excretion Renal
Therapeutic considerations
Pregnancy cat. C
Legal status POM (UK) -only (US)
Routes Oral
 Yes check.svgY(what is this?)  (verify)
.Venlafaxine (Effexor, Efexor, Alventa, Argofan, Trevilor) is an arylalkanolamine serotonin-norepinephrine reuptake inhibitor (SNRI)[1].^ If this doesn't work, then I might try fluoxetine (generic Prozac), which is a very inexpensive selective serotonin reuptake inhibitor or SSRI. If this fails, several alternatives are available.

^ The SSRI or Selective Serotonin Reuptake Inhibitor family of medicines are currently the most popular type of anti-depressant medications.

^ Table 6.13 -- Symptoms of Serotonin Reuptake Inhibitor Withdrawal Syndrome .
  • ADHD Overview 17 January 2010 5:36 UTC www.vakkur.com [Source type: Academic]

.First introduced by Wyeth in 1993, it is licensed for the treatment of major depressive disorder (MDD), as an anxiolytic, and comorbid indications.^ Phases of treatment of major depression.
  • Using Second-Generation Antidepressants to Treat Depressive Disorders: A Clinical Practice Guideline from the American College of Physicians — Ann Intern Med 17 January 2010 5:36 UTC www.annals.org [Source type: Academic]

^ Efficacy of sertraline in the treatment of children and adolescents with major depressive disorder.
  • Antidepressants - Pharmacy Clinical Policy Bulletins Aetna Non-Medicare Prescription Drug Plan 17 January 2010 5:36 UTC www.aetna.com [Source type: Academic]

^ Escitalopram in the treatment of major depressive disorder: a meta-analysis.
  • Effexor withdrawal. Effexor withdrawal side effects, Effexor withdrawal warnings, Effexor withdrawal precautions, Effexor withdrawal adverse effects. 17 January 2010 5:36 UTC prozactruth.com [Source type: Academic]

.In 2007, venlafaxine was the sixth most commonly prescribed antidepressant on the U.S. retail market, with 17.2 million prescriptions.^ In addition, a September 2004 Consumer Reports study ranked venlafaxine as the most effective among six commonly prescribed antidepressants.
  • HMDB: Showing Venlafaxine (HMDB05016) 17 January 2010 5:36 UTC hmdb.ca [Source type: Academic]

^ A comparison of duloxetine with fluoxetine has been performed but no comparison with venlafaxine, the other antidepressant in the same therapeutic class with a significant market share, has been undertaken.
  • BioMed Central | Full text | Duloxetine compared with fluoxetine and venlafaxine: use of meta-regression analysis for indirect comparisons 17 January 2010 5:36 UTC www.biomedcentral.com [Source type: Academic]

[2] .In children and adolescents, venlafaxine (like other anti-depressants) has a potential to increase suicidal thoughts, attempts and events of self-harm.^ Depression in children and adolescents.
  • Effexor withdrawal. Effexor withdrawal side effects, Effexor withdrawal warnings, Effexor withdrawal precautions, Effexor withdrawal adverse effects. 17 January 2010 5:36 UTC prozactruth.com [Source type: Academic]

^ However, studies have shown that a small number of people (especially children/teenages) who take antidepressants for any condition may experience worsening depression, other mental/mood symptoms, or suicidal thoughts/attempts.
  • Psych Central Reviews - Effexor (venlafaxine) 17 January 2010 5:36 UTC forums.psychcentral.com [Source type: General]
  • Psych Central Reviews - Effexor (venlafaxine) 17 January 2010 5:36 UTC forums.psychcentral.com [Source type: General]

^ FDA ALERT [07/2005]: Suicidal Thoughts or Actions in Children and Adults Patients with depression or other mental illnesses often think about or attempt suicide.
  • Effexor withdrawal. Effexor withdrawal side effects, Effexor withdrawal warnings, Effexor withdrawal precautions, Effexor withdrawal adverse effects. 17 January 2010 5:36 UTC prozactruth.com [Source type: Academic]

Contents

Indications

Approved

.Venlafaxine is used primarily for the treatment of major depression, generalized anxiety disorder, social anxiety disorder, obsessive–compulsive disorder, panic disorder, and menopausal hot flashes in adults.^ Duloxetine: a review of its use in the treatment of generalized anxiety disorder.
  • Effexor withdrawal. Effexor withdrawal side effects, Effexor withdrawal warnings, Effexor withdrawal precautions, Effexor withdrawal adverse effects. 17 January 2010 5:36 UTC prozactruth.com [Source type: Academic]

^ Effexor XR (venlafaxine) for Generalized Anxiety Disorder : I've used Paxil to treat what was panic disorder and generalized anxiety disorder.
  • venlafaxine systemic User Reviews at Drugs.com 17 January 2010 5:36 UTC www.drugs.com [Source type: General]

^ Phases of treatment of major depression.
  • Using Second-Generation Antidepressants to Treat Depressive Disorders: A Clinical Practice Guideline from the American College of Physicians — Ann Intern Med 17 January 2010 5:36 UTC www.annals.org [Source type: Academic]

[3]

Depression

.Multiple double blind studies show venlafaxine's effectiveness in treating depression.^ Double-blind, randomized comparison of mirtazapine and paroxetine in elderly depressed patients.
  • Using Second-Generation Antidepressants to Treat Depressive Disorders: A Clinical Practice Guideline from the American College of Physicians — Ann Intern Med 17 January 2010 5:36 UTC www.annals.org [Source type: Academic]

^ Adverse Reactions Associated with Discontinuation of Treatment: Nineteen percent (537/2897) of venlafaxine-treated patients in Phase II and III depression studies discontinued treatment due to an adverse reaction (see Table II).
  • Effexor withdrawal. Effexor withdrawal side effects, Effexor withdrawal warnings, Effexor withdrawal precautions, Effexor withdrawal adverse effects. 17 January 2010 5:36 UTC prozactruth.com [Source type: Academic]

^ Limited evidence (48, 49) showed similar efficacy among fluoxetine, nefazodone, paroxetine, and sertraline for treating depression in patients with accompanying insomnia.
  • Using Second-Generation Antidepressants to Treat Depressive Disorders: A Clinical Practice Guideline from the American College of Physicians — Ann Intern Med 17 January 2010 5:36 UTC www.annals.org [Source type: Academic]

.Venlafaxine has similar efficacy to the tricyclic antidepressants amitriptyline (Elavil) and imipramine and is better tolerated than amitriptyline.^ First-generation antidepressants (tricyclic antidepressants and monoamine oxidase inhibitors) are less commonly used than second-generation antidepressants, which have similar efficacy to and lower toxicity in overdose than first-generation antidepressants.
  • Using Second-Generation Antidepressants to Treat Depressive Disorders: A Clinical Practice Guideline from the American College of Physicians — Ann Intern Med 17 January 2010 5:36 UTC www.annals.org [Source type: Academic]

^ Efficacy and tolerability of selective serotonin reuptake inhibitors compared with tricyclic antidepressants in depression treated in primary care: systematic review and meta-analysis.
  • Antidepressants - Pharmacy Clinical Policy Bulletins Aetna Non-Medicare Prescription Drug Plan 17 January 2010 5:36 UTC www.aetna.com [Source type: Academic]

^ Patient compliance with the newer antidepressants is considerably better than with the old.
  • Access and Utilization of New Antidepressant and Antipsychotic Medications 17 January 2010 5:36 UTC aspe.os.dhhs.gov [Source type: Academic]

.Its efficacy is similar to or better than sertraline (Zoloft) and fluoxetine (Prozac), depending on the criteria and rating scales used.^ First-generation antidepressants (tricyclic antidepressants and monoamine oxidase inhibitors) are less commonly used than second-generation antidepressants, which have similar efficacy to and lower toxicity in overdose than first-generation antidepressants.
  • Using Second-Generation Antidepressants to Treat Depressive Disorders: A Clinical Practice Guideline from the American College of Physicians — Ann Intern Med 17 January 2010 5:36 UTC www.annals.org [Source type: Academic]

^ Evidence from 1 fair-quality head-to-head trial showed that fluoxetine and sertraline had similar antidepressive efficacy in patients with psychomotor retardation but sertraline had better efficacy in patients with psychomotor agitation (44) .
  • Using Second-Generation Antidepressants to Treat Depressive Disorders: A Clinical Practice Guideline from the American College of Physicians — Ann Intern Med 17 January 2010 5:36 UTC www.annals.org [Source type: Academic]

^ Limited evidence (48, 49) showed similar efficacy among fluoxetine, nefazodone, paroxetine, and sertraline for treating depression in patients with accompanying insomnia.
  • Using Second-Generation Antidepressants to Treat Depressive Disorders: A Clinical Practice Guideline from the American College of Physicians — Ann Intern Med 17 January 2010 5:36 UTC www.annals.org [Source type: Academic]

.Higher doses of venlafaxine are more effective, and more patients achieved remission or were "very much improved". The efficacy was similar if the number of patients who achieved "response" or were "improved" was considered.^ Furthermore, the proportion of patients considered to be in remission (ie, essentially symptom free) at endpoint, based on achieving a MADRS total score 10, was 46% for paroxetine and 63% for venlafaxine, again reflective of a substantial treatment response; however, without a placebo control group, these efficacy data must be interpreted cautiously.
  • Neuropsychopharmacology - Estimates of Serotonin and Norepinephrine Transporter Inhibition in Depressed Patients Treated with Paroxetine or Venlafaxine 17 January 2010 5:36 UTC www.nature.com [Source type: Academic]

^ To put this level of MADRS change in clinical perspective using other efficacy endpoints, the mean proportion of patients considered to be either much improved or very much improved at endpoint based on the CGI was approximately 70% for paroxetine and 80% for venlafaxine.
  • Neuropsychopharmacology - Estimates of Serotonin and Norepinephrine Transporter Inhibition in Depressed Patients Treated with Paroxetine or Venlafaxine 17 January 2010 5:36 UTC www.nature.com [Source type: Academic]

^ For patients who have had 2 or more episodes of depression, an even longer duration of therapy may be beneficial (Grade: strong recommendation; moderate-quality evidence).
  • Using Second-Generation Antidepressants to Treat Depressive Disorders: A Clinical Practice Guideline from the American College of Physicians — Ann Intern Med 17 January 2010 5:36 UTC www.annals.org [Source type: Academic]

.A meta-analysis comparing venlafaxine and combined groups of SSRI or tricyclic antidepressants showed venlafaxine's superiority.^ Comprehensive analysis of remission (COMPARE) with venlafaxine versus SSRIs.
  • Neuropsychopharmacology - Estimates of Serotonin and Norepinephrine Transporter Inhibition in Depressed Patients Treated with Paroxetine or Venlafaxine 17 January 2010 5:36 UTC www.nature.com [Source type: Academic]

^ While we recognize that none of the trials involving duloxetine used venlafaxine as an active comparator, our results are in accordance with a recent meta-analysis comparing duloxetine and venlafaxine in the treatment of MDD [ 45 ] and a review comparing second-generation antidepressants [ 46 ].
  • BioMed Central | Full text | Duloxetine compared with fluoxetine and venlafaxine: use of meta-regression analysis for indirect comparisons 17 January 2010 5:36 UTC www.biomedcentral.com [Source type: Academic]

^ The effect of venlafaxine compared with other antidepressants and placebo in the treatment of major depression: A meta-analysis.
  • Effexor withdrawal. Effexor withdrawal side effects, Effexor withdrawal warnings, Effexor withdrawal precautions, Effexor withdrawal adverse effects. 17 January 2010 5:36 UTC prozactruth.com [Source type: Academic]

[4] .Judged by the same criteria, venlafaxine was similar in efficacy to the atypical antidepressant bupropion (Wellbutrin); however, the remission rate was significantly lower for venlafaxine.^ First-generation antidepressants (tricyclic antidepressants and monoamine oxidase inhibitors) are less commonly used than second-generation antidepressants, which have similar efficacy to and lower toxicity in overdose than first-generation antidepressants.
  • Using Second-Generation Antidepressants to Treat Depressive Disorders: A Clinical Practice Guideline from the American College of Physicians — Ann Intern Med 17 January 2010 5:36 UTC www.annals.org [Source type: Academic]

^ Evidence from 6 fair-quality head-to-head trials comparing fluoxetine or paroxetine with sertraline, sertraline with bupropion, and sertraline with venlafaxine showed similar antidepressive efficacy for patients with MDD and anxiety symptoms ( 23 , 42–47 ).
  • Using Second-Generation Antidepressants to Treat Depressive Disorders: A Clinical Practice Guideline from the American College of Physicians — Ann Intern Med 17 January 2010 5:36 UTC www.annals.org [Source type: Academic]

^ However, this should not be considered a definitive finding, since responses to psychiatric medications can vary significantly from individual to individual; Venlafaxine hydrochloride is a prescription antidepressant that belongs to the class of antidepressants called serotonin-norepinephrine reuptake inhibitors (SNRI).
  • HMDB: Showing Venlafaxine (HMDB05016) 17 January 2010 5:36 UTC hmdb.ca [Source type: Academic]

[5] .In a double-blind study, patients who did not respond to an SSRI were switched to venlafaxine or citalopram.^ Patients were included who had switched from an SSRI after at least two consecutive months of therapy followed by at least two consecutive months of a TCA (n=172) or venlafaxine (n=188).
  • Access and Utilization of New Antidepressant and Antipsychotic Medications 17 January 2010 5:36 UTC aspe.os.dhhs.gov [Source type: Academic]

^ The results of these studies exhibit mild evidence for venlafaxine being more cost-effective than SSRIs.
  • Access and Utilization of New Antidepressant and Antipsychotic Medications 17 January 2010 5:36 UTC aspe.os.dhhs.gov [Source type: Academic]

^ Bielski RJ , Ventura D , Chang CC A double-blind comparison of escitalopram and venlafaxine extended release in the treatment of major depressive disorder.
  • Using Second-Generation Antidepressants to Treat Depressive Disorders: A Clinical Practice Guideline from the American College of Physicians — Ann Intern Med 17 January 2010 5:36 UTC www.annals.org [Source type: Academic]

Similar improvement was observed in both groups.[6]

Off-label / investigational uses

.Many doctors are starting to prescribe venlafaxine "off label" for the treatment of diabetic neuropathy (in a similar manner to duloxetine) and migraine prophylaxis (in some people, however, venlafaxine can exacerbate or cause migraines).^ Effexor XR (venlafaxine) for Depression : I started taking Effexor XR 3 1/2 years ago while in an eating disorder treatment center.
  • venlafaxine systemic User Reviews at Drugs.com 17 January 2010 5:36 UTC www.drugs.com [Source type: General]

^ However...beware that this medication -- despite what ANY doctor tells you -- will cause rapid weight gain.
  • Psych Central Reviews - Effexor (venlafaxine) 17 January 2010 5:36 UTC forums.psychcentral.com [Source type: General]

^ Effexor XR (venlafaxine) for Depression : I've just started using it, to take the edge off of anxiety and panic problems.
  • venlafaxine systemic User Reviews at Drugs.com 17 January 2010 5:36 UTC www.drugs.com [Source type: General]

.Studies have shown venlafaxine's effectiveness for these conditions.^ Venlafaxine was shown to be effective for depression in multiple double blind studies.
  • Venlafaxine: Encyclopedia of chemistry, analytics & pharmaceutics with 64,557 entries. 17 January 2010 5:36 UTC www.chemie.de [Source type: Academic]

^ Studies have shown venlafaxine's effectiveness for these conditions.
  • Venlafaxine: Encyclopedia of chemistry, analytics & pharmaceutics with 64,557 entries. 17 January 2010 5:36 UTC www.chemie.de [Source type: Academic]

^ Only venlafaxine has been shown to be effective in refractory patients in an open study.
  • Virtual Hospital: Clinical Psychopharmacology Seminar : Venlafaxine (Effexor®) 17 January 2010 5:36 UTC www.tu.edu [Source type: Academic]

[7][8] .It has also been found to reduce the severity of 'hot-flashes' in menopausal women.^ My hot flashes were very severe.
  • venlafaxine systemic User Reviews at Drugs.com 17 January 2010 5:36 UTC www.drugs.com [Source type: General]

^ It has also been found to reduce the severity of 'hot-flashes' in menopausal women.
  • Venlafaxine: Encyclopedia of chemistry, analytics & pharmaceutics with 64,557 entries. 17 January 2010 5:36 UTC www.chemie.de [Source type: Academic]

^ Intervention Details: Drug: venlafaxine Venlafaxine taper dose from 37.5mg for one week to 75 mg for 3 weeks Detailed Description: Hot flashes are the most severe and fourth most prevalent menopausal symptom reported by women with breast cancer.
  • Venlafaxine for Hot Flashes After Breast Cancer - Full Text View - ClinicalTrials.gov 17 January 2010 5:36 UTC clinicaltrials.gov [Source type: Academic]

[9][10]
.Substantial weight loss in patients with major depression, generalized anxiety disorder, and social phobia has been noted, but the manufacturer does not recommend use as an anorectic either alone or in combination with phentermine or other amphetamine-like drugs.^ Duloxetine: a review of its use in the treatment of generalized anxiety disorder.
  • Effexor withdrawal. Effexor withdrawal side effects, Effexor withdrawal warnings, Effexor withdrawal precautions, Effexor withdrawal adverse effects. 17 January 2010 5:36 UTC prozactruth.com [Source type: Academic]

^ It is also used for other general depressive disorders.
  • HMDB: Showing Venlafaxine (HMDB05016) 17 January 2010 5:36 UTC hmdb.ca [Source type: Academic]

^ Generalized Anxiety Disorder : After several years/bouts of physical anxiety this was like a wonder drug.
  • venlafaxine systemic User Reviews at Drugs.com 17 January 2010 5:36 UTC www.drugs.com [Source type: General]

[3] .Venlafaxine hydrochloride is in the phenethylamine class of modern chemicals, which includes amphetamine, methylendioxymethamphetamine (MDMA), and methamphetamine.^ Antidepressant Venlafaxine is a phenethylamine bicyclic derivative, chemically unrelated to tricyclic, tetracyclic or other available antidepressant agents.
  • Effexor withdrawal. Effexor withdrawal side effects, Effexor withdrawal warnings, Effexor withdrawal precautions, Effexor withdrawal adverse effects. 17 January 2010 5:36 UTC prozactruth.com [Source type: Academic]

^ The chemical structure of venlafaxine is designated (R/S)-1-[2-(dimethylamino)-1-(4 methoxyphenyl)ethyl] cyclohexanol hydrochloride or (+/-)-1-[alpha [alpha- (dimethylamino)methyl] p-methoxybenzyl] cyclohexanol hydrochloride and it has the empirical formula of C17H27NO2.
  • HMDB: Showing Venlafaxine (HMDB05016) 17 January 2010 5:36 UTC hmdb.ca [Source type: Academic]

.This chemical structure likely lends to its activating properties; however, some patients find venlafaxine highly sedating despite its more common stimulatory effects.^ However, haloperidol patients were more likely to be admitted to day hospitals.
  • Access and Utilization of New Antidepressant and Antipsychotic Medications 17 January 2010 5:36 UTC aspe.os.dhhs.gov [Source type: Academic]

^ However, I have had some severe side effects.
  • venlafaxine systemic User Reviews at Drugs.com 17 January 2010 5:36 UTC www.drugs.com [Source type: General]

^ However, patients initiating on amitriptyline were more than three times as likely to require a change in antidepressant pharmacotherapy, while patients initially prescribed nortriptyline were nearly four times more likely to change medication relative to patients initially prescribed fluoxetine.
  • Access and Utilization of New Antidepressant and Antipsychotic Medications 17 January 2010 5:36 UTC aspe.os.dhhs.gov [Source type: Academic]

.Venlafaxine is not approved for the treatment of depressive phases of bipolar disorder; this has some potential danger as venlafaxine can induce mania, mixed states, rapid cycling and/or psychosis in some bipolar patients, particularly if they are not also being treated with a mood stabilizer.^ Phases of treatment of major depression.
  • Using Second-Generation Antidepressants to Treat Depressive Disorders: A Clinical Practice Guideline from the American College of Physicians — Ann Intern Med 17 January 2010 5:36 UTC www.annals.org [Source type: Academic]

^ Effexor (venlafaxine) for Bipolar Disorder : I'm on Effexor 150mg.
  • venlafaxine systemic User Reviews at Drugs.com 17 January 2010 5:36 UTC www.drugs.com [Source type: General]

^ Venlafaxine is used to treat major depressive disorder, anxiety, and panic disorder.
  • Psych Central Reviews - Effexor (venlafaxine) 17 January 2010 5:36 UTC forums.psychcentral.com [Source type: General]
  • Psych Central Reviews - Effexor (venlafaxine) 17 January 2010 5:36 UTC forums.psychcentral.com [Source type: General]

[3]
.Due to its action on both the serotoninergic and adrenergic systems, venlafaxine is also used as a treatment to reduce episodes of cataplexy, a form of muscle weakness, in patients with the sleep disorder narcolepsy.^ Effexor XR (venlafaxine) for Depression : I started taking Effexor XR 3 1/2 years ago while in an eating disorder treatment center.
  • venlafaxine systemic User Reviews at Drugs.com 17 January 2010 5:36 UTC www.drugs.com [Source type: General]

^ The present invention provides a novel salt of O-desmethyl-venlafaxine, O-desmethyl-venlafaxine succinate, as well as polymorphs, pharmaceutical compositions, dosage forms, and methods of use with the same.
  • Succinate salt of O-desmethyl-venlafaxine - Patent 7026508 17 January 2010 5:36 UTC www.freepatentsonline.com [Source type: Academic]

^ Bielski RJ , Ventura D , Chang CC A double-blind comparison of escitalopram and venlafaxine extended release in the treatment of major depressive disorder.
  • Using Second-Generation Antidepressants to Treat Depressive Disorders: A Clinical Practice Guideline from the American College of Physicians — Ann Intern Med 17 January 2010 5:36 UTC www.annals.org [Source type: Academic]

[11]
.Venlafaxine was found in one study to be equal to Anafranil (Clomipramine) in the treatment of OCD with fewer side effects.^ After one year no side effects.
  • venlafaxine systemic User Reviews at Drugs.com 17 January 2010 5:36 UTC www.drugs.com [Source type: General]

^ This is similar to rates found in studies of hormonal agents, but makes it more difficult to ascertain the true effects of therapy on hot flashes.
  • Nonhormonal Therapies for Hot Flashes in Menopause - February 1, 2006 - American Family Physician 17 January 2010 5:36 UTC www.aafp.org [Source type: Academic]

^ Dose-finding study of fluoxetine and venlafaxine for the treatment of self-injurious and stereotypic behavior in rhesus macaques (Macaca mulatta).
  • Effexor withdrawal. Effexor withdrawal side effects, Effexor withdrawal warnings, Effexor withdrawal precautions, Effexor withdrawal adverse effects. 17 January 2010 5:36 UTC prozactruth.com [Source type: Academic]

[12]
.Due to its tendency to increase blood pressure and its modulative effects on the autonomic nervous system, venlafaxine is often used to treat orthostatic intolerance and postural orthostatic tachycardia syndrome.^ In the trials using venlafaxine for hot flashes there were no reported increases in blood pressure, which is a dose-related adverse effect commonly associated with this agent.
  • Nonhormonal Therapies for Hot Flashes in Menopause - February 1, 2006 - American Family Physician 17 January 2010 5:36 UTC www.aafp.org [Source type: Academic]

^ Johns Wort should be avoided while taking fluvoxamine due to the increased side effects of too much serotonin.
  • Psych Central Reviews - Effexor (venlafaxine) 17 January 2010 5:36 UTC forums.psychcentral.com [Source type: General]
  • Psych Central Reviews - Effexor (venlafaxine) 17 January 2010 5:36 UTC forums.psychcentral.com [Source type: General]

^ Evidence evaluating adverse events, such as seizures, cardiovascular risks (increases in systolic or diastolic blood pressure and pulse or heart rate), hyponatremia, hepatotoxicity, or the serotonin syndrome, is scarce but should be kept in mind when patients are being treated with a second-generation antidepressant.
  • Using Second-Generation Antidepressants to Treat Depressive Disorders: A Clinical Practice Guideline from the American College of Physicians — Ann Intern Med 17 January 2010 5:36 UTC www.annals.org [Source type: Academic]

[13]

Contraindications

.Venlafaxine is contraindicated in children and adolescents because it can increase suicidal thoughts, attempts, and self-harm (see Venlafaxine#Suicidality).^ The U.S. Food and Drug Administration advises that all patients receiving antidepressants be closely monitored on a regular basis for increases in suicidal thoughts and behaviors (100) .
  • Using Second-Generation Antidepressants to Treat Depressive Disorders: A Clinical Practice Guideline from the American College of Physicians — Ann Intern Med 17 January 2010 5:36 UTC www.annals.org [Source type: Academic]

^ Taking antidepressants may increase suicidal thoughts and actions in about 1 out of 50 people 18 years or younger.
  • Effexor withdrawal. Effexor withdrawal side effects, Effexor withdrawal warnings, Effexor withdrawal precautions, Effexor withdrawal adverse effects. 17 January 2010 5:36 UTC prozactruth.com [Source type: Academic]

^ In addition, SSRIs are associated with an increased risk for suicide attempts compared with placebo.
  • Using Second-Generation Antidepressants to Treat Depressive Disorders: A Clinical Practice Guideline from the American College of Physicians — Ann Intern Med 17 January 2010 5:36 UTC www.annals.org [Source type: Academic]

.Furthermore, studies of venlafaxine in these age groups have not established its efficacy or safety.^ Children: Safety and efficacy in children below the age of 18 have not been established.
  • Effexor withdrawal. Effexor withdrawal side effects, Effexor withdrawal warnings, Effexor withdrawal precautions, Effexor withdrawal adverse effects. 17 January 2010 5:36 UTC prozactruth.com [Source type: Academic]

^ The results of these studies exhibit mild evidence for venlafaxine being more cost-effective than SSRIs.
  • Access and Utilization of New Antidepressant and Antipsychotic Medications 17 January 2010 5:36 UTC aspe.os.dhhs.gov [Source type: Academic]

^ Efficacy and effectiveness of these agents do not differ among subgroups based on age, sex, or race or ethnicity.
  • Using Second-Generation Antidepressants to Treat Depressive Disorders: A Clinical Practice Guideline from the American College of Physicians — Ann Intern Med 17 January 2010 5:36 UTC www.annals.org [Source type: Academic]

[14] .Venlafaxine is not recommended in patients hypersensitive to venlafaxine.^ Venlafaxine is not recommended in patients hypersensitive to venlafaxine.
  • Venlafaxine: Encyclopedia of chemistry, analytics & pharmaceutics with 64,557 entries. 17 January 2010 5:36 UTC www.chemie.de [Source type: Academic]

^ Contraindications Venlafaxine is not recommended in patients hypersensitive to venlafaxine.
  • Venlafaxine - Drug information from Medic8.com 17 January 2010 5:36 UTC www.medic8.com [Source type: Academic]

^ Measurement of blood pressure is therefore recommended for patients receiving venlafaxine.
  • Efexor - Summary of Product Characteristics (SPC) - electronic Medicines Compendium (eMC) 17 January 2010 5:36 UTC emc.medicines.org.uk [Source type: Academic]

It should not be taken by anyone who is allergic to the inactive ingredients, which include gelatin, cellulose, ethylcellulose, iron oxide, titanium dioxide and hypromellose. .It should never be used with a monoamine oxidase inhibitor (MAOI), as it can cause potentially deadly serotonin syndrome.^ First-generation antidepressants (tricyclic antidepressants and monoamine oxidase inhibitors) are less commonly used than second-generation antidepressants, which have similar efficacy to and lower toxicity in overdose than first-generation antidepressants.
  • Using Second-Generation Antidepressants to Treat Depressive Disorders: A Clinical Practice Guideline from the American College of Physicians — Ann Intern Med 17 January 2010 5:36 UTC www.annals.org [Source type: Academic]

^ Hypertensive crisis (ie, markedly elevated blood pressure) and serotonin syndrome can occur when monoamine oxidase inhibitors are combined with noradrenergic and serotonin agonists, respectively.
  • ADHD Overview 17 January 2010 5:36 UTC www.vakkur.com [Source type: Academic]

^ Serotonin reuptake inhibitor withdrawal syndrome can be remembered by using the mnemonic FLUSH: .
  • ADHD Overview 17 January 2010 5:36 UTC www.vakkur.com [Source type: Academic]

.At least 14 days must pass between the use of venlafaxine and MAO inhibitors.^ Avoid using this medicine with MAO inhibitors.
  • Psych Central Reviews - Effexor (venlafaxine) 17 January 2010 5:36 UTC forums.psychcentral.com [Source type: General]
  • Psych Central Reviews - Effexor (venlafaxine) 17 January 2010 5:36 UTC forums.psychcentral.com [Source type: General]

^ Do not take this medicine within 14 days of stopping MAO inhibitors.
  • Psych Central Reviews - Effexor (venlafaxine) 17 January 2010 5:36 UTC forums.psychcentral.com [Source type: General]
  • Psych Central Reviews - Effexor (venlafaxine) 17 January 2010 5:36 UTC forums.psychcentral.com [Source type: General]

^ Therefore, venlafaxine should not be used in combination with MAO inhibitors or within two weeks of terminating treatment with MAO inhibitor's.
  • Effexor withdrawal. Effexor withdrawal side effects, Effexor withdrawal warnings, Effexor withdrawal precautions, Effexor withdrawal adverse effects. 17 January 2010 5:36 UTC prozactruth.com [Source type: Academic]

.Caution should also be used in those with a seizure disorder.^ Caution should also be used in those with a seizure disorder.
  • Venlafaxine - Drug information from Medic8.com 17 January 2010 5:36 UTC www.medic8.com [Source type: Academic]
  • Venlafaxine: Encyclopedia of chemistry, analytics & pharmaceutics with 64,557 entries. 17 January 2010 5:36 UTC www.chemie.de [Source type: Academic]

^ These medicines must be used very carefully in those who have bipolar disorder because they may trigger a manic episode.
  • Why You May Need Atypical Antidepressants - Depression - Health.com 17 January 2010 5:36 UTC www.health.com [Source type: General]

^ When the medication is used in elderly people and patients of advanced age, it does not need any dose correction, but it should be administered with caution, as many elderly patients also suffer from such diseases as disorder of kidney functioning and other.
  • Buy Effexor. generic - Venlafaxine 17 January 2010 5:36 UTC www.tl-pharmacy.com [Source type: FILTERED WITH BAYES]

Glaucoma

.Venlafaxine can increase eye pressure, so those with glaucoma may require more frequent eye checks.^ Venlafaxine may be prepared in accordance with procedures known in the art, such as those described in U.S. Pat.
  • Succinate salt of O-desmethyl-venlafaxine - Patent 7026508 17 January 2010 5:36 UTC www.freepatentsonline.com [Source type: Academic]

^ Weak evidence indicates that bupropion may be associated with an increased risk for seizures, venlafaxine may be associated with an increased risk for cardiovascular events, and nefazodone may be associated with an increased risk for hepatotoxicity.
  • Using Second-Generation Antidepressants to Treat Depressive Disorders: A Clinical Practice Guideline from the American College of Physicians — Ann Intern Med 17 January 2010 5:36 UTC www.annals.org [Source type: Academic]

^ The resulting solution may optionally be filtered to remove any byproducts, such as those produced during the preparation of the free base of O-desmethyl-venlafaxine.
  • Succinate salt of O-desmethyl-venlafaxine - Patent 7026508 17 January 2010 5:36 UTC www.freepatentsonline.com [Source type: Academic]

[3]

Pregnant women

.There are no adequate, well-controlled studies of venlafaxine in pregnant women.^ Pregnancy, Labor and Delivery: There are no adequate and well controlled studies with venlafaxine in pregnant women.
  • Effexor withdrawal. Effexor withdrawal side effects, Effexor withdrawal warnings, Effexor withdrawal precautions, Effexor withdrawal adverse effects. 17 January 2010 5:36 UTC prozactruth.com [Source type: Academic]

^ However, in one study 14 there were no significant changes in endometrial thickness from baseline in the soy-treated patients.
  • Nonhormonal Therapies for Hot Flashes in Menopause - February 1, 2006 - American Family Physician 17 January 2010 5:36 UTC www.aafp.org [Source type: Academic]

^ In another randomized study, 7 researchers evaluated the effectiveness of venlafaxine at three different dosages in reducing hot flashes among 228 women with a history of breast cancer.
  • Nonhormonal Therapies for Hot Flashes in Menopause - February 1, 2006 - American Family Physician 17 January 2010 5:36 UTC www.aafp.org [Source type: Academic]

.Therefore, venlafaxine should only be used during pregnancy if clearly needed.^ Use this medication during pregnancy is and.

^ Together you and then they are commonly used during pregnancy only.
  • myLargescale.com ARCHIVE Forums - Generic effexor. Cheap Effexor (Venlafaxine) online pharmacies. - All About Your Garden Railroad & G Scale Trains 17 January 2010 5:36 UTC archive.mylargescale.com [Source type: General]

^ Effexor (venlafaxine) 100MG is not recommended for use during pregnancy.

[3] .Prospective studies have not shown any statistically significant congenital malformations.^ There was no statistically significant difference between fluoxetine and placebo for mean change in HAMD-17 total score in any of the studies.
  • BioMed Central | Full text | Duloxetine compared with fluoxetine and venlafaxine: use of meta-regression analysis for indirect comparisons 17 January 2010 5:36 UTC www.biomedcentral.com [Source type: Academic]

^ This study, based on HMO medical claims, concluded that although treatment with fluoxetine increased total costs, the increase was not significant statistically.
  • Access and Utilization of New Antidepressant and Antipsychotic Medications 17 January 2010 5:36 UTC aspe.os.dhhs.gov [Source type: Academic]

[15] .There have, however, been some reports of self-limiting effects on newborn infants.^ However, I have had some severe side effects.
  • venlafaxine systemic User Reviews at Drugs.com 17 January 2010 5:36 UTC www.drugs.com [Source type: General]

^ There were some minor side effects at the beginning, such as wakefuleness at night; my doctor suggested I dose in the morning.
  • venlafaxine systemic User Reviews at Drugs.com 17 January 2010 5:36 UTC www.drugs.com [Source type: General]

^ In the trials using venlafaxine for hot flashes there were no reported increases in blood pressure, which is a dose-related adverse effect commonly associated with this agent.
  • Nonhormonal Therapies for Hot Flashes in Menopause - February 1, 2006 - American Family Physician 17 January 2010 5:36 UTC www.aafp.org [Source type: Academic]

[16] .As with other serotonin reuptake inhibitors, these effects are generally short-lived, lasting only 3 to 5 days,[17] and rarely resulting in severe complications.^ SSRI = selective serotonin reuptake inhibitor .
  • Nonhormonal Therapies for Hot Flashes in Menopause - February 1, 2006 - American Family Physician 17 January 2010 5:36 UTC www.aafp.org [Source type: Academic]

^ Selective serotonin reuptake inhibitors in childhood depression: systematic review of published versus unpublished data.
  • Antidepressants - Pharmacy Clinical Policy Bulletins Aetna Non-Medicare Prescription Drug Plan 17 January 2010 5:36 UTC www.aetna.com [Source type: Academic]

^ Sproule BA, Naranjo CA, Bremner KE, Hassan PC. Selective serotonin reuptake inhibitors and CNS drug interactions.
  • Antidepressants - Pharmacy Clinical Policy Bulletins Aetna Non-Medicare Prescription Drug Plan 17 January 2010 5:36 UTC www.aetna.com [Source type: Academic]

[18] .Use of Venlafaxine in pregnancy should be considered on a case-by-case basis.^ Use of activated charcoal, induction of emesis, or gastric lavage should be considered.
  • Effexor withdrawal. Effexor withdrawal side effects, Effexor withdrawal warnings, Effexor withdrawal precautions, Effexor withdrawal adverse effects. 17 January 2010 5:36 UTC prozactruth.com [Source type: Academic]

^ Therefore, venlafaxine should not be used in combination with MAO inhibitors or within two weeks of terminating treatment with MAO inhibitor's.
  • Effexor withdrawal. Effexor withdrawal side effects, Effexor withdrawal warnings, Effexor withdrawal precautions, Effexor withdrawal adverse effects. 17 January 2010 5:36 UTC prozactruth.com [Source type: Academic]

^ Therefore, venlafaxine should only be used during pregnancy if clearly needed.
  • Effexor withdrawal. Effexor withdrawal side effects, Effexor withdrawal warnings, Effexor withdrawal precautions, Effexor withdrawal adverse effects. 17 January 2010 5:36 UTC prozactruth.com [Source type: Academic]

Heart disease and hypertension

.The FDA asked the manufacturers of all SNRIs to include the risk of persistent pulmonary hypertension (PPHN) in prescribing data as of July 19, 2006. Medications containing venlafaxine caused a mean heart rate increase of 4 bpm in clinical trials, along with a sustained increase in blood pressure in some.^ Sustained Hypertension: Treatment with venlafaxine was associated with modest but sustained increases in blood pressure during premarketing studies.
  • Effexor withdrawal. Effexor withdrawal side effects, Effexor withdrawal warnings, Effexor withdrawal precautions, Effexor withdrawal adverse effects. 17 January 2010 5:36 UTC prozactruth.com [Source type: Academic]

^ Vital Sign Changes: Venlafaxine treatment (averaged over all dose groups) in clinical trials was associated with a mean increase in pulse rate of approximately 3 beats per minute, compared to no change for placebo.
  • Effexor withdrawal. Effexor withdrawal side effects, Effexor withdrawal warnings, Effexor withdrawal precautions, Effexor withdrawal adverse effects. 17 January 2010 5:36 UTC prozactruth.com [Source type: Academic]

^ Red clover isoflavones do not appear to be more effective than placebo in reducing hot flashes, based on limited data from small clinical trials.
  • Nonhormonal Therapies for Hot Flashes in Menopause - February 1, 2006 - American Family Physician 17 January 2010 5:36 UTC www.aafp.org [Source type: Academic]

Adverse effects

Suicide

.The US Food and Drug Administration body (FDA) requires all antidepressants, including venlafaxine, to carry a black box warning with a generic warning about a possible suicide risk.^ The U.S. Food and Drug Administration advises that all patients receiving antidepressants be closely monitored on a regular basis for increases in suicidal thoughts and behaviors (100) .
  • Using Second-Generation Antidepressants to Treat Depressive Disorders: A Clinical Practice Guideline from the American College of Physicians — Ann Intern Med 17 January 2010 5:36 UTC www.annals.org [Source type: Academic]

^ Khan A , Khan S , Kolts R , Brown WA Suicide rates in clinical trials of SSRIs, other antidepressants, and placebo: analysis of FDA reports.
  • Using Second-Generation Antidepressants to Treat Depressive Disorders: A Clinical Practice Guideline from the American College of Physicians — Ann Intern Med 17 January 2010 5:36 UTC www.annals.org [Source type: Academic]

^ All of these drugs are tertiary amine tricyclic antidepressants (TCAs) except amoxapine.
  • ADHD Overview 17 January 2010 5:36 UTC www.vakkur.com [Source type: Academic]

.In addition, the most recent research[citation needed] indicated that patients taking venlafaxine are at increased risk of suicide.^ Taking antidepressants may increase suicidal thoughts and actions in about 1 out of 50 people 18 years or younger.
  • Effexor withdrawal. Effexor withdrawal side effects, Effexor withdrawal warnings, Effexor withdrawal precautions, Effexor withdrawal adverse effects. 17 January 2010 5:36 UTC prozactruth.com [Source type: Academic]

^ In order to reduce the risk of overdose, prescriptions for venlafaxine should be written for the smallest quantity of tablets consistent with good patient management.
  • Effexor withdrawal. Effexor withdrawal side effects, Effexor withdrawal warnings, Effexor withdrawal precautions, Effexor withdrawal adverse effects. 17 January 2010 5:36 UTC prozactruth.com [Source type: Academic]

^ Side effect with venlafaxine is suidical ideation which is at most risk.
  • Psych Central Reviews - Effexor (venlafaxine) 17 January 2010 5:36 UTC forums.psychcentral.com [Source type: General]
  • Psych Central Reviews - Effexor (venlafaxine) 17 January 2010 5:36 UTC forums.psychcentral.com [Source type: General]

.A study conducted in Finland followed more than 15,000 patients for 3.4 years.^ The results of these studies exhibit mild evidence for venlafaxine being more cost-effective than SSRIs.
  • Access and Utilization of New Antidepressant and Antipsychotic Medications 17 January 2010 5:36 UTC aspe.os.dhhs.gov [Source type: Academic]

^ However, assuming a shorter initial hospital stay (14 days), clozapine was found to be more cost-saving (3-year net savings of $15,036).
  • Access and Utilization of New Antidepressant and Antipsychotic Medications 17 January 2010 5:36 UTC aspe.os.dhhs.gov [Source type: Academic]

^ Although this study included no direct measure of treatment outcomes, it did show that patients were more likely to continue treatment on fluoxetine than they were on a TCA. The 701 patients in the study were representative of private sector depressed patients.
  • Access and Utilization of New Antidepressant and Antipsychotic Medications 17 January 2010 5:36 UTC aspe.os.dhhs.gov [Source type: Academic]

.Venlafaxine increased suicide risk 1.6-fold (statistically significant), as compared to no treatment.^ No significant difference compared with placebo .
  • Nonhormonal Therapies for Hot Flashes in Menopause - February 1, 2006 - American Family Physician 17 January 2010 5:36 UTC www.aafp.org [Source type: Academic]

^ Because this difference did not achieve statistical significance, the authors concluded that the cost of treating depression was identical between the two treatment groups.
  • Access and Utilization of New Antidepressant and Antipsychotic Medications 17 January 2010 5:36 UTC aspe.os.dhhs.gov [Source type: Academic]

^ The study found no significant differences in length of follow-up, length of stay, or hospitalization rates between the two treatment groups.
  • Access and Utilization of New Antidepressant and Antipsychotic Medications 17 January 2010 5:36 UTC aspe.os.dhhs.gov [Source type: Academic]

At the same time, fluoxetine (Prozac) halved the suicide risk.[19]
.In another study, the data on more than 200,000 cases was obtained from the UK general practice research database.^ However, in sensitivity analyses, SSRIs were more cost-effective than was venlafaxine in an inpatient worst case scenario, although venlafaxine remained dominant in all outpatient analyses.
  • Access and Utilization of New Antidepressant and Antipsychotic Medications 17 January 2010 5:36 UTC aspe.os.dhhs.gov [Source type: Academic]

^ The results of these studies exhibit mild evidence for venlafaxine being more cost-effective than SSRIs.
  • Access and Utilization of New Antidepressant and Antipsychotic Medications 17 January 2010 5:36 UTC aspe.os.dhhs.gov [Source type: Academic]

^ However, in neither of these cases, did treatment costs increase by more than 3%.
  • Access and Utilization of New Antidepressant and Antipsychotic Medications 17 January 2010 5:36 UTC aspe.os.dhhs.gov [Source type: Academic]

.The patients taking venlafaxine had significantly higher risk of completed suicide than the ones on fluoxetine (Prozac) (2.8 times) or citalopram (Celexa) (2.4 times).^ A. Bupropion, bupropion SR, budeprion XL citalopram, fluoxetine, fluvoxamine, maprotiline, paroxetine, sertraline, venlafaxine , Celexa, Cymbalta, Effexor, Lexapro, Paxil, Pexeva, Prozac, Prozac Weekly, Rapiflux, Wellbutrin, Wellbutrin SR and Zoloft may be subject to quantity limits.
  • Antidepressants - Pharmacy Clinical Policy Bulletins Aetna Non-Medicare Prescription Drug Plan 17 January 2010 5:36 UTC www.aetna.com [Source type: Academic]

^ One fair-quality trial showed a statistically significantly better response and remission rate for venlafaxine than for fluoxetine (42) .
  • Using Second-Generation Antidepressants to Treat Depressive Disorders: A Clinical Practice Guideline from the American College of Physicians — Ann Intern Med 17 January 2010 5:36 UTC www.annals.org [Source type: Academic]

^ Bupropion had a significantly lower rate of sexual adverse events than fluoxetine or sertraline (84–88) .
  • Using Second-Generation Antidepressants to Treat Depressive Disorders: A Clinical Practice Guideline from the American College of Physicians — Ann Intern Med 17 January 2010 5:36 UTC www.annals.org [Source type: Academic]

.Even after taking into consideration the fact that venlafaxine was generally prescribed for more severe depression, venlafaxine was associated with 1.6-1.7 times more suicides than fluoxetine or citalopram.^ Most of the second-generation antidepressants had similar adverse events, with some differences in the incidence of specific adverse events: Venlafaxine had a higher incidence of nausea and vomiting than other SSRIs; sertraline had a higher rate of diarrhea than bupropion, citalopram, fluoxetine, fluvoxamine, mirtazapine, nefazodone, paroxetine, or venlafaxine; mirtazapine and paroxetine resulted in higher weight gain than sertraline, trazodone, or venlafaxine; and trazodone was associated with a higher incidence of somnolence than bupropion, fluoxetine, mirtazapine, paroxetine, or venlafaxine.
  • Using Second-Generation Antidepressants to Treat Depressive Disorders: A Clinical Practice Guideline from the American College of Physicians — Ann Intern Med 17 January 2010 5:36 UTC www.annals.org [Source type: Academic]

^ The Medical Subject Heading terms and keywords included for literature search involved combining depressive disorders with 12 specific second-generation antidepressants (bupropion, citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, mirtazapine, nefazodone, paroxetine, sertraline, trazodone, and venlafaxine) and their specific trade names.
  • Using Second-Generation Antidepressants to Treat Depressive Disorders: A Clinical Practice Guideline from the American College of Physicians — Ann Intern Med 17 January 2010 5:36 UTC www.annals.org [Source type: Academic]

^ Keywords for search included terms for depressive disorders and 12 specific second-generation antidepressants—bupropion, citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, mirtazapine, nefazodone, paroxetine, sertraline, trazodone, and venlafaxine—and their specific trade names.
  • Using Second-Generation Antidepressants to Treat Depressive Disorders: A Clinical Practice Guideline from the American College of Physicians — Ann Intern Med 17 January 2010 5:36 UTC www.annals.org [Source type: Academic]

.This difference was no longer statistically significant due to the rarity of completed suicides.^ Because this difference did not achieve statistical significance, the authors concluded that the cost of treating depression was identical between the two treatment groups.
  • Access and Utilization of New Antidepressant and Antipsychotic Medications 17 January 2010 5:36 UTC aspe.os.dhhs.gov [Source type: Academic]

^ The study found no significant differences in length of follow-up, length of stay, or hospitalization rates between the two treatment groups.
  • Access and Utilization of New Antidepressant and Antipsychotic Medications 17 January 2010 5:36 UTC aspe.os.dhhs.gov [Source type: Academic]

^ There was no statistically significant difference between fluoxetine and placebo for mean change in HAMD-17 total score in any of the studies.
  • BioMed Central | Full text | Duloxetine compared with fluoxetine and venlafaxine: use of meta-regression analysis for indirect comparisons 17 January 2010 5:36 UTC www.biomedcentral.com [Source type: Academic]

.However, for the attempted suicides (more frequent event) the 1.2-1.3 times higher risk for venlafaxine still stayed statistically significant after the adjustment.^ Effexor withdrawal Urinary Frequency - Having to urinate more often than usual or between unusually short time periods.
  • Effexor withdrawal. Effexor withdrawal side effects, Effexor withdrawal warnings, Effexor withdrawal precautions, Effexor withdrawal adverse effects. 17 January 2010 5:36 UTC prozactruth.com [Source type: Academic]

^ However, in sensitivity analyses, SSRIs were more cost-effective than was venlafaxine in an inpatient worst case scenario, although venlafaxine remained dominant in all outpatient analyses.
  • Access and Utilization of New Antidepressant and Antipsychotic Medications 17 January 2010 5:36 UTC aspe.os.dhhs.gov [Source type: Academic]

^ However, assuming a shorter initial hospital stay (14 days), clozapine was found to be more cost-saving (3-year net savings of $15,036).
  • Access and Utilization of New Antidepressant and Antipsychotic Medications 17 January 2010 5:36 UTC aspe.os.dhhs.gov [Source type: Academic]

[20]
.An analysis of clinical trials by the FDA statisticians showed the incidence of suicidal behaviour among the adults on venlafaxine to be not significantly different from fluoxetine or placebo.^ A pooled analysis of all of the Wyeth-sponsored venlafaxine clinical trials revealed that remission rate differences for venlafaxine vs SSRI therapy were small but statistically significant, largely attributed to venlafaxine-fluoxetine differences ( Nemeroff et al , 2008 ).
  • Neuropsychopharmacology - Estimates of Serotonin and Norepinephrine Transporter Inhibition in Depressed Patients Treated with Paroxetine or Venlafaxine 17 January 2010 5:36 UTC www.nature.com [Source type: Academic]

^ Evaluation of the electrocardiograms for 769 patients who received venlafaxine in 4- to 6 week double-blind trials showed that the incidence of trial-emergent conduction abnormalities did not differ from that with placebo.
  • Effexor withdrawal. Effexor withdrawal side effects, Effexor withdrawal warnings, Effexor withdrawal precautions, Effexor withdrawal adverse effects. 17 January 2010 5:36 UTC prozactruth.com [Source type: Academic]

^ Laboratory Changes: Of the serum chemistry and hematology parameters monitored during clinical trials with venlafaxine, a statistically significant difference with placebo was seen only for serum cholesterol, i.e., patients treated with venlafaxine had mean increases from baseline of 3 mg/dL, a change of unknown clinical significance.
  • Effexor withdrawal. Effexor withdrawal side effects, Effexor withdrawal warnings, Effexor withdrawal precautions, Effexor withdrawal adverse effects. 17 January 2010 5:36 UTC prozactruth.com [Source type: Academic]

[21] .A possible explanation for this discrepancy is that suicidal patients are generally excluded from clinical trials, and so clinical trials do not represent the real population of patients.^ Khan A , Khan S , Kolts R , Brown WA Suicide rates in clinical trials of SSRIs, other antidepressants, and placebo: analysis of FDA reports.
  • Using Second-Generation Antidepressants to Treat Depressive Disorders: A Clinical Practice Guideline from the American College of Physicians — Ann Intern Med 17 January 2010 5:36 UTC www.annals.org [Source type: Academic]

^ The search focused on randomized placebo-controlled clinical trials involving adult patients treated for acute phase Major Depressive Disorder.
  • BioMed Central | Full text | Duloxetine compared with fluoxetine and venlafaxine: use of meta-regression analysis for indirect comparisons 17 January 2010 5:36 UTC www.biomedcentral.com [Source type: Academic]

^ Efficacy and effectiveness probabilities were taken from a six-week clinical trial in 717 patients with major depression.
  • Access and Utilization of New Antidepressant and Antipsychotic Medications 17 January 2010 5:36 UTC aspe.os.dhhs.gov [Source type: Academic]

[citation needed]
.Venlafaxine is contraindicated in children, adolescents and young adults.^ Antidepressant use in children, adolescents, and adults .
  • Antidepressants - Pharmacy Clinical Policy Bulletins Aetna Non-Medicare Prescription Drug Plan 17 January 2010 5:36 UTC www.aetna.com [Source type: Academic]

.According to the FDA analysis of clinical trials[21] venlafaxine caused a statistically significant 5-fold increase in suicidal ideation and behavior in persons younger than 25. In another analysis, venlafaxine was no better than placebo among children (7–11 years old) but improved depression in adolescents (12–17 years old).^ Fluoxetine for acute treatment of depression in children and adolescents: a placebo-controlled, randomized clinical trial.
  • Antidepressants - Pharmacy Clinical Policy Bulletins Aetna Non-Medicare Prescription Drug Plan 17 January 2010 5:36 UTC www.aetna.com [Source type: Academic]

^ A double-blind, randomized, placebo-controlled trial of fluoxetine in children and adolescents with depression.
  • Antidepressants - Pharmacy Clinical Policy Bulletins Aetna Non-Medicare Prescription Drug Plan 17 January 2010 5:36 UTC www.aetna.com [Source type: Academic]

^ Depression in children and adolescents.
  • Effexor withdrawal. Effexor withdrawal side effects, Effexor withdrawal warnings, Effexor withdrawal precautions, Effexor withdrawal adverse effects. 17 January 2010 5:36 UTC prozactruth.com [Source type: Academic]

.However, in both groups, hostility and suicidal behavior increased in comparison to those receiving a placebo.^ The U.S. Food and Drug Administration advises that all patients receiving antidepressants be closely monitored on a regular basis for increases in suicidal thoughts and behaviors (100) .
  • Using Second-Generation Antidepressants to Treat Depressive Disorders: A Clinical Practice Guideline from the American College of Physicians — Ann Intern Med 17 January 2010 5:36 UTC www.annals.org [Source type: Academic]

^ In addition, SSRIs are associated with an increased risk for suicide attempts compared with placebo.
  • Using Second-Generation Antidepressants to Treat Depressive Disorders: A Clinical Practice Guideline from the American College of Physicians — Ann Intern Med 17 January 2010 5:36 UTC www.annals.org [Source type: Academic]

^ Total costs for the clozapine group were increased in the first year after treatment but decreased in the second year of treatment for both ITT and completer analysis.
  • Access and Utilization of New Antidepressant and Antipsychotic Medications 17 January 2010 5:36 UTC aspe.os.dhhs.gov [Source type: Academic]

[22] .In a study involving antidepressants that had failed to produce results in depressed teenagers, teens whose SSRI treatment had failed who were randomly switched to either another SSRI or to venlafaxine showed an increased rate of suicide on venlafaxine.^ However, studies have shown that a small number of people (especially children/teenages) who take antidepressants for any condition may experience worsening depression, other mental/mood symptoms, or suicidal thoughts/attempts.
  • Psych Central Reviews - Effexor (venlafaxine) 17 January 2010 5:36 UTC forums.psychcentral.com [Source type: General]
  • Psych Central Reviews - Effexor (venlafaxine) 17 January 2010 5:36 UTC forums.psychcentral.com [Source type: General]

^ While we recognize that none of the trials involving duloxetine used venlafaxine as an active comparator, our results are in accordance with a recent meta-analysis comparing duloxetine and venlafaxine in the treatment of MDD [ 45 ] and a review comparing second-generation antidepressants [ 46 ].
  • BioMed Central | Full text | Duloxetine compared with fluoxetine and venlafaxine: use of meta-regression analysis for indirect comparisons 17 January 2010 5:36 UTC www.biomedcentral.com [Source type: Academic]

^ Reference is made to studies conducted in other countries when they are of very high quality or the results compare and contrast to those for the US. Newer Antidepressants Compared to Older Antidepressants SSRIs as a Class Smith and Sherrill found that cost of treatment of depressed patients in TennCare with SSRIs or with TCAs did not differ substantially.
  • Access and Utilization of New Antidepressant and Antipsychotic Medications 17 January 2010 5:36 UTC aspe.os.dhhs.gov [Source type: Academic]

Among teenagers who were suicidal at the beginning of the study, the rate of suicidal attempts and self-harm was significantly higher, by about 60%, after the switch to venlafaxine than after the switch to an SSRI. [23]

Common side effects

.NOTE: The percentage of occurrences for each side effect listed comes from clinical trial data provided by Wyeth Pharmaceuticals Inc.^ Unreported side effects are possible, talk to your healthcare provider if any other symptoms occur.
  • Psych Central Reviews - Effexor (venlafaxine) 17 January 2010 5:36 UTC forums.psychcentral.com [Source type: General]
  • Psych Central Reviews - Effexor (venlafaxine) 17 January 2010 5:36 UTC forums.psychcentral.com [Source type: General]

^ Such data may not necessarily reflect the actual rate of these adverse effects in clinical practice or the actual differences between these various drugs.
  • ADHD Overview 17 January 2010 5:36 UTC www.vakkur.com [Source type: Academic]

^ However, considering increased appetite is listed as a possible side-effect, I'm a little surprised that mine seems to have decreased instead.
  • Psych Central Reviews - Effexor (venlafaxine) 17 January 2010 5:36 UTC forums.psychcentral.com [Source type: General]
  • Psych Central Reviews - Effexor (venlafaxine) 17 January 2010 5:36 UTC forums.psychcentral.com [Source type: General]

.The percentages indicate the percentage of people that experienced the side effect in clinical trials.^ That lasted a couple of days, but I've heard some people have side effects that persist a lot longer than that.
  • Psych Central Reviews - Effexor (venlafaxine) 17 January 2010 5:36 UTC forums.psychcentral.com [Source type: General]
  • Psych Central Reviews - Effexor (venlafaxine) 17 January 2010 5:36 UTC forums.psychcentral.com [Source type: General]

^ What are the possible adipex side effects SIDE effects interactions indications?
  • Forum: BayShip and Yacht - recommendation 17 January 2010 5:36 UTC www.synfo.com [Source type: General]

^ While venlafaxine has not been systematically studied in clinical trials for its potential for abuse, there was no indication of drug-seeking behaviour in the clinical trials.
  • Effexor withdrawal. Effexor withdrawal side effects, Effexor withdrawal warnings, Effexor withdrawal precautions, Effexor withdrawal adverse effects. 17 January 2010 5:36 UTC prozactruth.com [Source type: Academic]

[3]

Less common to rare side-effects

.Note 'Rare' adverse effects occur in fewer than 1 in 1000 patients.^ Incidence of each respective adverse effect for patients taking each drug minus the incidence for each drug's parallel placebo control in double-blind placebo-controlled studies.
  • ADHD Overview 17 January 2010 5:36 UTC www.vakkur.com [Source type: Academic]

^ Drug costs were estimated to be $31,476 per 1000 patients more for SSRIs than for TCAs.
  • Access and Utilization of New Antidepressant and Antipsychotic Medications 17 January 2010 5:36 UTC aspe.os.dhhs.gov [Source type: Academic]

^ It should be noted that significantly fewer patients treated with haloperidol completed the acute phase of treatment than did patients treated with olanzapine (43% versus 64%).
  • Access and Utilization of New Antidepressant and Antipsychotic Medications 17 January 2010 5:36 UTC aspe.os.dhhs.gov [Source type: Academic]

Dose dependency of adverse events

.A comparison of adverse event rates in a fixed-dose study comparing venlafaxine 75, 225, and 375 mg/day with placebo revealed a dose dependency for some of the more common adverse events associated with venlafaxine use.^ Still more preferably the dosage of venlafaxine is about 75 mg to about 150 mg/day.
  • Succinate salt of O-desmethyl-venlafaxine - Patent 7026508 17 January 2010 5:36 UTC www.freepatentsonline.com [Source type: Academic]

^ The dosage of venlafaxine is preferably about 75 mg to about 350 mg/day and more preferably about 75 mg to about 225 mg/day.
  • Succinate salt of O-desmethyl-venlafaxine - Patent 7026508 17 January 2010 5:36 UTC www.freepatentsonline.com [Source type: Academic]

^ The researchers concluded that use of a TCA was associated with greater per patient post-initiation total healthcare costs ($366) compared to treatment with fluoxetine.
  • Access and Utilization of New Antidepressant and Antipsychotic Medications 17 January 2010 5:36 UTC aspe.os.dhhs.gov [Source type: Academic]

.The rule for including events was to enumerate those that occurred at an incidence of 5% or more for at least one of the venlafaxine groups and for which the incidence was at least twice the placebo incidence for at least one venlafaxine group.^ Dose Dependency of Adverse Events: A comparison of adverse event rates in a fixed-dose study comparing Effexor 75, 225, and 375 mg/day with placebo revealed a dose dependency for some of the more common adverse events associated with Effexor use, as shown in Table IV. The rule for including events was to enumerate those that occurred at an incidence of 5% or more for at least one of the venlafaxine groups and for which the incidence was at least twice the placebo incidence for at least one Effexor group.
  • Effexor withdrawal. Effexor withdrawal side effects, Effexor withdrawal warnings, Effexor withdrawal precautions, Effexor withdrawal adverse effects. 17 January 2010 5:36 UTC prozactruth.com [Source type: Academic]

^ Discontinuation Symptoms: While the discontinuation effects of venlafaxine have not been systematically evaluated in controlled clinical trials, a retrospective survey of new events occurring during taper or following discontinuation revealed the following six events that occurred at an incidence of at least 5%, and for which the incidence for venlafaxine was at least twice the placebo incidence: asthenia, dizziness, headache, insomnia, nausea and nervousness.
  • Effexor withdrawal. Effexor withdrawal side effects, Effexor withdrawal warnings, Effexor withdrawal precautions, Effexor withdrawal adverse effects. 17 January 2010 5:36 UTC prozactruth.com [Source type: Academic]

^ Patients were included who had switched from an SSRI after at least two consecutive months of therapy followed by at least two consecutive months of a TCA (n=172) or venlafaxine (n=188).
  • Access and Utilization of New Antidepressant and Antipsychotic Medications 17 January 2010 5:36 UTC aspe.os.dhhs.gov [Source type: Academic]

.Tests for potential dose relationships for these events (Cochran-Armitage Test, with a criterion of exact 2-sided p-value <=0.05) suggested a dose-dependency for several adverse events in this list, including chills, hypertension, anorexia, nausea, agitation, dizziness, somnolence, tremor, yawning, sweating, and abnormal ejaculation.^ Tests for potential dose relationships for these events (Cochran-Armitage Test, with a criterion of exact 2-sided p-value <= 0.05) suggested a dose-dependency for several adverse events in this list, including chills, hypertension, anorexia, nausea, agitation, dizziness, somnolence, tremor, yawning, sweating, and abnormal ejaculation .
  • Effexor withdrawal. Effexor withdrawal side effects, Effexor withdrawal warnings, Effexor withdrawal precautions, Effexor withdrawal adverse effects. 17 January 2010 5:36 UTC prozactruth.com [Source type: Academic]

^ Commonly Observed Adverse Reactions: The most commonly observed adverse events associated with the use of venlafaxine (incidence of 5% or greater) and not seen at an equivalent incidence among placebo-treated patients (i.e., incidence for venlafaxine at least twice that for placebo), derived from the 1% incidence Table III, were asthenia, sweating, nausea, constipation, anorexia, vomiting, somnolence, dry mouth, dizziness nervousness, anxiety, tremor, blurred vision, and abnormal ejaculation/orgasm and impotence in men.
  • Effexor withdrawal. Effexor withdrawal side effects, Effexor withdrawal warnings, Effexor withdrawal precautions, Effexor withdrawal adverse effects. 17 January 2010 5:36 UTC prozactruth.com [Source type: Academic]

^ As discussed earlier, these studies have significant limitations including potential selection artifacts and historical bias.
  • Access and Utilization of New Antidepressant and Antipsychotic Medications 17 January 2010 5:36 UTC aspe.os.dhhs.gov [Source type: Academic]

[3]

Memory loss

.In a study of 70 patients that compared the tolerability of venlafaxine at standard doses, ranging from 75 to 300 mg, against relatively high doses (rarely prescribed), ranging from 375 to 600 mg per day, for treating DSM-IV major depressive disorder "failing memory" was reported in 44% of cases.^ In 5 of the 8 cases, patents were receiving doses of 150 mg/day or less.
  • Effexor withdrawal. Effexor withdrawal side effects, Effexor withdrawal warnings, Effexor withdrawal precautions, Effexor withdrawal adverse effects. 17 January 2010 5:36 UTC prozactruth.com [Source type: Academic]

^ I have severe depression and take 75 mg twice a day.
  • venlafaxine systemic User Reviews at Drugs.com 17 January 2010 5:36 UTC www.drugs.com [Source type: General]

^ Taurine transporter in lymphocytes of patients with major depression treated with venlafaxine plus psychotherapy.
  • Effexor withdrawal. Effexor withdrawal side effects, Effexor withdrawal warnings, Effexor withdrawal precautions, Effexor withdrawal adverse effects. 17 January 2010 5:36 UTC prozactruth.com [Source type: Academic]

.The severity of venlafaxine-induced memory loss was also noted to increase with dose and length of treatment.^ I had to increase the dose several times because it would stop working as well as at first.
  • Psych Central Reviews - Effexor (venlafaxine) 17 January 2010 5:36 UTC forums.psychcentral.com [Source type: General]
  • Psych Central Reviews - Effexor (venlafaxine) 17 January 2010 5:36 UTC forums.psychcentral.com [Source type: General]

^ Several studies demonstrate that although total medical costs may initially increase, by the second year of treatment cost savings begin to be realized.
  • Access and Utilization of New Antidepressant and Antipsychotic Medications 17 January 2010 5:36 UTC aspe.os.dhhs.gov [Source type: Academic]

^ Effexor XR (venlafaxine) for Depression : I feel the need to write a review of this medication as I am currently experiencing severe withdrawal symptoms from missing one dose.
  • venlafaxine systemic User Reviews at Drugs.com 17 January 2010 5:36 UTC www.drugs.com [Source type: General]

[24]

Discontinuation syndrome

.In vitro studies revealed that venlafaxine has virtually no affinity for opiate, benzodiazepine, or N-methyl-D-aspartic acid (NMDA) receptors.^ Drug Abuse and Dependence: Physical and Psychological Dependence: In vitro studies revealed that venlafaxine has virtually no affinity for opiate, benzodiazepine, phencyclidine (PCP), or N-methyl-D-aspartic acid (NMDA) receptors.
  • Effexor withdrawal. Effexor withdrawal side effects, Effexor withdrawal warnings, Effexor withdrawal precautions, Effexor withdrawal adverse effects. 17 January 2010 5:36 UTC prozactruth.com [Source type: Academic]

^ Venlafaxine and ODV have no significant affinity for muscarinic, histaminergic, or alpha1-adrenergic receptors in vitro.
  • Effexor withdrawal. Effexor withdrawal side effects, Effexor withdrawal warnings, Effexor withdrawal precautions, Effexor withdrawal adverse effects. 17 January 2010 5:36 UTC prozactruth.com [Source type: Academic]

^ Pregnancy, Labor and Delivery: There are no adequate and well controlled studies with venlafaxine in pregnant women.
  • Effexor withdrawal. Effexor withdrawal side effects, Effexor withdrawal warnings, Effexor withdrawal precautions, Effexor withdrawal adverse effects. 17 January 2010 5:36 UTC prozactruth.com [Source type: Academic]

.It has no significant CNS stimulant activity in rodents.^ It has no significant CNS stimulant activity in rodents.
  • Effexor withdrawal. Effexor withdrawal side effects, Effexor withdrawal warnings, Effexor withdrawal precautions, Effexor withdrawal adverse effects. 17 January 2010 5:36 UTC prozactruth.com [Source type: Academic]

^ Venlafaxine and ODV have no significant activity for muscarinic cholinergic, H1-histaminergic, or alpha2-adrenergic receptors.
  • Venlafaxine 17 January 2010 5:36 UTC www.umm.edu [Source type: Academic]
  • Venlafaxine - Erewhon Natural Foods 17 January 2010 5:36 UTC www.erewhonmarket.com [Source type: Academic]

^ In primate drug discrimination studies, venlafaxine showed no significant stimulant or depressant abuse liability.
  • Effexor withdrawal. Effexor withdrawal side effects, Effexor withdrawal warnings, Effexor withdrawal precautions, Effexor withdrawal adverse effects. 17 January 2010 5:36 UTC prozactruth.com [Source type: Academic]

.In primate drug discrimination studies, venlafaxine showed no significant stimulant or depressant abuse liability.^ In primate drug discrimination studies, venlafaxine showed no significant stimulant or depressant abuse liability.
  • Venlafaxine: Encyclopedia of chemistry, analytics & pharmaceutics with 64,557 entries. 17 January 2010 5:36 UTC www.chemie.de [Source type: Academic]
  • Effexor withdrawal. Effexor withdrawal side effects, Effexor withdrawal warnings, Effexor withdrawal precautions, Effexor withdrawal adverse effects. 17 January 2010 5:36 UTC prozactruth.com [Source type: Academic]

^ Venlafaxine does not inhibit monoamine oxidase and has no significant affinity for muscarinic, histaminergic or alpha-1 adrenergic receptors.
  • Extended release venlafaxine formulation - Patent application 17 January 2010 5:36 UTC www.faqs.org [Source type: Reference]

^ One large good-quality study, STAR*D (Sequenced Treatment Alternatives to Relieve Depression) (33) , provided the best evidence for assessing alternative medications (sustained-release bupropion, sertraline, and extended-release venlafaxine) in patients whose initial therapy failed; it showed that 1 in 4 patients became symptom-free after switching medications and found no difference among the 3 drugs.
  • Using Second-Generation Antidepressants to Treat Depressive Disorders: A Clinical Practice Guideline from the American College of Physicians — Ann Intern Med 17 January 2010 5:36 UTC www.annals.org [Source type: Academic]

[3]
.Notwithstanding these findings, some patients stopping venlafaxine use experience SSRI discontinuation syndrome .^ Patients were included who had switched from an SSRI after at least two consecutive months of therapy followed by at least two consecutive months of a TCA (n=172) or venlafaxine (n=188).
  • Access and Utilization of New Antidepressant and Antipsychotic Medications 17 January 2010 5:36 UTC aspe.os.dhhs.gov [Source type: Academic]

^ The results of these studies exhibit mild evidence for venlafaxine being more cost-effective than SSRIs.
  • Access and Utilization of New Antidepressant and Antipsychotic Medications 17 January 2010 5:36 UTC aspe.os.dhhs.gov [Source type: Academic]

^ Some of these studies also have arms comparing fluoxetine to other SSRIs.
  • Access and Utilization of New Antidepressant and Antipsychotic Medications 17 January 2010 5:36 UTC aspe.os.dhhs.gov [Source type: Academic]

.This is especially noted if a patient misses a dose, but can also occur when reduction of dosage is done with a doctor's care.^ It should be noted that the venlafaxine dose was in the low end of the therapeutic dosage, as was the single lithium dose.
  • Effexor withdrawal. Effexor withdrawal side effects, Effexor withdrawal warnings, Effexor withdrawal precautions, Effexor withdrawal adverse effects. 17 January 2010 5:36 UTC prozactruth.com [Source type: Academic]

^ They usually occur within the first few days of discontinuing treatment, but there have been very rare reports of such symptoms in patients who have inadvertently missed a dose.
  • Efexor - Summary of Product Characteristics (SPC) - electronic Medicines Compendium (eMC) 17 January 2010 5:36 UTC emc.medicines.org.uk [Source type: Academic]

^ Faster than 75mg: 384 MDD pt DB PC with improvement in 1-2 weeks noted especially in higher dose groups.

.The high risk of discontinuation syndrome symptoms may reflect venlafaxine's short half-life.^ In dialysis patients, venlafaxine elimination half-life was prolonged by about 180% and clearance was decreased by about 56%.
  • Effexor withdrawal. Effexor withdrawal side effects, Effexor withdrawal warnings, Effexor withdrawal precautions, Effexor withdrawal adverse effects. 17 January 2010 5:36 UTC prozactruth.com [Source type: Academic]

^ Furthermore, the high risperidone dosages may aggravate side effects (e.g., extrapyramidal syndrome (EPS)) and limit the real world effectiveness of risperidone in the simulation.
  • Access and Utilization of New Antidepressant and Antipsychotic Medications 17 January 2010 5:36 UTC aspe.os.dhhs.gov [Source type: Academic]

^ Weak evidence indicates that bupropion may be associated with an increased risk for seizures, venlafaxine may be associated with an increased risk for cardiovascular events, and nefazodone may be associated with an increased risk for hepatotoxicity.
  • Using Second-Generation Antidepressants to Treat Depressive Disorders: A Clinical Practice Guideline from the American College of Physicians — Ann Intern Med 17 January 2010 5:36 UTC www.annals.org [Source type: Academic]

[25] .Missing even a single dose can induce discontinuation effects in some patients.^ Even a single missed dose can result in the withdrawal symptoms.
  • Venlafaxine: Encyclopedia of chemistry, analytics & pharmaceutics with 64,557 entries. 17 January 2010 5:36 UTC www.chemie.de [Source type: Academic]

^ Missing even a single dose can induce discontinuation effects in some patients.
  • Venlafaxine: Encyclopedia of chemistry, analytics & pharmaceutics with 64,557 entries. 17 January 2010 5:36 UTC www.chemie.de [Source type: Academic]

^ Some psychiatrists have reported difficulties with withdrawal effects from missing a single dose.

[26] Discontinuation is similar in nature to those of SSRIs such as Paroxetine (Paxil or Seroxat). .Sudden discontinuation of venlafaxine particularly seemed to cause discontinuation symptoms during the first 3 days in a study of 18 patients.^ Inactive ingredients 2.5 mg 5 days not like to try patients on long-term prednisone often during your child's doctor.
  • Forum: BayShip and Yacht - recommendation 17 January 2010 5:36 UTC www.synfo.com [Source type: General]

^ In the outpatient setting, trazadone was the most cost-effective agent at $20 per symptom free day, followed by venlafaxine ($23), and TCAs ($29).
  • Access and Utilization of New Antidepressant and Antipsychotic Medications 17 January 2010 5:36 UTC aspe.os.dhhs.gov [Source type: Academic]

^ Effexor (venlafaxine) for Depression : This medicine worked great for the first 3 or 4 years but now I am not feeling as well and am taking 300 mg per day.
  • venlafaxine systemic User Reviews at Drugs.com 17 January 2010 5:36 UTC www.drugs.com [Source type: General]

.[27] As reported in 2001 by Haddad in the journal Drug Safety, "another strategy to consider is switching to fluoxetine, which may suppress the discontinuation symptoms, but which has little tendency to cause such symptoms itself," and then discontinuing that.^ Outcomes may be skewed due to physician unfamiliarity with the drug and the fact that paroxetine and sertraline may have been used early on as second-line therapy for patients who discontinued fluoxetine.
  • Access and Utilization of New Antidepressant and Antipsychotic Medications 17 January 2010 5:36 UTC aspe.os.dhhs.gov [Source type: Academic]

^ The aim of such studies may be to show superiority over the active comparator or to demonstrate that at least a similar balance between benefit and risk exists when the drug of interest is compared with another acknowledged standard antidepressant.
  • BioMed Central | Full text | Duloxetine compared with fluoxetine and venlafaxine: use of meta-regression analysis for indirect comparisons 17 January 2010 5:36 UTC www.biomedcentral.com [Source type: Academic]

^ Dropouts were considered regardless of cause, which gave a rough indicator of the tolerability and safety and efficacy of the treatment.
  • BioMed Central | Full text | Duloxetine compared with fluoxetine and venlafaxine: use of meta-regression analysis for indirect comparisons 17 January 2010 5:36 UTC www.biomedcentral.com [Source type: Academic]

[25]Some psychiatrists actually prescribe the singular .SSRIs to alleviate the symptoms of venlafaxine withdrawal.^ Cost-effectiveness ratios calculated that costs per symptom-free day in the inpatient setting were lower for venlafaxine ($93) than SSRIs ($146).
  • Access and Utilization of New Antidepressant and Antipsychotic Medications 17 January 2010 5:36 UTC aspe.os.dhhs.gov [Source type: Academic]

.Although many other drugs can cause withdrawal symptoms which are not associated with addiction or dependence, for example, anticonvulsants, beta-blockers, nitrates, diuretics, centrally acting antihypertensives, sympathomimetics, heparin, tamoxifen, dopaminergic agents, antipsychotics, and lithium,[25] addiction or dependence is a more common effect described for drugs that (are thought to, or may) improve mental well-being.^ Effexor withdrawal Sluggishness - Lack of alertness and energy, as well as being slow to respond or perform in life.
  • Effexor withdrawal. Effexor withdrawal side effects, Effexor withdrawal warnings, Effexor withdrawal precautions, Effexor withdrawal adverse effects. 17 January 2010 5:36 UTC prozactruth.com [Source type: Academic]

^ Effexor withdrawal Anaphylaxis - A violent, sudden, and severe drop in blood pressure caused by a re-exposure to a foreign protein or a second dosage of a drug that may be fatal unless emergency treatment is given right away.
  • Effexor withdrawal. Effexor withdrawal side effects, Effexor withdrawal warnings, Effexor withdrawal precautions, Effexor withdrawal adverse effects. 17 January 2010 5:36 UTC prozactruth.com [Source type: Academic]

^ Other adverse events described as seizures or withdrawal symptoms of overdose call your doctor about all rights reserved.
  • Forum: BayShip and Yacht - recommendation 17 January 2010 5:36 UTC www.synfo.com [Source type: General]

[28]

Serotonin syndrome

.The development of a potentially life-threatening serotonin syndrome (also more recently classified as "serotonin toxicity")[29] may occur with Venlafaxine treatment, particularly with concomitant use of serotonergic drugs (including SSRIs, SNRIs, dextromethorphan, tramadol, meperidine/pethidine and triptans) and with drugs that impair metabolism of serotonin (including MAOIs).^ Patients were included who had switched from an SSRI after at least two consecutive months of therapy followed by at least two consecutive months of a TCA (n=172) or venlafaxine (n=188).
  • Access and Utilization of New Antidepressant and Antipsychotic Medications 17 January 2010 5:36 UTC aspe.os.dhhs.gov [Source type: Academic]

^ Cytochrome P450 IID6: Venlafaxine is metabolized to its active metabolite, ODV, by cytochrome P450 IID6 Therefore, the potential exists for a drug interaction between venlafaxine and drugs that inhibit cytochrome P450-IID6 metabolism.
  • Effexor withdrawal. Effexor withdrawal side effects, Effexor withdrawal warnings, Effexor withdrawal precautions, Effexor withdrawal adverse effects. 17 January 2010 5:36 UTC prozactruth.com [Source type: Academic]

^ However, the scope of this guideline is limited to pharmacotherapy with second-generation antidepressants (selective serotonin reuptake inhibitors [SSRIs], serotonin norepinephrine reuptake inhibitors [SNRIs], and selective serotonin norepinephrine reuptake inhibitors [SSNRIs]).
  • Using Second-Generation Antidepressants to Treat Depressive Disorders: A Clinical Practice Guideline from the American College of Physicians — Ann Intern Med 17 January 2010 5:36 UTC www.annals.org [Source type: Academic]

.Serotonin syndrome symptoms may include mental status changes (e.g., agitation, hallucinations, coma), autonomic instability (e.g., tachycardia, labile blood pressure, hyperthermia), neuromuscular aberrations (e.g., hyperreflexia, incoordination) and/or gastrointestinal symptoms (e.g., nausea, vomiting, diarrhea).^ Table 6.13 -- Symptoms of Serotonin Reuptake Inhibitor Withdrawal Syndrome .
  • ADHD Overview 17 January 2010 5:36 UTC www.vakkur.com [Source type: Academic]

^ Effexor withdrawal Neuroleptic Malignant Syndrome - A life threatening, rare reaction to an anti-psychotic drug marked by fever, muscular rigidity, changed mental status, and dysfunction of the autonomic nervous system.
  • Effexor withdrawal. Effexor withdrawal side effects, Effexor withdrawal warnings, Effexor withdrawal precautions, Effexor withdrawal adverse effects. 17 January 2010 5:36 UTC prozactruth.com [Source type: Academic]

^ Effexor XR (venlafaxine) for Irritable Bowel Syndrome : Worked really well for irritable bowel syndrome, but unfortunately it affected my blood pressure.
  • venlafaxine systemic User Reviews at Drugs.com 17 January 2010 5:36 UTC www.drugs.com [Source type: General]

Venlafaxine-induced serotonin syndrome has also been reported when venlafaxine has been taken in isolation in overdose.[30] .An abortive serotonin syndrome state, in which some but not all of the symptoms of the full serotonin syndrome are present, has been reported with venlafaxine at mid-range dosages (150 mg per day)[31] A case of a patient with serotonin syndrome induced by low-dose venlafaxine (37.5 mg per day) has also been reported.^ Still more preferably the dosage of venlafaxine is about 75 mg to about 150 mg/day.
  • Succinate salt of O-desmethyl-venlafaxine - Patent 7026508 17 January 2010 5:36 UTC www.freepatentsonline.com [Source type: Academic]

^ Dose-related hyperprolactinemia induced by venlafaxine.
  • Effexor withdrawal. Effexor withdrawal side effects, Effexor withdrawal warnings, Effexor withdrawal precautions, Effexor withdrawal adverse effects. 17 January 2010 5:36 UTC prozactruth.com [Source type: Academic]

^ I take 225 dose a day, not sure if it is a high or low dosage.
  • Psych Central Reviews - Effexor (venlafaxine) 17 January 2010 5:36 UTC forums.psychcentral.com [Source type: General]

[32]

Combined serotonin toxicity and SSRI discontinuation syndrome

.Venlafaxine may be particularly hazardous to those individuals who are susceptible to both venlafaxine-induced serotonin toxicity (also known as serotonin syndrome) and SSRI discontinuation syndrome.^ Patients were included who had switched from an SSRI after at least two consecutive months of therapy followed by at least two consecutive months of a TCA (n=172) or venlafaxine (n=188).
  • Access and Utilization of New Antidepressant and Antipsychotic Medications 17 January 2010 5:36 UTC aspe.os.dhhs.gov [Source type: Academic]

^ Venlafaxine may be prepared in accordance with procedures known in the art, such as those described in U.S. Pat.
  • Succinate salt of O-desmethyl-venlafaxine - Patent 7026508 17 January 2010 5:36 UTC www.freepatentsonline.com [Source type: Academic]

^ Any crystals prepared by the aforementioned methods may be recovered by technique known to those silled in the art, such as, for example, filtration.
  • Succinate salt of O-desmethyl-venlafaxine - Patent 7026508 17 January 2010 5:36 UTC www.freepatentsonline.com [Source type: Academic]

.In such cases individuals who have developed the potentially fatal serotonin toxicity and/or may be at risk of doing so may find cessation or dose reduction unachievable placing them at continuing risk.^ Thus, at higher concentrations/doses paroxetine loses its SERT selectivity and, like venlafaxine, may act as a dual serotonin/norepinephrine uptake inhibitor (SNRI).
  • Neuropsychopharmacology - Estimates of Serotonin and Norepinephrine Transporter Inhibition in Depressed Patients Treated with Paroxetine or Venlafaxine 17 January 2010 5:36 UTC www.nature.com [Source type: Academic]

^ Since there was so much individual variability in clearance between patients with renal impairment, individualization of dosing may be desirable in some patients.
  • Effexor withdrawal. Effexor withdrawal side effects, Effexor withdrawal warnings, Effexor withdrawal precautions, Effexor withdrawal adverse effects. 17 January 2010 5:36 UTC prozactruth.com [Source type: Academic]

^ For patients who experience a sustained increase in blood pressure during treatment with venlafaxine, either a dose reduction or discontinuation of venlafaxine should be considered.
  • Effexor withdrawal. Effexor withdrawal side effects, Effexor withdrawal warnings, Effexor withdrawal precautions, Effexor withdrawal adverse effects. 17 January 2010 5:36 UTC prozactruth.com [Source type: Academic]

.As it is not possible to determine which patients are likely to develop the most severe symptoms of the discontinuation syndrome before cessation or dose reduction is attempted, this dual risk requires that all patients are closely monitored during any increase in dosage (when the patient is most at risk of developing serotonin toxicity)[33] and that such increases are carried out in the smallest incremental steps possible.^ Most patients reported no symptoms.
  • Effexor withdrawal. Effexor withdrawal side effects, Effexor withdrawal warnings, Effexor withdrawal precautions, Effexor withdrawal adverse effects. 17 January 2010 5:36 UTC prozactruth.com [Source type: Academic]

^ The U.S. Food and Drug Administration advises that all patients receiving antidepressants be closely monitored on a regular basis for increases in suicidal thoughts and behaviors (100) .
  • Using Second-Generation Antidepressants to Treat Depressive Disorders: A Clinical Practice Guideline from the American College of Physicians — Ann Intern Med 17 January 2010 5:36 UTC www.annals.org [Source type: Academic]

^ Inactive ingredients 2.5 mg 5 days not like to try patients on long-term prednisone often during your child's doctor.
  • Forum: BayShip and Yacht - recommendation 17 January 2010 5:36 UTC www.synfo.com [Source type: General]

.Additionally, patients who recommence venlafaxine or revert to a higher dosage following a failed attempt to discontinue the drug or reduce dosage are another group with an increased risk of developing serotonin toxicity.^ Patients were included who had switched from an SSRI after at least two consecutive months of therapy followed by at least two consecutive months of a TCA (n=172) or venlafaxine (n=188).
  • Access and Utilization of New Antidepressant and Antipsychotic Medications 17 January 2010 5:36 UTC aspe.os.dhhs.gov [Source type: Academic]

^ Weak evidence indicates that bupropion may be associated with an increased risk for seizures, venlafaxine may be associated with an increased risk for cardiovascular events, and nefazodone may be associated with an increased risk for hepatotoxicity.
  • Using Second-Generation Antidepressants to Treat Depressive Disorders: A Clinical Practice Guideline from the American College of Physicians — Ann Intern Med 17 January 2010 5:36 UTC www.annals.org [Source type: Academic]

^ Yet another method of preparing ODV free base is by demethylating venlafaxine or a salt thereof (e.g., a non-reducible salt of venlafaxine, such as the hydrochloride salt) with an alkali metal salt of a trialkylborohydride.
  • Succinate salt of O-desmethyl-venlafaxine - Patent 7026508 17 January 2010 5:36 UTC www.freepatentsonline.com [Source type: Academic]

[28]

Overdosage

Overdosing with the drug can result in cardiac arrhythmia, hypotension, seizures, coma or even death. .Plasma venlafaxine concentrations in overdose survivors have ranged from 6-24 mg/l, while postmortem blood levels in fatalities are often in the 10-90 mg/l range.^ By flattening the curve as in sustained release formulation, Formulation #2, the peak blood plasma level is reduced and the tmax delayed.
  • Succinate salt of O-desmethyl-venlafaxine - Patent 7026508 17 January 2010 5:36 UTC www.freepatentsonline.com [Source type: Academic]

^ Noncompartmental pharmacokinetic parameters were calculated from the individual dog plasma O-desmethyl-venlafaxine and O-desmethyl-venlafaxine-glucuronide concentration-time profiles.
  • Succinate salt of O-desmethyl-venlafaxine - Patent 7026508 17 January 2010 5:36 UTC www.freepatentsonline.com [Source type: Academic]

^ In other embodiments of the invention the dosage will range from about 30 mg to about 90 mg/day.
  • Succinate salt of O-desmethyl-venlafaxine - Patent 7026508 17 January 2010 5:36 UTC www.freepatentsonline.com [Source type: Academic]

[34]

Available forms

Effexor XR 75 mg and 150 mg capsules
Generic 75mg (top) and 150mg (bottom) venlafaxine capsules by Krka
.Effexor is distributed in pentagon-shaped peach-colored tablets of 25 mg, 37.5 mg, 50 mg, 75 mg, and 100 mg.^ Ultram ER 100 mg tablets per day ultram has no effect.
  • Forum: BayShip and Yacht - recommendation 17 January 2010 5:36 UTC www.synfo.com [Source type: General]

.There is also an extended-release version distributed in capsules of 37.5 mg (gray/peach), 75 mg (peach), and 150 mg (brownish red).^ The answer was to take it in the morning - I'm taking 75mg of the extended release capsules and and 37.5mg of the tablet, with breakfast.
  • venlafaxine systemic User Reviews at Drugs.com 17 January 2010 5:36 UTC www.drugs.com [Source type: General]

^ I started at a dose of 75 mg and was increased to a dose of 150 mg after 4 weeks.
  • Psych Central Reviews - Effexor (venlafaxine) 17 January 2010 5:36 UTC forums.psychcentral.com [Source type: General]

^ Do not chew, divide, or crush the extended-release tablet or capsule.
  • Psych Central Reviews - Effexor (venlafaxine) 17 January 2010 5:36 UTC forums.psychcentral.com [Source type: General]
  • Psych Central Reviews - Effexor (venlafaxine) 17 January 2010 5:36 UTC forums.psychcentral.com [Source type: General]

Venlafaxine extended release (XR)

.Venlafaxine extended release is chemically the same as normal venlafaxine.^ Venlafaxine extended release is chemically the same as normal venlafaxine.
  • Venlafaxine - Drug information from Medic8.com 17 January 2010 5:36 UTC www.medic8.com [Source type: Academic]
  • Venlafaxine: Encyclopedia of chemistry, analytics & pharmaceutics with 64,557 entries. 17 January 2010 5:36 UTC www.chemie.de [Source type: Academic]

^ The Patent Description & Claims data below is from USPTO Patent Application 20060018963, Extended release venlafaxine besylate tablets.
  • Extended release venlafaxine besylate tablets invention 17 January 2010 5:36 UTC www.freshpatents.com [Source type: Reference]

^ Receive info on patent apps like Extended release venlafaxine besylate tablets or other areas of interest.
  • Extended release venlafaxine besylate tablets invention 17 January 2010 5:36 UTC www.freshpatents.com [Source type: Reference]

.The extended release version (sometimes referred to as controlled release) controls the release of the drug into the gastrointestinal tract over a longer period than normal venlafaxine.^ Bielski RJ , Ventura D , Chang CC A double-blind comparison of escitalopram and venlafaxine extended release in the treatment of major depressive disorder.
  • Using Second-Generation Antidepressants to Treat Depressive Disorders: A Clinical Practice Guideline from the American College of Physicians — Ann Intern Med 17 January 2010 5:36 UTC www.annals.org [Source type: Academic]

^ The effectiveness of venlafaxine in long-term use (i.e., for more than 4 to 6 weeks) has not been systematically evaluated in controlled trials.
  • Effexor withdrawal. Effexor withdrawal side effects, Effexor withdrawal warnings, Effexor withdrawal precautions, Effexor withdrawal adverse effects. 17 January 2010 5:36 UTC prozactruth.com [Source type: Academic]

^ The dosage forms may also include immediate release as well as formulations adapted for controlled, sustained, extended, or delayed release.
  • Succinate salt of O-desmethyl-venlafaxine - Patent 7026508 17 January 2010 5:36 UTC www.freepatentsonline.com [Source type: Academic]

.This results in a lower peak plasma concentration.^ This results in a lower peak plasma concentration.
  • Venlafaxine - Drug information from Medic8.com 17 January 2010 5:36 UTC www.medic8.com [Source type: Academic]
  • Venlafaxine: Encyclopedia of chemistry, analytics & pharmaceutics with 64,557 entries. 17 January 2010 5:36 UTC www.chemie.de [Source type: Academic]

^ Mean peak plasma concentrations of venlafaxine range from approximately 33 to 172ng/ml after 25 to 150mg single doses, and are reached in approximately 2.4 hours.
  • Efexor - Summary of Product Characteristics (SPC) - electronic Medicines Compendium (eMC) 17 January 2010 5:36 UTC emc.medicines.org.uk [Source type: Academic]

^ Pharmacokinetics: Venlafaxine is well absorbed, with peak plasma concentrations occurring approximately 2 hours after dosing.
  • Effexor withdrawal. Effexor withdrawal side effects, Effexor withdrawal warnings, Effexor withdrawal precautions, Effexor withdrawal adverse effects. 17 January 2010 5:36 UTC prozactruth.com [Source type: Academic]

.Studies have shown that the extended release formula has a lower incidence of patients suffering from nausea as a side effect resulting in a lower number of patients stopping their treatment due to nausea.^ Studies have shown that the extended release formula has a lower incidence of patients suffering from nausea as a side effect resulting in a lower number of patients stopping their treatment due to nausea.
  • Venlafaxine - Drug information from Medic8.com 17 January 2010 5:36 UTC www.medic8.com [Source type: Academic]
  • Venlafaxine: Encyclopedia of chemistry, analytics & pharmaceutics with 64,557 entries. 17 January 2010 5:36 UTC www.chemie.de [Source type: Academic]

^ Common side effects Nausea .
  • Venlafaxine - Drug information from Medic8.com 17 January 2010 5:36 UTC www.medic8.com [Source type: Academic]

^ Incidence based on number of female patients.
  • Effexor withdrawal. Effexor withdrawal side effects, Effexor withdrawal warnings, Effexor withdrawal precautions, Effexor withdrawal adverse effects. 17 January 2010 5:36 UTC prozactruth.com [Source type: Academic]

[35] .In Australia, New Zealand and Switzerland, Wyeth sells their venlafaxine XR tablets under the name "Efexor-XR" (note the spelling with one 'f', rather than "Effexor-XR").^ Effexor® XR (venlafaxine formulation) (available from Wyeth-Ayerst Pharmaceuticals of St. Davids, Pa.
  • Succinate salt of O-desmethyl-venlafaxine - Patent 7026508 17 January 2010 5:36 UTC www.freepatentsonline.com [Source type: Academic]

^ Do not take effexor XR. Venlafaxine cause me to use effexor XR outcomes were documented.
  • Forum: BayShip and Yacht - recommendation 17 January 2010 5:36 UTC www.synfo.com [Source type: General]

^ Some drugs are listed under more than one CYP enzyme.
  • ADHD Overview 17 January 2010 5:36 UTC www.vakkur.com [Source type: Academic]

.In Brazil Medley sells a venlafaxine XR capsule under the brand name Alenthus XR. In September 2008, Osmotica Pharmaceuticals began marketing venlafaxine extended release tablets in the United States to compete with Wyeth's capsule-form, Effexor-XR. Sales of branded Efexor XR have remained strong, at US$2.7bn.^ The present invention provides a novel salt of O-desmethyl-venlafaxine, O-desmethyl-venlafaxine succinate, as well as polymorphs, pharmaceutical compositions, dosage forms, and methods of use with the same.
  • Succinate salt of O-desmethyl-venlafaxine - Patent 7026508 17 January 2010 5:36 UTC www.freepatentsonline.com [Source type: Academic]

^ Bielski RJ , Ventura D , Chang CC A double-blind comparison of escitalopram and venlafaxine extended release in the treatment of major depressive disorder.
  • Using Second-Generation Antidepressants to Treat Depressive Disorders: A Clinical Practice Guideline from the American College of Physicians — Ann Intern Med 17 January 2010 5:36 UTC www.annals.org [Source type: Academic]

^ Effexor® XR (venlafaxine formulation) (available from Wyeth-Ayerst Pharmaceuticals of St. Davids, Pa.
  • Succinate salt of O-desmethyl-venlafaxine - Patent 7026508 17 January 2010 5:36 UTC www.freepatentsonline.com [Source type: Academic]

[36]

Generic

.Generic venlafaxine is available in the United States as of August 2006 and in Canada as of December 2006. Generic forms of the extended-release version have been available in Canada as of January 2007 and currently include Co Venlafaxine XR (Cobalt Pharmaceuticals Inc.^ The present invention provides a novel salt of O-desmethyl-venlafaxine, O-desmethyl-venlafaxine succinate, as well as polymorphs, pharmaceutical compositions, dosage forms, and methods of use with the same.
  • Succinate salt of O-desmethyl-venlafaxine - Patent 7026508 17 January 2010 5:36 UTC www.freepatentsonline.com [Source type: Academic]

^ Succinic acid salts of O-desmethyl-venlafaxine exist as enantiomers and this invention includes racemic mixtures as well as stereoisomerically pure forms of the same.
  • Succinate salt of O-desmethyl-venlafaxine - Patent 7026508 17 January 2010 5:36 UTC www.freepatentsonline.com [Source type: Academic]

^ Bielski RJ , Ventura D , Chang CC A double-blind comparison of escitalopram and venlafaxine extended release in the treatment of major depressive disorder.
  • Using Second-Generation Antidepressants to Treat Depressive Disorders: A Clinical Practice Guideline from the American College of Physicians — Ann Intern Med 17 January 2010 5:36 UTC www.annals.org [Source type: Academic]

), Gen-Venlafaxine XR (Genpharm), Riva-Venlafaxine XR (Laboratoire Riva Inc.), .Novo Venlafaxine XR (Novopharm Limited), PMS-Venlafaxine XR (Pharmascience Inc.^ How does Novo- Venlafaxine XR? To keep taking them, once a day with food.
  • Forum: BayShip and Yacht - recommendation 17 January 2010 5:36 UTC www.synfo.com [Source type: General]

), Ratio-Venlafaxine XR (ratiopharm), Viepax (in Israel) and Sandoz Venlafaxine XR (Sandoz Canada Inc.). Generic versions of both drug forms are available now in India. Generic versions are also available in the UK such as Vaxalin manufactured by RatioPharm GmbH.[37]

Overdose

.Most patients overdosing with venlafaxine develop only mild symptoms.^ Most patients overdosing with venlafaxine develop only mild symptoms.
  • Venlafaxine: Encyclopedia of chemistry, analytics & pharmaceutics with 64,557 entries. 17 January 2010 5:36 UTC www.chemie.de [Source type: Academic]

^ Most patients reported no symptoms.
  • Effexor withdrawal. Effexor withdrawal side effects, Effexor withdrawal warnings, Effexor withdrawal precautions, Effexor withdrawal adverse effects. 17 January 2010 5:36 UTC prozactruth.com [Source type: Academic]

^ "Discontinuation symptoms have been systematically evaluated in patients taking venlafaxine....
  • PsychoTropical Research - Dr Ken Gillman, Serotonin Syndrome, Mirtazapine, Dual Action Drugs. Antidepressants - Venlafaxine. 17 January 2010 5:36 UTC www.psychotropical.com [Source type: Academic]

.However, severe toxicity is reported with the most common symptoms being CNS depression, serotonin toxicity, seizure, or cardiac conduction abnormalities.^ Note, however, that both of these studies were conducted before the introduction of most of the antidepressant agents of interest in this report.
  • Access and Utilization of New Antidepressant and Antipsychotic Medications 17 January 2010 5:36 UTC aspe.os.dhhs.gov [Source type: Academic]

^ Which is not to say I haven't gotten severely depressed on it, but I credit it with being the reason I'm still walking around on the planet.
  • Psych Central Reviews - Effexor (venlafaxine) 17 January 2010 5:36 UTC forums.psychcentral.com [Source type: General]
  • Psych Central Reviews - Effexor (venlafaxine) 17 January 2010 5:36 UTC forums.psychcentral.com [Source type: General]

^ Crying all the time, feeling spaced out, severe insomnia, increased depressive symptoms, dizziness ...
  • Psych Central Reviews - Effexor (venlafaxine) 17 January 2010 5:36 UTC forums.psychcentral.com [Source type: General]

[38] .Venlafaxine's toxicity appears to be higher than other SSRIs, with a fatal toxic dose closer to that of the tricyclic antidepressants than the SSRIs.^ First-generation antidepressants (tricyclic antidepressants and monoamine oxidase inhibitors) are less commonly used than second-generation antidepressants, which have similar efficacy to and lower toxicity in overdose than first-generation antidepressants.
  • Using Second-Generation Antidepressants to Treat Depressive Disorders: A Clinical Practice Guideline from the American College of Physicians — Ann Intern Med 17 January 2010 5:36 UTC www.annals.org [Source type: Academic]

^ Most of the second-generation antidepressants had similar adverse events, with some differences in the incidence of specific adverse events: Venlafaxine had a higher incidence of nausea and vomiting than other SSRIs; sertraline had a higher rate of diarrhea than bupropion, citalopram, fluoxetine, fluvoxamine, mirtazapine, nefazodone, paroxetine, or venlafaxine; mirtazapine and paroxetine resulted in higher weight gain than sertraline, trazodone, or venlafaxine; and trazodone was associated with a higher incidence of somnolence than bupropion, fluoxetine, mirtazapine, paroxetine, or venlafaxine.
  • Using Second-Generation Antidepressants to Treat Depressive Disorders: A Clinical Practice Guideline from the American College of Physicians — Ann Intern Med 17 January 2010 5:36 UTC www.annals.org [Source type: Academic]

^ Khan A , Khan S , Kolts R , Brown WA Suicide rates in clinical trials of SSRIs, other antidepressants, and placebo: analysis of FDA reports.
  • Using Second-Generation Antidepressants to Treat Depressive Disorders: A Clinical Practice Guideline from the American College of Physicians — Ann Intern Med 17 January 2010 5:36 UTC www.annals.org [Source type: Academic]

.Doses of 900 mg or more are likely to cause moderate toxicity.^ In outpatient settings there was no evidence of the usefulness of doses greater than 225 mg/day for moderately depressed patients.
  • Effexor withdrawal. Effexor withdrawal side effects, Effexor withdrawal warnings, Effexor withdrawal precautions, Effexor withdrawal adverse effects. 17 January 2010 5:36 UTC prozactruth.com [Source type: Academic]

^ More severely depressed inpatients have responded to higher doses, between 350 and 375 mg/day, given in 3 divided doses.
  • Effexor withdrawal. Effexor withdrawal side effects, Effexor withdrawal warnings, Effexor withdrawal precautions, Effexor withdrawal adverse effects. 17 January 2010 5:36 UTC prozactruth.com [Source type: Academic]

^ If the medicine was used in high doses more than 10 mg was recorded for informational purposes only being used.
  • Forum: BayShip and Yacht - recommendation 17 January 2010 5:36 UTC www.synfo.com [Source type: General]

[39] Deaths have been reported following very large doses.[40][41]
.On May 31 2006, The Medicines and Healthcare products Regulatory Agency (MHRA) UK has concluded its review into all the latest safety evidence relating to venlafaxine particularly looked at the risks associated with overdose.^ These recommendations are based on the systematic evidence review by Gartlehner and colleagues (2) and the Agency for Healthcare Research and Quality–sponsored RTI International–University of North Carolina Evidence-based Practice Center evidence report (1) .
  • Using Second-Generation Antidepressants to Treat Depressive Disorders: A Clinical Practice Guideline from the American College of Physicians — Ann Intern Med 17 January 2010 5:36 UTC www.annals.org [Source type: Academic]

^ Review Date: Tue October 31, 2006 .
  • Psych Central Reviews - Effexor (venlafaxine) 17 January 2010 5:36 UTC forums.psychcentral.com [Source type: General]
  • Psych Central Reviews - Effexor (venlafaxine) 17 January 2010 5:36 UTC forums.psychcentral.com [Source type: General]

^ In order to reduce the risk of overdose, prescriptions for venlafaxine should be written for the smallest quantity of tablets consistent with good patient management.
  • Effexor withdrawal. Effexor withdrawal side effects, Effexor withdrawal warnings, Effexor withdrawal precautions, Effexor withdrawal adverse effects. 17 January 2010 5:36 UTC prozactruth.com [Source type: Academic]

.The advice are, the need for specialist supervision in those severely depressed or hospitalized patients who need doses 300 mg or more; cardiac contra-indications are more targeted towards high risk groups; patients with uncontrolled hypertension should not take venlafaxine, and blood pressure monitoring is recommended for all patients; and updated advice on possible drug interactions.^ Taking certain medications with you if you have all, possible interactions.
  • Forum: BayShip and Yacht - recommendation 17 January 2010 5:36 UTC www.synfo.com [Source type: General]

^ Mirtazapine versus venlafaxine in hospitalized severely depressed patients with melancholic features.
  • Using Second-Generation Antidepressants to Treat Depressive Disorders: A Clinical Practice Guideline from the American College of Physicians — Ann Intern Med 17 January 2010 5:36 UTC www.annals.org [Source type: Academic]

^ Guelfi JD , Ansseau M , Timmerman L , Kørsgaard S Mirtazapine-Venlafaxine Study Group Mirtazapine versus venlafaxine in hospitalized severely depressed patients with melancholic features.
  • Using Second-Generation Antidepressants to Treat Depressive Disorders: A Clinical Practice Guideline from the American College of Physicians — Ann Intern Med 17 January 2010 5:36 UTC www.annals.org [Source type: Academic]

[42]
.On October 17, 2006 Wyeth and the FDA notified healthcare professionals of revisions to the Overdosage/Human Experience section of the prescribing information for Effexor (venlafaxine), indicated for treatment of major depressive disorder.^ Phases of treatment of major depression.
  • Using Second-Generation Antidepressants to Treat Depressive Disorders: A Clinical Practice Guideline from the American College of Physicians — Ann Intern Med 17 January 2010 5:36 UTC www.annals.org [Source type: Academic]

^ Comparison of venlafaxine and imipramine in the acute treatment of major depression in outpatients.

^ Effexor is used for treatment of depression.
  • Psych Central Reviews - Effexor (venlafaxine) 17 January 2010 5:36 UTC forums.psychcentral.com [Source type: General]
  • Psych Central Reviews - Effexor (venlafaxine) 17 January 2010 5:36 UTC forums.psychcentral.com [Source type: General]

.In postmarketing experience, there have been reports of overdose with venlafaxine, occurring predominantly in combination with alcohol and/or other drugs.^ In postmarketing experience, there have been reports of overdose with venlafaxine, occurring predominantly in combination with alcohol and/or other drugs.
  • Venlafaxine: Encyclopedia of chemistry, analytics & pharmaceutics with 64,557 entries. 17 January 2010 5:36 UTC www.chemie.de [Source type: Academic]

^ For venlafaxine, subjects who are CYP2D6 poor metabolizers or who are taking interacting drugs may achieve concentrations similar to those found in overdose with therapeutic doses.
  • Relative toxicity of venlafaxine and selective serotonin reuptake inhibitors in overdose compared to tricyclic antidepressants -- Whyte et al. 96 (5): 369 -- QJM 17 January 2010 5:36 UTC qjmed.oxfordjournals.org [Source type: Academic]

^ Symptoms and Treatment: Human Experience: There were 14 reports of acute overdose with venlafaxine, either alone or in combination with other drugs and/or alcohol, among the patients included in the premarketing evaluation.
  • Effexor withdrawal. Effexor withdrawal side effects, Effexor withdrawal warnings, Effexor withdrawal precautions, Effexor withdrawal adverse effects. 17 January 2010 5:36 UTC prozactruth.com [Source type: Academic]

.Published retrospective studies report that venlafaxine overdosage may be associated with an increased risk of fatal outcome compared to that observed with SSRI antidepressant products, but lower than that for tricyclic antidepressants.^ In these analyses, the rate for venlafaxine is higher than that for SSRIs, but lower than that for tricyclic antidepressants.
  • Efexor - Summary of Product Characteristics (SPC) - electronic Medicines Compendium (eMC) 17 January 2010 5:36 UTC emc.medicines.org.uk [Source type: Academic]

^ SSRIs: Concurrent use may increase risk of serotonin syndrome .
  • Venlafaxine 17 January 2010 5:36 UTC www.umm.edu [Source type: Academic]
  • Venlafaxine - Erewhon Natural Foods 17 January 2010 5:36 UTC www.erewhonmarket.com [Source type: Academic]

^ In addition, SSRIs are associated with an increased risk for suicide attempts compared with placebo.
  • Using Second-Generation Antidepressants to Treat Depressive Disorders: A Clinical Practice Guideline from the American College of Physicians — Ann Intern Med 17 January 2010 5:36 UTC www.annals.org [Source type: Academic]

.Healthcare professionals are advised to prescribe Effexor and Effexor XR in the smallest quantity of capsules consistent with good patient management to reduce the risk of overdose.^ I'm back on the Effexor XR and life is good again!
  • Venlafaxine Side Effects - The People's Pharmacy® 17 January 2010 5:36 UTC www.peoplespharmacy.com [Source type: FILTERED WITH BAYES]

^ Prescriptions should be written for the smallest quantity consistent with good patient care.
  • Venlafaxine 17 January 2010 5:36 UTC www.umm.edu [Source type: Academic]

^ It is also recommended that prescriptions for antidepressants be written for the smallest quantity of tablets consistent with good patient management, in order to reduce the risk of overdose.
  • Venlafaxine 17 January 2010 5:36 UTC www.umm.edu [Source type: Academic]

[43]
A report in the British Medical Journal in 2002 by Dr. Nicholas Buckley and colleagues at the Department of Clinical Pharmacology and Toxicology, Canberra Hospital, Australia studying fatal toxicity index (deaths per million prescriptions) found that venlafaxine's fatal toxicity is higher than that of other serotoninergic antidepressants but it is similar to that of some of the less toxic tricyclic antidepressants. .Overall they found serious toxicity could occur following venlafaxine overdose with reports of deaths, arrythmias, and seizures.^ Severe rhabdomyolysis following venlafaxine overdose.
  • Effexor withdrawal. Effexor withdrawal side effects, Effexor withdrawal warnings, Effexor withdrawal precautions, Effexor withdrawal adverse effects. 17 January 2010 5:36 UTC prozactruth.com [Source type: Academic]

^ Overall they found serious toxicity could occur following venlafaxine overdose with reports of deaths, arrythmias, and seizures.
  • Venlafaxine: Encyclopedia of chemistry, analytics & pharmaceutics with 64,557 entries. 17 January 2010 5:36 UTC www.chemie.de [Source type: Academic]

^ A doctor from the Department of Pharmacy Services College of Pharmacy, Medical University of South Carolina, Charleston, South Carolina, reported on the death of a 39-year-old patient with a 30 g overdose.
  • Venlafaxine: Encyclopedia of chemistry, analytics & pharmaceutics with 64,557 entries. 17 January 2010 5:36 UTC www.chemie.de [Source type: Academic]

.They did, however, state that this type of data is open to criticism pointing out that mortality data may be influenced by previous literature and that "less toxic" drugs may be preferentially prescribed to patients at higher risk of poisoning and suicide but they are also less likely to be listed as the sole cause of death from overdose.^ They did, however, state that this type of data is open to criticism pointing out that mortality data may be influenced by previous literature and that "less toxic" drugs may be preferentially prescribed to patients at higher risk of poisoning and suicide but they are also less likely to be listed as the sole cause of death from overdose.
  • Venlafaxine: Encyclopedia of chemistry, analytics & pharmaceutics with 64,557 entries. 17 January 2010 5:36 UTC www.chemie.de [Source type: Academic]

^ Some SSRI advocates point out the lower overdose risk of SSRI. By this they mean that SSRIs are less likely to result in death when taken as an overdose than are TCAs.

^ The FDA has asked the sponsors of all SNRIs to include the potential risk for persistent pulmonary hypertension(PPHN) in prescribing data as of July 19, 2006.
  • Venlafaxine: Encyclopedia of chemistry, analytics & pharmaceutics with 64,557 entries. 17 January 2010 5:36 UTC www.chemie.de [Source type: Academic]

.It also assumes that drugs are taken in overdose with similar frequency and in similar amounts.^ It also assumes that drugs are taken in overdose with similar frequency and in similar amounts.
  • Venlafaxine: Encyclopedia of chemistry, analytics & pharmaceutics with 64,557 entries. 17 January 2010 5:36 UTC www.chemie.de [Source type: Academic]

^ For venlafaxine, subjects who are CYP2D6 poor metabolizers or who are taking interacting drugs may achieve concentrations similar to those found in overdose with therapeutic doses.
  • Relative toxicity of venlafaxine and selective serotonin reuptake inhibitors in overdose compared to tricyclic antidepressants -- Whyte et al. 96 (5): 369 -- QJM 17 January 2010 5:36 UTC qjmed.oxfordjournals.org [Source type: Academic]

.They suggested "clinicians need to consider whether factors in their patients reduce or compensate for this risk before prescribing venlafaxine."^ They suggested "clinicians need to consider whether factors in their patients reduce or compensate for this risk before prescribing venlafaxine."
  • Venlafaxine: Encyclopedia of chemistry, analytics & pharmaceutics with 64,557 entries. 17 January 2010 5:36 UTC www.chemie.de [Source type: Academic]

^ For example, the drug abuse by at risk patients of certain non-prescription drugs can cause this serious effect and emphasizes the importance of good medical history sharing between General Practitioners and Psychiatrists as both may prescribe Venlafaxine.
  • HMDB: Showing Venlafaxine (HMDB05016) 17 January 2010 5:36 UTC hmdb.ca [Source type: Academic]

^ For example, the drug abuse by at-risk patients of certain non-prescription drugs can cause this serious effect, and emphasizes the importance of good medical history sharing between general practitioners and psychiatrists, as both may prescribe venlafaxine.
  • Venlafaxine: Encyclopedia of chemistry, analytics & pharmaceutics with 64,557 entries. 17 January 2010 5:36 UTC www.chemie.de [Source type: Academic]

[44]
.The February 27, 2007 Vancouver Sun reported that the BC Drug and Poison Information Centre has alerted doctors that the drug poses a significant risk of death from overdose, saying that venlafaxine "appears more toxic than it was originally hoped".[45] A doctor from the Department of Pharmacy Services College of Pharmacy, Medical University of South Carolina, Charleston, South Carolina, reported on the death of a 39-year-old patient with a 30 g overdose.^ However, in sensitivity analyses, SSRIs were more cost-effective than was venlafaxine in an inpatient worst case scenario, although venlafaxine remained dominant in all outpatient analyses.
  • Access and Utilization of New Antidepressant and Antipsychotic Medications 17 January 2010 5:36 UTC aspe.os.dhhs.gov [Source type: Academic]

^ The results of these studies exhibit mild evidence for venlafaxine being more cost-effective than SSRIs.
  • Access and Utilization of New Antidepressant and Antipsychotic Medications 17 January 2010 5:36 UTC aspe.os.dhhs.gov [Source type: Academic]

^ Effexor XR (venlafaxine) for Panic Disorder : I'm 19 years old and have been on Effexor for about 2 years now.
  • venlafaxine systemic User Reviews at Drugs.com 17 January 2010 5:36 UTC www.drugs.com [Source type: General]

[40] .To put this into perspective, a patient would have to take over 66 of the infrequently prescribed 450 mg high dosage pills, or 400 of the commonly prescribed 75 mg pills.^ For the first week, patients received PAR 12.5 mg/day or VEN 75 mg/day.
  • Neuropsychopharmacology - Estimates of Serotonin and Norepinephrine Transporter Inhibition in Depressed Patients Treated with Paroxetine or Venlafaxine 17 January 2010 5:36 UTC www.nature.com [Source type: Academic]

^ More preferably, each dosage form contains from about 30 to about 200 mg of ODV succinate (as measured by the free base equivalent) and even more preferably from about 75 to about 150 mg of ODV succinate (as measured by the free base equivalent).
  • Succinate salt of O-desmethyl-venlafaxine - Patent 7026508 17 January 2010 5:36 UTC www.freepatentsonline.com [Source type: Academic]

^ Still more preferably the dosage of venlafaxine is about 75 mg to about 150 mg/day.
  • Succinate salt of O-desmethyl-venlafaxine - Patent 7026508 17 January 2010 5:36 UTC www.freepatentsonline.com [Source type: Academic]

Management of overdosage

.There is no specific antidote for venlafaxine and management is generally supportive, providing treatment for the immediate symptoms.^ No specific antidotes for venlafaxine are known.
  • Effexor withdrawal. Effexor withdrawal side effects, Effexor withdrawal warnings, Effexor withdrawal precautions, Effexor withdrawal adverse effects. 17 January 2010 5:36 UTC prozactruth.com [Source type: Academic]

^ No studies compared efficacy, effectiveness, and harms of second-generation antidepressants among subgroups and the general population for treatment of depressive syndromes.
  • Using Second-Generation Antidepressants to Treat Depressive Disorders: A Clinical Practice Guideline from the American College of Physicians — Ann Intern Med 17 January 2010 5:36 UTC www.annals.org [Source type: Academic]

^ U.S. managed healthcare plans to compare treatment with venlafaxine to treatment with TCAs 77 .
  • Access and Utilization of New Antidepressant and Antipsychotic Medications 17 January 2010 5:36 UTC aspe.os.dhhs.gov [Source type: Academic]

Administration of activated charcoal can prevent absorption of the drug. .Monitoring of cardiac rhythm and vital signs is indicated.^ Monitoring of cardiac rhythm and vital signs is recommended, as are general supportive and symptomatic measures.
  • Efexor - Summary of Product Characteristics (SPC) - electronic Medicines Compendium (eMC) 17 January 2010 5:36 UTC emc.medicines.org.uk [Source type: Academic]

^ Monitoring of cardiac rhythm and vital signs is recommended.
  • Effexor withdrawal. Effexor withdrawal side effects, Effexor withdrawal warnings, Effexor withdrawal precautions, Effexor withdrawal adverse effects. 17 January 2010 5:36 UTC prozactruth.com [Source type: Academic]

^ Monitoring of cardiac rhythm and vital signs is indicated.
  • Venlafaxine: Encyclopedia of chemistry, analytics & pharmaceutics with 64,557 entries. 17 January 2010 5:36 UTC www.chemie.de [Source type: Academic]

Seizures are managed with benzodiazepines or other anti-convulsants. .Forced diuresis, hemodialysis, exchange transfusion, or hemoperfusion are unlikely to be of benefit in hastening the removal of venlafaxine, due to the drug's high volume of distribution.^ Due to the large volume of distribution of venlafaxine hydrochloride, forced diuresis, dialysis, hemoperfusion and exchange transfusion are unlikely to be of benefit.
  • Effexor withdrawal. Effexor withdrawal side effects, Effexor withdrawal warnings, Effexor withdrawal precautions, Effexor withdrawal adverse effects. 17 January 2010 5:36 UTC prozactruth.com [Source type: Academic]

^ Similar steady-state volumes of distribution are exhibited for venlafaxine (7+/-4 L/kg) and ODV (6+/-2 L/kg).
  • Effexor withdrawal. Effexor withdrawal side effects, Effexor withdrawal warnings, Effexor withdrawal precautions, Effexor withdrawal adverse effects. 17 January 2010 5:36 UTC prozactruth.com [Source type: Academic]

[46]

Mechanism of action

.Venlafaxine is a bicyclic antidepressant, and is usually categorized as a serotonin-norepinephrine reuptake inhibitor (SNRI), but it has been referred to as a serotonin-norepinephrine-dopamine reuptake inhibitor.^ The pharmacogenomics of selective serotonin reuptake inhibitors .
  • Neuropsychopharmacology - Estimates of Serotonin and Norepinephrine Transporter Inhibition in Depressed Patients Treated with Paroxetine or Venlafaxine 17 January 2010 5:36 UTC www.nature.com [Source type: Academic]

^ Affinities of venlafaxine and various reuptake inhibitors for the serotonin and norepinephrine transporters.
  • Neuropsychopharmacology - Estimates of Serotonin and Norepinephrine Transporter Inhibition in Depressed Patients Treated with Paroxetine or Venlafaxine 17 January 2010 5:36 UTC www.nature.com [Source type: Academic]

^ The mechanism of venlafaxine's antidepressant action in humans is believed to be associated with its potentiation of neurotransmitter activity in the CNS. Preclinical studies have shown that venlafaxine and its major metabolite, O-desmethylvenlafaxine (ODV), are potent inhibitors of neuronal serotonin and norepinephrine reuptake and weak inhibitors of dopamine reuptake.
  • Effexor withdrawal. Effexor withdrawal side effects, Effexor withdrawal warnings, Effexor withdrawal precautions, Effexor withdrawal adverse effects. 17 January 2010 5:36 UTC prozactruth.com [Source type: Academic]

[47][48] .It works by blocking the transporter "reuptake" proteins for key neurotransmitters affecting mood, thereby leaving more active neurotransmitters in the synapse.^ It actually started working the first couple of days I used it and then I titrated up to a dose twice a day and it has enabled me to be on a more even mood throughout the day.
  • venlafaxine systemic User Reviews at Drugs.com 17 January 2010 5:36 UTC www.drugs.com [Source type: General]

.The neurotransmitters affected are serotonin (5-hydroxytryptamine) and norepinephrine (noradrenaline).^ Serotonin and noradrenaline (also called norepinephrine) are neurotransmitters made by the cells in the brain.
  • BluePages Depression Information - Treatments: Medical Treatments - Antidepressants: SNRIs 17 January 2010 5:36 UTC bluepages.anu.edu.au [Source type: FILTERED WITH BAYES]

^ SNRI (Serotonin Noradrenaline [Norepinephrine] Reuptake Inhibitor) antidepressants .
  • BluePages Depression Information - Treatments: Medical Treatments - Antidepressants: SNRIs 17 January 2010 5:36 UTC bluepages.anu.edu.au [Source type: FILTERED WITH BAYES]

^ Serotonin and noradrenaline are two such neurotransmitters and have various functions that we know of.
  • Efexor XL (venlafaxine) 17 January 2010 5:36 UTC www.netdoctor.co.uk [Source type: FILTERED WITH BAYES]
  • Efexor XL (venlafaxine) 17 January 2010 5:36 UTC www.netdoctor.co.uk [Source type: FILTERED WITH BAYES]
  • Efexor (Venlafaxine) 28 x 75mg 17 January 2010 5:36 UTC www.elitenetpharmacy.com [Source type: FILTERED WITH BAYES]

.Additionally, in high doses it weakly inhibits the reuptake of dopamine,[49] with recent evidence showing that the norepinephrine transporter also transports some dopamine as well, implying that SNRIs may also increase dopamine transmission.^ Limited evidence (48, 49) showed similar efficacy among fluoxetine, nefazodone, paroxetine, and sertraline for treating depression in patients with accompanying insomnia.
  • Using Second-Generation Antidepressants to Treat Depressive Disorders: A Clinical Practice Guideline from the American College of Physicians — Ann Intern Med 17 January 2010 5:36 UTC www.annals.org [Source type: Academic]

^ If needed, the dose may be further increased up to 225 mg/day.
  • Effexor withdrawal. Effexor withdrawal side effects, Effexor withdrawal warnings, Effexor withdrawal precautions, Effexor withdrawal adverse effects. 17 January 2010 5:36 UTC prozactruth.com [Source type: Academic]

^ However, the 95% upper confidence limit on the ICER was positive, implying that fluoxetine may actually increase annual per patient charges.
  • Access and Utilization of New Antidepressant and Antipsychotic Medications 17 January 2010 5:36 UTC aspe.os.dhhs.gov [Source type: Academic]

This is because SNRIs work by inhibiting reuptake, i.e. preventing the serotonin and norepinephrine transporters from taking their respective neurotransmitters back to their storage vesicles for later use. If the norepinephrine transporter normally recycles some dopamine too, then SNRIs will also enhance dopaminergic transmission. .However, while concurrent increase in dopamine (particularly in the prefrontal cortex) is likely to occur[50], the antidepressant effects of any drug are believed to result largely from the modulation of serotonin and norepinephrine; dopamine is thought to play a comparatively small role in depression[51].^ The mechanism of venlafaxine's antidepressant action in humans is believed to be associated with its potentiation of neurotransmitter activity in the CNS. Preclinical studies have shown that venlafaxine and its major metabolite, O-desmethylvenlafaxine (ODV), are potent inhibitors of neuronal serotonin and norepinephrine reuptake and weak inhibitors of dopamine reuptake.
  • Effexor withdrawal. Effexor withdrawal side effects, Effexor withdrawal warnings, Effexor withdrawal precautions, Effexor withdrawal adverse effects. 17 January 2010 5:36 UTC prozactruth.com [Source type: Academic]

^ However, studies have shown that a small number of people (especially children/teenages) who take antidepressants for any condition may experience worsening depression, other mental/mood symptoms, or suicidal thoughts/attempts.
  • Psych Central Reviews - Effexor (venlafaxine) 17 January 2010 5:36 UTC forums.psychcentral.com [Source type: General]
  • Psych Central Reviews - Effexor (venlafaxine) 17 January 2010 5:36 UTC forums.psychcentral.com [Source type: General]

^ The majority of antidepressants used to treat major depressive disorder (MDD) are primarily antagonists at the human serotonin (SERT) and/or norepinephrine transporters (NET) ( Owens et al , 1997 , 2001 ; Nemeroff and Owens, 2002 ).
  • Neuropsychopharmacology - Estimates of Serotonin and Norepinephrine Transporter Inhibition in Depressed Patients Treated with Paroxetine or Venlafaxine 17 January 2010 5:36 UTC www.nature.com [Source type: Academic]

Pharmacokinetics

.Venlafaxine is well absorbed with at least 92% of an oral dose being absorbed into systemic circulation.^ Venlafaxine is well absorbed with at least 92% of an oral dose being absorbed into systemic circulation.
  • Venlafaxine: Encyclopedia of chemistry, analytics & pharmaceutics with 64,557 entries. 17 January 2010 5:36 UTC www.chemie.de [Source type: Academic]

^ Pharmacokinetics Venlafaxine is well absorbed with at least 92% of an oral dose being absorbed into systemic circulation.
  • Venlafaxine - Drug information from Medic8.com 17 January 2010 5:36 UTC www.medic8.com [Source type: Academic]

^ On the basis of mass balance studies, at least 92% of a single oral dose of venlafaxine is absorbed.
  • Extended release venlafaxine formulation - Patent application 17 January 2010 5:36 UTC www.faqs.org [Source type: Reference]

.It is extensively metabolized in the liver via the CYP2D6 isoenzyme to desvenlafaxine (O-desmethylvenlafaxine), which is just as potent a serotonin-norepinephrine reuptake inhibitor as the parent compound, meaning that the differences in metabolism between extensive and poor metabolizers are not clinically important in terms of efficacy.^ The pharmacogenomics of selective serotonin reuptake inhibitors .
  • Neuropsychopharmacology - Estimates of Serotonin and Norepinephrine Transporter Inhibition in Depressed Patients Treated with Paroxetine or Venlafaxine 17 January 2010 5:36 UTC www.nature.com [Source type: Academic]

^ Affinities of venlafaxine and various reuptake inhibitors for the serotonin and norepinephrine transporters.
  • Neuropsychopharmacology - Estimates of Serotonin and Norepinephrine Transporter Inhibition in Depressed Patients Treated with Paroxetine or Venlafaxine 17 January 2010 5:36 UTC www.nature.com [Source type: Academic]

^ The mechanism of venlafaxine's antidepressant action in humans is believed to be associated with its potentiation of neurotransmitter activity in the CNS. Preclinical studies have shown that venlafaxine and its major metabolite, O-desmethylvenlafaxine (ODV), are potent inhibitors of neuronal serotonin and norepinephrine reuptake and weak inhibitors of dopamine reuptake.
  • Effexor withdrawal. Effexor withdrawal side effects, Effexor withdrawal warnings, Effexor withdrawal precautions, Effexor withdrawal adverse effects. 17 January 2010 5:36 UTC prozactruth.com [Source type: Academic]

.Side effects, however, are reported to be more severe in CYP2D6 poor metabolizers.^ However Effexor's side effects.
  • Forum: BayShip and Yacht - recommendation 17 January 2010 5:36 UTC www.synfo.com [Source type: General]

^ However, I have had some severe side effects.
  • venlafaxine systemic User Reviews at Drugs.com 17 January 2010 5:36 UTC www.drugs.com [Source type: General]

^ The most commonly reported adverse events were constipation, diarrhea, dizziness, headache, insomnia, nausea, sexual side effects, and somnolence.
  • Using Second-Generation Antidepressants to Treat Depressive Disorders: A Clinical Practice Guideline from the American College of Physicians — Ann Intern Med 17 January 2010 5:36 UTC www.annals.org [Source type: Academic]

[52] .Steady-state concentrations of venlafaxine and its metabolite are attained in the blood within 3 days.^ Multiple-Dose Pharmacokinetic Profile: Steady-state concentrations of both venlafaxine and ODV in plasma were attained after approximately 3 days of multiple dose therapy.
  • Effexor withdrawal. Effexor withdrawal side effects, Effexor withdrawal warnings, Effexor withdrawal precautions, Effexor withdrawal adverse effects. 17 January 2010 5:36 UTC prozactruth.com [Source type: Academic]

^ Within 2 days, I was a wreck emotionally (depressive, sobbing for no reason), cognitively (all over the place, no concentration), and physically (impaired motor coordination among other things).
  • venlafaxine systemic User Reviews at Drugs.com 17 January 2010 5:36 UTC www.drugs.com [Source type: General]

^ As shown in the insets of Figure 1 , there is a high degree of inter-individual variability in the resultant steady-state serum concentrations produced by identical dosages.
  • Neuropsychopharmacology - Estimates of Serotonin and Norepinephrine Transporter Inhibition in Depressed Patients Treated with Paroxetine or Venlafaxine 17 January 2010 5:36 UTC www.nature.com [Source type: Academic]

.Therapeutic effects are usually achieved within 3 to 4 weeks.^ "And the effects we saw were within a week."
  • CNN.com - Health - Anti-depressant counters hot flashes from menopause, chemotherapy - December 15, 2000 17 January 2010 5:36 UTC www.cnn.com [Source type: News]

^ Therapeutic effects are usually achieved within 3 to 4 weeks.
  • Venlafaxine: Encyclopedia of chemistry, analytics & pharmaceutics with 64,557 entries. 17 January 2010 5:36 UTC www.chemie.de [Source type: Academic]

^ If there is no response within 2-weeks of reaching 150 mg/day the dose is again increased in steps of 25 mg/dose until a total daily dose of 300 mg/day is achieved.
  • Focus on Venlafaxine 17 January 2010 5:36 UTC priory.com [Source type: Academic]

.No accumulation of venlafaxine has been observed during chronic administration in healthy subjects.^ No accumulation of venlafaxine has been observed during chronic administration in healthy subjects.
  • Venlafaxine - Drug information from Medic8.com 17 January 2010 5:36 UTC www.medic8.com [Source type: Academic]
  • Venlafaxine: Encyclopedia of chemistry, analytics & pharmaceutics with 64,557 entries. 17 January 2010 5:36 UTC www.chemie.de [Source type: Academic]

^ A specific antidote, for venlafaxine administered under which the total of 24 healthy subjects.

^ Cimetidine: Concomitant administration of cimetidine and venlafaxine in a steady-state study for both drugs in 18 healthy male subjects resulted in inhibition of first-pass metabolism of venlafaxine.
  • Effexor withdrawal. Effexor withdrawal side effects, Effexor withdrawal warnings, Effexor withdrawal precautions, Effexor withdrawal adverse effects. 17 January 2010 5:36 UTC prozactruth.com [Source type: Academic]
  • EFFEXOR XR - Order Effexor 75mg 60 Pills ... (effexor xr) 17 January 2010 5:36 UTC barnus.2trom.com [Source type: General]

The primary route of excretion of venlafaxine and its metabolites is via the kidneys.[3] .The half-life of venlafaxine is relatively short, and, therefore, patients are directed to adhere to a strict medication routine, avoiding missing a dose.^ Effexor XR (venlafaxine) for Anxiety and Stress : I am amazed at how this medication changed my life.
  • venlafaxine systemic User Reviews at Drugs.com 17 January 2010 5:36 UTC www.drugs.com [Source type: General]

^ The total direct medical costs of treating patients with olanzapine over the five-year period were $1,539 less than for haloperidol and $1,875 less than for risperidone.
  • Access and Utilization of New Antidepressant and Antipsychotic Medications 17 January 2010 5:36 UTC aspe.os.dhhs.gov [Source type: Academic]

^ Effexor XR (venlafaxine) for Anxiety and Stress : This medication changed my life.
  • venlafaxine systemic User Reviews at Drugs.com 17 January 2010 5:36 UTC www.drugs.com [Source type: General]

.Even a single missed dose can result in the withdrawal symptoms.^ Even a single missed doses can result in the withdrawal symptoms.
  • Venlafaxine - Drug information from Medic8.com 17 January 2010 5:36 UTC www.medic8.com [Source type: Academic]

^ Even a single missed dose can result in the withdrawal symptoms.
  • Venlafaxine: Encyclopedia of chemistry, analytics & pharmaceutics with 64,557 entries. 17 January 2010 5:36 UTC www.chemie.de [Source type: Academic]

^ After 5 years in remission the dose was decreased to 50 mg without any problems, but when trying to stop it he would always experience discontinuation symptoms hours after missing the dose.
  • Venlafaxine discontinuation symptoms on prolonged low dose -- Dechene 29 (10): 395 -- The Psychiatrist 17 January 2010 5:36 UTC pb.rcpsych.org [Source type: Academic]

[26]
Carriers of the (T;T) allele of rs2032583 [53] SNP in the ABCB1 gene are 7x less likely to respond to Venlafaxine treatment. This genetic variant is present in about two thirds of people of European descent and 80% to 90% of East Asians.

Drug interactions

.Venlafaxine should be taken with caution when using St John's wort.^ Johns Wort should be avoided while taking fluvoxamine due to the increased side effects of too much serotonin.
  • Psych Central Reviews - Effexor (venlafaxine) 17 January 2010 5:36 UTC forums.psychcentral.com [Source type: General]
  • Psych Central Reviews - Effexor (venlafaxine) 17 January 2010 5:36 UTC forums.psychcentral.com [Source type: General]

^ Therefore, venlafaxine should not be used in combination with MAO inhibitors or within two weeks of terminating treatment with MAO inhibitor's.
  • Effexor withdrawal. Effexor withdrawal side effects, Effexor withdrawal warnings, Effexor withdrawal precautions, Effexor withdrawal adverse effects. 17 January 2010 5:36 UTC prozactruth.com [Source type: Academic]

^ Therefore, venlafaxine should only be used during pregnancy if clearly needed.
  • Effexor withdrawal. Effexor withdrawal side effects, Effexor withdrawal warnings, Effexor withdrawal precautions, Effexor withdrawal adverse effects. 17 January 2010 5:36 UTC prozactruth.com [Source type: Academic]

[54] .Venlafaxine may lower the seizure threshold, and co-administration with other drugs that lower the seizure threshold such as bupropion and tramadol should be done with caution and at low doses.^ Consequently, caution is advised if the concomitant administration of venlafaxine and such drugs is required.
  • Effexor withdrawal. Effexor withdrawal side effects, Effexor withdrawal warnings, Effexor withdrawal precautions, Effexor withdrawal adverse effects. 17 January 2010 5:36 UTC prozactruth.com [Source type: Academic]

^ It should be noted that the venlafaxine dose was in the low end of the therapeutic dosage, as was the single lithium dose.
  • Effexor withdrawal. Effexor withdrawal side effects, Effexor withdrawal warnings, Effexor withdrawal precautions, Effexor withdrawal adverse effects. 17 January 2010 5:36 UTC prozactruth.com [Source type: Academic]

^ As such, the results of this study suggest that sertraline is more cost-effective than fluoxetine, although these results should be interpreted with caution.
  • Access and Utilization of New Antidepressant and Antipsychotic Medications 17 January 2010 5:36 UTC aspe.os.dhhs.gov [Source type: Academic]

[55]
.There have been false positive phencyclidine (PCP) results caused by Venlafaxine with certain on-site routine urine-based drug tests.^ Drug Abuse and Dependence: Physical and Psychological Dependence: In vitro studies revealed that venlafaxine has virtually no affinity for opiate, benzodiazepine, phencyclidine (PCP), or N-methyl-D-aspartic acid (NMDA) receptors.
  • Effexor withdrawal. Effexor withdrawal side effects, Effexor withdrawal warnings, Effexor withdrawal precautions, Effexor withdrawal adverse effects. 17 January 2010 5:36 UTC prozactruth.com [Source type: Academic]

^ However, results were somewhat sensitive to drug costs, which were based upon dosages of 10mg/day for olanzapine and 15mg/day for haloperidol.
  • Access and Utilization of New Antidepressant and Antipsychotic Medications 17 January 2010 5:36 UTC aspe.os.dhhs.gov [Source type: Academic]

^ After trying several drugs such as paroxetine, prozac, and traditional anti-depressives, I finaly experienced positive results with this drug.
  • Psych Central Reviews - Effexor (venlafaxine) 17 January 2010 5:36 UTC forums.psychcentral.com [Source type: General]
  • Psych Central Reviews - Effexor (venlafaxine) 17 January 2010 5:36 UTC forums.psychcentral.com [Source type: General]

[56][57]
.Although the synergistic effects may not be as bad as with other anti-depressants, it is still not recommended to take venlafaxine with alcohol.^ However, studies have shown that a small number of people (especially children/teenages) who take antidepressants for any condition may experience worsening depression, other mental/mood symptoms, or suicidal thoughts/attempts.
  • Psych Central Reviews - Effexor (venlafaxine) 17 January 2010 5:36 UTC forums.psychcentral.com [Source type: General]
  • Psych Central Reviews - Effexor (venlafaxine) 17 January 2010 5:36 UTC forums.psychcentral.com [Source type: General]

^ For patients who have had 2 or more episodes of depression, an even longer duration of therapy may be beneficial (Grade: strong recommendation; moderate-quality evidence).
  • Using Second-Generation Antidepressants to Treat Depressive Disorders: A Clinical Practice Guideline from the American College of Physicians — Ann Intern Med 17 January 2010 5:36 UTC www.annals.org [Source type: Academic]

^ Effexor XR (venlafaxine) for Depression : I started taking Effexor XR 3 1/2 years ago while in an eating disorder treatment center.
  • venlafaxine systemic User Reviews at Drugs.com 17 January 2010 5:36 UTC www.drugs.com [Source type: General]

[58]

Physical/chemical properties

.The chemical structure of venlafaxine is designated (R/S)-1-[2-(dimethylamino)-1-(4 methoxyphenyl)ethyl] cyclohexanol hydrochloride or (±)-1-[a [a- (dimethylamino)methyl] p-methoxybenzyl] cyclohexanol hydrochloride and it has the empirical formula of C17H27NO2.^ O-desmethyl-venlafaxine, chemically named 1-[2-(dimethylamino)-1-(4-phenol)ethyl]-cyclohexanol, was exemplified as a fumarate salt in U.S. Pat.
  • Succinate salt of O-desmethyl-venlafaxine - Patent 7026508 17 January 2010 5:36 UTC www.freepatentsonline.com [Source type: Academic]

^ The no-effect dose of dialysis in the liver only take Ambien with a chemical structure.
  • Forum: BayShip and Yacht - recommendation 17 January 2010 5:36 UTC www.synfo.com [Source type: General]

.It is a white to off-white crystalline solid.^ It is a white to off-white crystalline solid.
  • Venlafaxine - Drug information from Medic8.com 17 January 2010 5:36 UTC www.medic8.com [Source type: Academic]
  • Venlafaxine: Encyclopedia of chemistry, analytics & pharmaceutics with 64,557 entries. 17 January 2010 5:36 UTC www.chemie.de [Source type: Academic]

^ Venlafaxine hydrochloride is a white to off-white crystalline solid with a solubility of 572 mg/mL in water (adjusted to ionic strength of 0.2 M with sodium chloride ).

^ Venlafaxine hydrochloride is a white to off-white crystalline solid with a solubility of 572 mg/mL in water (adjusted to ionic strength of 0.2 M with sodium chloride).
  • Adv Effexor ( Venlafaxine Hydrochloride ) 17 January 2010 5:36 UTC psyweb.com [Source type: FILTERED WITH BAYES]

.Venlafaxine is structurally and pharmacologically related to the atypical opioid analgesic Tramadol and more distantly the newly-released opioid Nucynta(Tapentadol), but not to any of the conventional antidepressant drugs, including tricyclic antidepressants, Selective serotonin reuptake inhibitors (SSRI), Monoamine oxidase inhibitors (MAOI), or reversible inhibitors of monoamine oxidase A (RIMA).^ Pharmacological profile of antidepressants and related compounds at human monoamine transporters.
  • Neuropsychopharmacology - Estimates of Serotonin and Norepinephrine Transporter Inhibition in Depressed Patients Treated with Paroxetine or Venlafaxine 17 January 2010 5:36 UTC www.nature.com [Source type: Academic]

^ The pharmacogenomics of selective serotonin reuptake inhibitors .
  • Neuropsychopharmacology - Estimates of Serotonin and Norepinephrine Transporter Inhibition in Depressed Patients Treated with Paroxetine or Venlafaxine 17 January 2010 5:36 UTC www.nature.com [Source type: Academic]

^ Remission rates during treatment with venlafaxine or selective serotonin reuptake inhibitors.
  • Neuropsychopharmacology - Estimates of Serotonin and Norepinephrine Transporter Inhibition in Depressed Patients Treated with Paroxetine or Venlafaxine 17 January 2010 5:36 UTC www.nature.com [Source type: Academic]

[39]

See also

Notes

  1. ^ Yardley JP, Husbands GE, Stack G, Butch J, Bicksler J, Moyer JA, Muth EA, Andree T, Fletcher H 3rd, James MN, et al. 2-Phenyl-2-(1-hydroxycycloalkyl)ethylamine derivatives: synthesis and antidepressant activity. J Med Chem. 1990 Oct;33(10):2899-905. doi:10.1021/jm00172a035 PMID 1976813
  2. ^ The number of prescriptions was calculated as the total of prescriptions for the corresponding generic and brand-name drugs using data from the charts for generic and brand-name drugs. "Top 200 generic drugs by units in 2007.". Drug Topics, Feb 18, 2008. http://drugtopics.modernmedicine.com/drugtopics/Top200Drugs/ArticleStandard/article/detail/491194. Retrieved 2008-10-23.  "Top 200 brand drugs by units in 2007.". Drug Topics, Feb 18, 2008. http://drugtopics.modernmedicine.com/drugtopics/PharmacyFactsAndFigures/ArticleStandard/article/detail/491210. Retrieved 2008-10-23. 
  3. ^ a b c d e f g h i "Effexor Medicines Data Sheet". Wyeth Pharmaceuticals Inc. 2006. http://www.wyeth.com/content/showlabeling.asp?id=99. Retrieved 17 September 2006. 
  4. ^ Golden RN, Nicholas L (2000). "Antidepressant efficacy of venlafaxine". Depression and anxiety 12 Suppl 1: 45–9. doi:10.1002/1520-6394(2000)12:1. PMID 11098413. 
  5. ^ Thase ME, Clayton AH, Haight BR, Thompson AH, Modell JG, Johnston JA (2006). "A double-blind comparison between bupropion XL and venlafaxine XR: sexual functioning, antidepressant efficacy, and tolerability". Journal of clinical psychopharmacology 26 (5): 482–8. doi:10.1097/01.jcp.0000239790.83707.ab. PMID 16974189. 
  6. ^ Lenox-Smith AJ, Jiang Q (2008). "Venlafaxine extended release versus citalopram in patients with depression unresponsive to a selective serotonin reuptake inhibitor". Int Clin Psychopharmacol 23 (3): 113–9. doi:10.1097/YIC.0b013e3282f424c2 (inactive 2008-06-21). PMID 18408525. 
  7. ^ Rowbotham M, Goli V, Kunz N, Lei D (2004). "Venlafaxine extended release in the treatment of painful diabetic neuropathy: a double-blind, placebo-controlled study". Pain 110 (3): 697–706. doi:10.1016/j.pain.2004.05.010. PMID 15288411. 
  8. ^ Ozyalcin S, Talu G, Kiziltan E, Yucel B, Ertas M, Disci R (2005). "The efficacy and safety of venlafaxine in the prophylaxis of migraine". Headache 45 (2): 144–52. doi:10.1111/j.1526-4610.2005.05029.x. PMID 15705120. 
  9. ^ Mayo Clinic staff (2005). "Beyond hormone therapy: Other medicines may help". Hot flashes: Ease the discomfort of menopause. Mayo Clinic. http://www.mayoclinic.com/invoke.cfm?id=HQ01409. Retrieved 19 August 2005. 
  10. ^ Schober C, Ansani N (2003). "Venlafaxine hydrochloride for the treatment of hot flashes". Ann Pharmacother 37 (11): 1703–7. doi:10.1345/aph.1C483. PMID 14565812. 
  11. ^ "Medications". Stanford University School of Medicine, Center for Narcolepsy. Revised 02/07/2003. http://med.stanford.edu/school/Psychiatry/narcolepsy/medications.html. Retrieved 2007-09-03. 
  12. ^ Albert U, Aguglia E, Maina G, Bogetto F (November 2002). "Venlafaxine versus clomipramine in the treatment of obsessive-compulsive disorder: a preliminary single-blind, 12-week, controlled study" (PDF). J Clin Psychiatry 63 (11): 1004–9. PMID 12444814. http://www.psychiatrist.com/privatepdf/2002/v63n11/v63n1108.pdf. 
  13. ^ Hain T (Revised 12/30/2007). "Orthostatic Hypotension". www.dizziness-and-balance.com. http://www.dizziness-and-balance.com/disorders/medical/orthostatic.html. Retrieved 2008-03-29. 
  14. ^ Courtney D (2004). "Selective serotonin reuptake inhibitor and venlafaxine use in children and adolescents with major depressive disorder: a systematic review of published randomized controlled trials". Can J Psychiatry 49 (8): 557–63. PMID 15453105. 
  15. ^ Gentile S (2005). "The safety of newer antidepressants in pregnancy and breastfeeding". Drug Saf 28 (2): 137–52. doi:10.2165/00002018-200528020-00005. PMID 15691224. 
  16. ^ de Moor R, Mourad L, ter Haar J, Egberts A (2003). "[Withdrawal symptoms in a neonate following exposure to venlafaxine during pregnancy]". Ned Tijdschr Geneeskd 147 (28): 1370–2. PMID 12892015. 
  17. ^ Ferreira E, Carceller AM, Agogué C, Martin BZ, St-André M, Francoeur D, Bérard A (2007). "[Effects of selective serotonin reuptake inhibitors and venlafaxine during pregnancy in term and preterm neonates]". Pediatrics 119 (1): 52–9. doi:10.1542/peds.2006-2133. PMID 17200271. 
  18. ^ Moses-Kolko EL, Bogen D, Perel J, Bregar A, Uhl K, Levin B, Wisner KL (2005). "[Neonatal signs after late in utero exposure to serotonin reuptake inhibitors: Literature review and implications for clinical applications]". JAMA 293 (19): 2372–83. doi:10.1001/jama.293.19.2372. PMID 15900008. 
  19. ^ Tiihonen J, Lönnqvist J, Wahlbeck K, Klaukka T, Tanskanen A, Haukka J (2006). "Antidepressants and the risk of suicide, attempted suicide, and overall mortality in a nationwide cohort". Arch. Gen. Psychiatry 63 (12): 1358–67. doi:10.1001/archpsyc.63.12.1358. PMID 17146010. 
  20. ^ Rubino A, Roskell N, Tennis P, Mines D, Weich S, Andrews E (2007). "Risk of suicide during treatment with venlafaxine, citalopram, fluoxetine, and dothiepin: retrospective cohort study". BMJ 334 (7587): 242. doi:10.1136/bmj.39041.445104.BE. PMID 17164297. 
  21. ^ a b "Overview for December 13 Meeting of Psychopharmacologic Drugs Advisory Committee" (PDF). November 16, 2006. http://www.fda.gov/ohrms/dockets/ac/06/briefing/2006-4272b1-01-FDA.pdf. Retrieved 2007-06-20. 
  22. ^ Emslie GJ, Findling RL, Yeung PP, Kunz NR, Li Y (2007). "Venlafaxine ER for the treatment of pediatric subjects with depression: results of two placebo-controlled trials". Journal of the American Academy of Child and Adolescent Psychiatry 46 (4): 479–88. doi:10.1097/chi.0b013e31802f5f03. PMID 17420682. 
  23. ^ Brent DA, Emslie GJ, Clarke GN, et al. (April 2009). "Predictors of spontaneous and systematically assessed suicidal adverse events in the treatment of SSRI-resistant depression in adolescents (TORDIA) study". Am J Psychiatry 166 (4): 418–26. doi:10.1176/appi.ajp.2008.08070976. PMID 19223438. 
  24. ^ Harrison CL, Ferrier N, Young AH (June 2004). "Tolerability of high-dose venlafaxine in depressed patients". J. Psychopharmacol. (Oxford) 18 (2): 200–4. doi:10.1177/0269881104042621. PMID 15260908. 
  25. ^ a b c Haddad PM (2001). "Antidepressant discontinuation syndromes". Drug Saf 24 (3): 183–97. doi:10.2165/00002018-200124030-00003. PMID 11347722. 
  26. ^ a b Parker G, Blennerhassett J (1998). "Withdrawal reactions associated with venlafaxine". Aust N Z J Psychiatry 32 (2): 291–4. doi:10.3109/00048679809062742. PMID 9588310. 
  27. ^ Fava M, Mulroy R, Alpert J, Nierenberg A, Rosenbaum J (1997). "Emergence of adverse events following discontinuation of treatment with extended-release venlafaxine". Am J Psychiatry 154 (12): 1760–2. PMID 9396960. 
  28. ^ a b Double D (1997). "Prescribing antidepressants in general practice. People may become psychologically dependent on antidepressants". BMJ 314 (7083): 829. PMID 9081020. 
  29. ^ Dunkley EJ, Isbister GK, Sibbritt D, Dawson AH, Whyte IM (September 2003). "The Hunter Serotonin Toxicity Criteria: simple and accurate diagnostic decision rules for serotonin toxicity". QJM 96 (9): 635–42. doi:10.1093/qjmed/hcg109. PMID 12925718. http://www.qjmed.oxfordjournals.org/cgi/content/full/96/9/635. 
  30. ^ Kolecki P (1997). "Isolated venlafaxine-induced serotonin syndrome". J Emerg Med 15 (4): 491–3. doi:10.1016/S0736-4679(97)00078-4. PMID 9279702. 
  31. ^ Ebert D. et al.. "Hallucinations as a side effect of venlafaxine treatment". Psychiatry On-line. http://www.priory.com/psych/venhall.htm. Retrieved 2008-06-17. 
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  33. ^ Venlafaxine (marketed as Effexor) FDA Alert: SSRIs/SNRI/Triptan and Serotonin Syndrome [issued 7/2006]
  34. ^ R. Baselt, Disposition of Toxic Drugs and Chemicals in Man, 8th edition, Biomedical Publications, Foster City, CA, 2008, pp. 1634-1637.
  35. ^ DeVane CL. (2003). "Immediate-release versus controlled-release formulations: pharmacokinetics of newer antidepressants in relation to nausea". J Clin Psychiatry 64 (Suppl 18): 14–9. PMID 14700450. 
  36. ^ Details for Effexor XR
  37. ^ [1]
  38. ^ Blythe D, Hackett L (1999). "Cardiovascular and neurological toxicity of venlafaxine". Hum Exp Toxicol 18 (5): 309–13. doi:10.1191/096032799678840165. PMID 10372752. 
  39. ^ a b Whyte I, Dawson A, Buckley N (2003). "Relative toxicity of venlafaxine and selective serotonin reuptake inhibitors in overdose compared to tricyclic antidepressants". QJM 96 (5): 369–74. doi:10.1093/qjmed/hcg062. PMID 12702786. 
  40. ^ a b Mazur J, Doty J, Krygiel A (2003). "Fatality related to a 30-g venlafaxine overdose". Pharmacotherapy 23 (12): 1668–72. doi:10.1592/phco.23.15.1668.31951. PMID 14695048. 
  41. ^ Banham N (1998). "Fatal venlafaxine overdose". Med J Aust 169 (8): 445, 448. PMID 9830400. 
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  43. ^ "Wyeth Letter to Health Care Providers". Wyeth Pharmaceuticals Inc. 2006. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm150546.htm. Retrieved 2009-08-06. 
  44. ^ Buckley N, McManus P (2002). "Fatal toxicity of serotoninergic and other antidepressant drugs: analysis of United Kingdom mortality data". BMJ 325 (7376): 1332–3. doi:10.1136/bmj.325.7376.1332. PMID 12468481. 
  45. ^ Fayerman, Pamela (February 27 2007). "Warning issued over drug". Vancouver Sun. http://www.canada.com/vancouversun/news/story.html?id=83f35b4e-ac13-4c09-b8de-44d16750b70b&k=58837. Retrieved 2007-06-02. 
  46. ^ Hanekamp B, Zijlstra J, Tulleken J, Ligtenberg J, van der Werf T, Hofstra L (2005). "Serotonin syndrome and rhabdomyolysis in venlafaxine poisoning: a case report". Neth J Med 63 (8): 316–8. PMID 16186642. 
  47. ^ [No Authors listed]. "Acute Effectiveness of Additional Drugs to the Standard Treatment of Depression". ClinicalTrials.gov. http://www.clinicaltrials.gov/ct/show/NCT00001483. Retrieved 23 June 2005. 
  48. ^ Goeringer K, McIntyre I, Drummer O (2001). "Postmortem tissue concentrations of venlafaxine". Forensic Sci Int 121 (1-2): 70–5. doi:10.1016/S0379-0738(01)00455-8. PMID 11516890. 
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Up to date as of December 30, 2010

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