Venlafaxine dosage, forms, and strengths

Venlafaxine is a generic prescription drug commonly prescribed as an antidepressant or anti-anxiety medication. Many prescribers and patients simply call it by the brand name Effexor XR. It belongs to a family of drugs called serotonin-norepinephrine reuptake inhibitors (SNRIs). These drugs increase certain chemicals that pass signals between nerves, increasing people’s ability to change, adapt, and regulate moods. Dosages depend on the formulation. Immediate-release tablets are usually taken two or three times daily, but extended-release capsules or tablets need only be taken once per day. Venlafaxine doses must be taken with food. 

Venlafaxine forms and strengths

Venlafaxine comes in three dosage forms:

• Immediate-release tablets: 25 mg, 37.5 mg, 50 mg, 75 mg, 100 mg

• Extended-release capsules: 37.5 mg, 75 mg, 150 mg

• Extended-release tablets: 75 mg, 150 mg, 225 mg

Venlafaxine dosage for adults

The FDA has approved venlafaxine as a treatment for major depressive disorder, generalized anxiety disorder (GAD), social anxiety disorder (SAD), and panic disorder (PD). Even so, healthcare professionals prescribe it off-label for a wide variety of other psychiatric disorders and medical conditions, including attention deficit hyperactivity disorder (ADHD), post-traumatic stress disorder (PTSD), premenstrual dysphoric disorder (PDD), nerve pain, fibromyalgia, hot flashes, and migraine prevention.

Venlafaxine is safe for most adults. However, healthcare providers never prescribe it to people with angle-closure glaucoma or allergies to venlafaxine or desvenlafaxine. Prescribers use venlafaxine with caution in people with bipolar disorder because it can induce mania.

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Venlafaxine dosage for major depressive disorder

Major depressive disorder (MDD) is diagnosed in people who experience depression symptoms persistently for two weeks or longer. SNRIs like venlafaxine are considered antidepressants because they often improve depression symptoms. 

Doses are taken every day. It will take several weeks of daily doses before mood improvement is noticeable. Although people may feel better in a few weeks, venlafaxine therapy usually continues for months to prevent depression symptoms from returning. 

• Standard adult dosage for major depressive disorder: 75–225 mg daily in 2–3 divided doses (immediate release) or once daily (extended-release)

• Maximum adult dosage for major depressive disorder: 225 mg daily (for outpatient treatment) or 375 mg daily (for hospitalized patients)

Venlafaxine dosage for generalized anxiety disorder

Generalized anxiety disorder is diagnosed when symptoms of anxiety about a variety of things are experienced on most days for at least six months. The standard treatment is cognitive behavioral therapy along with medications, if necessary. The first-line medications used are selective serotonin reuptake inhibitors (SSRIs) such as Prozac (fluoxetine) and SNRIs such as venlafaxine.

Only extended-release venlafaxine is FDA-approved to treat anxiety disorders. As with depression, people need to take venlafaxine doses every day for several weeks before there’s any noticeable relief of anxiety symptoms. Treatment typically lasts for several months or longer. 

• Standard adult dosage for generalized anxiety disorder: 75–225 mg extended-release tablets or capsules taken once daily

• Maximum adult dosage for generalized anxiety disorder: 225 mg daily

Venlafaxine dosage for social anxiety disorder

A person is diagnosed with social anxiety disorder when they experience persistent and intense fear or worry about various types of social situations. The preferred treatment is cognitive behavioral therapy along with SSRIs and SNRIs. 

Extended-release venlafaxine doses are taken once daily. People may not notice significant decreases in their social fears until they’ve been taking the drug for a few weeks. The maximum dosage is 75 mg because there’s no evidence that higher doses work better than a daily 75 mg dose.

• Standard adult dosage for social anxiety disorder: 75 mg extended-release tablets or capsules taken once daily

• Maximum adult dosage for social anxiety disorder: 75 mg daily

Venlafaxine dosage for panic disorder

Panic is a sudden onrush of intense fear. It’s often more than just a feeling, it’s a physical experience, as well, with heart palpitations, sweating, shaking, chest pain, and nausea. People with panic disorder experience frequent panic attacks for no external reason. 

As with other anxiety disorders, cognitive behavioral therapy is a first-line treatment. The first-line medication therapies are SSRIs and SNRIs. Healthcare professionals may also prescribe beta blockers to calm the physical symptoms of panic attacks or benzodiazepines to calm people down.

Extended-release tablets or capsules are taken once daily, every day. As before, it will take several weeks of daily venlafaxine doses before people notice an improvement in their panic attacks. 

• Standard adult dosage for panic disorder: 75–225 mg extended-release tablets or capsules taken once daily

• Maximum adult dosage for panic disorder: 225 mg daily

Venlafaxine dosage for children

Venlafaxine is not FDA-approved for use in pediatric patients.

Venlafaxine dosage restrictions

People with kidney disease or liver impairment will be prescribed lower doses:

• Patients with renal impairment (kidney disease): 

  • Mild to moderate renal impairment (creatinine clearance 30–89 mL/min): daily doses reduced by 25% to 50%

  • Severe renal impairment (creatinine clearance less than 30 mL/min): daily doses reduced by 50%

  • Hemodialysis: daily doses reduced by 50%

• Patients with hepatic impairment (liver dysfunction): 

  • Mild to moderate hepatic impairment (Child-Pugh Class A or B): daily doses reduced by 50%

  • Severe hepatic impairment (Child-Pugh Class C): daily doses reduced by 50% or more

How to take venlafaxine

Venlafaxine tablets and capsules are taken every day. Immediate-release tablets are taken two or three times daily, but extended-release capsules and tablets are taken once daily:

• Take venlafaxine as instructed. 

• The dose may change during the course of treatment. 

• Please read the Medication Guide that comes with this medication.

• Take venlafaxine doses with food.

• Take immediate-release venlafaxine tablets orally two to three times daily as instructed.

• Take extended-release venlafaxine tablets or capsules orally once daily.

• Extended-release tablets or capsules can be taken in the morning or evening but take them at the same time each day.

• Swallow the tablets or capsules whole with a drink of water. Do not crush, break, or chew them.

• Store venlafaxine tablets or capsules at room temperature, protected from moisture and humidity.

Venlafaxine dosage FAQs

How long does it take venlafaxine to work?

It takes several weeks before people begin to notice a significant improvement in their symptoms. People in tune with the patient often sense a change before the patient can. Venlafaxine therapy usually lasts for several months, even after symptoms abate. Therapy continues because the patient may emotionally feel better because the medication is working. 

How long does venlafaxine stay in your system?

The body converts venlafaxine into another drug called desvenlafaxine or ODV (o-desmethylvenlafaxine). That’s the active form of the drug. It takes the body about 48 hours to clear nearly 90% of a venlafaxine dose from the body, including its active metabolite ODV. 

What happens if I miss a dose of venlafaxine?

Take a missed dose as soon as possible. Skip the missed dose if it’s almost time for the next dose. Never take extra doses to make up for a missed dose.

How long can you take venlafaxine?

Venlafaxine is intended for long-term use. Most people will take venlafaxine for several months, but there are no limits set on the duration of venlafaxine therapy.

How do I stop taking venlafaxine?

To avoid withdrawal symptoms, do not stop taking venlafaxine until talking to the prescriber. Suddenly stopping a drug like venlafaxine can bring on discontinuation syndrome. Symptoms of discontinuation syndrome include anxiety, irritability, restlessness, tiredness, trouble sleeping, nightmares, dizziness, headache, shaking, confusion, vomiting, nausea, and diarrhea.

Patients and prescribers may choose to stop venlafaxine because of intolerable side effects, allergic reactions, a sense that the medication is no longer needed, or ineffectiveness. Other drugs that may help with depression include other SNRIs, SSRIs, tricyclic antidepressants, monoamine oxidase inhibitors (MAOIs), Wellbutrin (bupropion), or atypical antidepressants. For anxiety disorders, other SNRIs, SSRIs, buspirone, beta blockers, and benzodiazepines are possible treatment options. 

What is the maximum dosage for venlafaxine?

The maximum dosage for venlafaxine is typically 225 mg daily. Prescribers do not exceed 75 mg daily doses for social anxiety disorder. That’s the highest effective dose so there’s no reason to use higher doses. 

Can you overdose on venlafaxine?

If too much venlafaxine is taken, get immediate emergency medical help. An overdose could be fatal if a large enough dose is taken or doses are combined with alcohol. Symptoms of a venlafaxine overdose include racing heartbeats, slow heart rate, somnolence, dilated pupils, vomiting, low blood pressure, vertigo, coma, or seizures.

What interacts with venlafaxine?

Never take venlafaxine with drugs called monoamine oxidase inhibitors (phenelzine, isocarboxazid, tranylcypromine, linezolid, rasagiline, selegiline, safinamide, and methylene blue. Anyone taking an MAO inhibitor must stop taking the drug for 14 days before starting venlafaxine. An MAO inhibitor can’t be started unless venlafaxine is discontinued for seven days. 

The most serious drug interaction associated with antidepressants is serotonin syndrome. It can happen when people take more than one serotonergic drug, that is, a drug that affects serotonin levels in the central nervous system (CNS). Examples include:

• Antidepressants

• Anxiety medications

• Antipsychotic medications

• Migraine drugs called triptans

• The bipolar disorder drug lithium

• Amphetamines

• Anticonvulsants

• Narcotic pain relievers such as tramadol

• Anti-nausea drugs,

• The supplements St. John’s wort and tryptophan

Venlafaxine slightly decreases the ability for the blood to clot, so healthcare professionals are cautious about the concomitant use of other drugs that cause bleeding including, nonsteroidal anti-inflammatory drugs (NSAIDs) and blood thinners such as warfarin.

What happens when you mix venlafaxine and alcohol?

Avoid alcohol when using venlafaxine. The combination may worsen side effects such as sleepiness or dizziness.

Is it safe to take venlafaxine during pregnancy?

Ask the prescriber for medical advice if you get pregnant. Venlafaxine is not contraindicated during pregnancy but may cause problems such as preeclampsia and postpartum hemorrhage when taken late in a pregnancy.

Is it safe to take venlafaxine while breastfeeding?

It should be okay to breastfeed while taking venlafaxine. However, the drug and its active metabolite are found in breast milk. It’s important that mothers monitor the baby for sedation and adequate weight gain.

What are the side effects of venlafaxine?

The most common adverse effects of desvenlafaxine are nausea, weight loss, sleepiness, dry mouth, sweating, loss of appetite, constipation, and sexual dysfunction. The most serious side effects include suicidal thoughts and behaviors (in young adults), high blood pressure (hypertension), serotonin syndrome, mania, low sodium (hyponatremia), high cholesterol, lung scarring (interstitial lung disease), and an increased risk of bleeding.

Sources

• Diagnosis and management of generalized anxiety disorder and panic disorder in adults, American Family Physician

• Effexor XR drug summary, Prescriber’s Digital Reference (PDR)

• Venlafaxine, Drugs and Lactation Database

• Venlafaxine, StatPearls

• Venlafaxine extended-release capsule prescribing information, DailyMed (NIH National Library of Medicine)

• Venlafaxine extended-release tablet prescribing information, DailyMed (NIH National Library of Medicine)

• Venlafaxine hydrochloride tablet prescribing information, DailyMed (NIH National Library of Medicine)