Highlighting uses, dosage, reviews, how to take & discontinue, side effects, pros & cons, and more

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Brand & Generic Names; Drug Classes

US brand name: Effexor
Generic name: venlafaxine

Drug Class(es)

Primary drug class: Antidepressants
Additional drug class(es): Serotonin and Norepinephrine Reuptake Inhibitor (SNRI)

Approved & Off-Label Uses (Indications)

Effexor’s US FDA Approved Treatment(s)

  • Major Depressive Disorder (MDD) - extended release (XR) approved October 1997, immediate-release (IR) approved December 1993
  • General Anxiety Disorder (GAD) - XR approved 11 March 1999
  • Social Anxiety Disorder (SAnD) - XR approved 11 February 2003
  • Panic Disorder - XR approved 18 November 2005

Uses Approved Overseas but not in the US

Off-Label Uses of Effexor

When & If Effexor Will Work

Effexor’s Usual Onset of Action (when it starts working)

Three weeks to a month.

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Likelihood of Working

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Taking and Discontinuing

How to Take Effexor

Effexor comes in immediate-release (IR) and extended release (XR) flavors, although hardly anyone takes the IR form anymore. Just be sure to check your prescription for that XR to make sure you are getting the extended release form. For the XR flavor, you start at 37.5 to 75mg a day, taken with food, at either breakfast or dinner, depending on if you’re apt to get wired or tired. Once you get the wired/tired issue straightened out, you take the med all at once at the same time every day. If you start at 37.5mg you can move up to 75mg after a week. As with any serotonergic antidepressant, it may take up to a month to feel any positive effect, so give it a month. Seriously, don’t move up above 75mg a day unless you feel it doing something positive or it’s been about a month. You’ll know if it’s going to do anything then. If you feel nothing, give up and take a med with a much easier discontinuation (i.e. anything that’s not an SNRI). After that you can move up in 37.5–75 mg increments, allowing at least a week between each increase until you reach the maximum of 375mg a day for the most severely depressed of patients. Or 450mg a day if you and your doctor have the balls for it. If the two of you are sure you are a rapid metabolizer of some medications, there are people who take 600mg a day, but roughly 1% of people on the planet, if that many, would metabolize it at a rate fast enough to need 600mg a day, and need to take the XR form twice a day. If you’re reading this site because you take your XR capsule in the morning and feel dizzy, confused, have headaches and feel like you’re wearing an electric eel for a hat after dinner every night, you may need to take a once-a-day pill twice a day.

The older immediate release version is pretty much the same, except that the dose is divided into two or three doses a day.

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How to Stop Taking Effexor (discontinuation / withdrawal)

Unless you need to discontinue the XR flavor at a more rapid rate due to a nasty side effect, your doctor should be recommending that you reduce your dosage by 37.5mg a day every week if you need to stop taking it, if not more slowly than that. You shouldn’t be doing it any faster than that unless it’s an emergency. Yes, that means if you’ve maxed out at 375mg a day it could take up to 10 weeks to get off of it. You can try it faster and hope it works out, and since the odds are actually with you it’s worth doing at the higher dosages and reduce the rate once you’re down to half of what you used to take, but it’s hardly a sure thing. Once you get down to that last 37.5mg a day you have several options:

  • If the discontinuation symptoms you’re experiencing are mild, if you’re experiencing any at all, then you may as well stop taking it. You’re in the plurality of people who have taken either version of Effexor who could stop taking it without too much of a hassle.
  • If the brain zaps or shivers and other discontinuation symptoms are still bad you can try taking one 37.5mg capsule every other day, or getting a prescription for generic venlafaxine IR and working your way down. As IR comes in a variety of dosages you have all sorts of ways you and your doctor can work out a discontinuation schedule from there.
  • If you still can’t stop taking it at a low dosage, you and your doctor may want to try Prozac (fluoxetine) prescription or samples. Generic fluoxetine will even do. 10mg a day is all you should need. Even with the proper discontinuation stopping the last 37.5mg can be hellish. Taking two weeks worth of Prozac (fluoxetine) will make the discontinuation a lot easier. So when you’re off of it and you cannot function, get on the Prozac for a week or two, then stop taking the Prozac. By that time you should find you’ll have either no discontinuation syndrome, or it won’t be nearly as bad.
  • If worse comes to worst, there’s always the liquid Prozac. Then you can work your way down from the equivalent of 10mg, or higher if 10mg was too low, to ever-so-slowly try to wean yourself off of the serotonergic part of Effexor that had its claws in you. Unlike most liquid medications of any type, Prozac’s oral solution tastes pretty good2, somewhere between really good mint-flavored mouthwash and so-so peppermint schnapps.

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Effexor’s Pros and Cons

Pros


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Cons

  • For many people Effexor has the absolute worst discontinuation syndrome of any antidepressant.
  • It is a medication people utterly loathe to have taken.
  • It is not uncommon for someone to fire their doctor during or immediately after they quit taking Effexor because the discontinuation syndrome can be that bad.


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Interesting Stuff your Doctor Probably didn’t Tell You about Effexor

Raw, freebase4 venlafaxine is actually one of, if not the least potent of all the antidepressants on the market. If venlafaxine hydrochloride weren’t so well absorbed and distributed Let’s see if I can write it down correctly this time. If the active ingredient were as well-absorbed and distributed when compared with the other ADs I could understand why it is so effective. As it is, I can’t understand why the hell it isn’t be practically a placebo. Those awesome shitty pharmacokinetics may have something to do with why the discontinuation syndrome sucks so much donkey dong, but that’s still just a guess of mine and there’s no research to back it up. Just like Paxil, the short half-lives of venlafaxine HCl and its active metabolite are a known reason why Effexor withdrawal sucks so much shit. And why some people experience SSRI/SNRI discontinuation syndrome if they miss a single dose, or are a few hours late in taking a dose!

It could be that it’s like bupropion, another weak-as-water5 drug that is surprisingly effective. According to Dr. Stahl, bupropion might be transformed into one or more of its three (so far known) active metabolites by the CYP450 genes in your brain instead of in your liver. So what it doesn’t have in the way of raw, pharmacological power, it makes up for by being undiluted by plasma. Perhaps venlafaxine HCl does the same thing.


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Best Known for

The discontinuation syndrome from hell.
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Effexor’s Side Effects

Typical Side Effects

Although an SNRI, because its effect on norepinephrine usually isn’t noticeable until you reach a dosage somewhere north of 150mg a day, its initial, and mostly short-term, side effects are more like an SSRI. Not that there’s all that much difference between the two classes. So expect a few of:

headache, nausea, dry mouth, sweating, sleepiness or insomnia (with insomnia a little more likely), constipation or diarrhea (constipation is somewhat more likely), weight gain (although less likely and severe than most SSRIs), and assorted sexual dysfunctions. While sexual dysfunction is also a little less likely than SSRIs, some women will get a sexual boost at the higher dosages instead of a sexual dampening. It’s neither as frequent nor as pronounced (usually) as with the other SNRIs or the NSRIs (Strattera and reboxetine), but it does happen.

Sorry guys, but a higher dosage usually means whatever problems you had in that area will probably just get worse.
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Uncommon Side Effects

  • increased or lowered blood pressure
  • sweating
  • farting
  • anorexia
  • twitching
  • shock-like sensations (while you’re still taking it)
  • alcohol intolerance and/or alcohol abuse
    • making it just the thing to talk about at AA meetings

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Freaky Rare Side Effects

  • Guys, if you thought everyone freaking out about the Lamictal Rash was bad, I have one word for you: balanitis.
  • Your hair may change color without Revlon.
  • Erotomania.
    • You know, I think that new hair color looks good on you…
  • Spontaneous orgasm.
    • OK, fine, take care of yourself then.

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What You Really Need to be Careful About

By all that is holy, never just abruptly/suddenly stop taking it (going cold turkey), without an extremely good reason. Like a life-threatening allergic reaction, or you’re in a coma.

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Pregnancy Category

C-Use with caution
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Pharmacology

Effexor’s Half-Life & How Long Until It Clears Your System

Plasma half-life: The half-life of venlafaxine is 3–7 hours, and o-desmethylvenlafaxine’s is 9–13 hours. That means it takes two days for one and five days for the other to clear out of your system.

Half-life is the average time it takes for you to process half of the drug’s active ingredient. If a drug has a half-life of around 24 hours and you take a dose of 100mg, you’ll have roughly the equivalent a 50mg dose after one day, a 25mg dose after two days, and so on. The rule of thumb is: multiply the half-life by five and you get how long it is for the dose you took to be cleared from your bloodstream6, so there’s nothing swimming around to attach itself to your brain and start doing stuff. That’s called “plasma clearance.” Complete clearance is a complex equation based on a lot of factors which may or may not: be published in the PI sheet, include personal data like your weight, or even completely figured out by corporate and independent researchers. It usually winds up being 2–5 days after plasma clearance no matter what7, but can take weeks. Sometimes a drug will clear from your brain and other organs before it clears from your blood.

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Steady State

Steady state is reached in: three days

Steady state is the flipside of half-life. This is when you can expect to get over side effects caused by fluctuating amounts of a medication in your bloodstream. Often, but not always the same amount of time as the plasma clearance above.

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How venlafaxine Works

the current best guess at any rate
Based upon the monoamine hypothesis of depression (i.e. you’re messed up due to an imbalance of one or more of three of the best understood neurotransmitters: serotonin, norepinephrine, and/or dopamine), Effexor attempts to balance your brain juices by inhibiting the reuptake (in English: delaying the breaking down and recycling) of serotonin and norepinephrine at their receptors in various (i.e. depending on which studies and books you’ve read and fancy brain scans you’ve looked at) locations in your brain. It may do a lot of other things that address depression, anxiety, other brain cooties and some off-label uses by encouraging the growth of new neurons, affecting hormones and CYP450 genes in your brain, and who knows what else. You also have serotonin and norepinephrine receptors throughout your body, especially in your GI and renal systems, which is why SSRIs & SNRIs are used to treat various conditions like IBS and incontinence. As it doesn’t really affect norepinephrine until you reach a dosage of at least 225mg a day (or 175–200 for IR), it is practically an SSRI, and thus not as effective for pain and pain-related conditions like fibromyalgia as other SNRIs like Cymbalta and Pristiq.

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Active Ingredient

venlafaxine hydrochloride and the active metabolite o-desmethylvenlafaxine

The active ingredient is usually the same as the generic name, but more often than not it’s a chemical salt of the substance identified as the generic. E.g. Fluoxetine is the generic for Prozac, but the active ingredient is fluoxetine hydrochloride (or HCl). It usually doesn’t make much of a difference outside of the more esoteric aspects of a drug’s pharmacology, but not always.


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Shelf Life

3 years
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Effexor’s Noted Drug-Drug, Drug-Food & Drug-Supplement Interactions

Check for Other Drug-Drug, Drug-Food & Drug-Supplement Interactions

Drugs.com’s drug-drug and drug-food interaction checker

It’s always a good idea to check for drug-drug interactions yourself. Just because most people in the crazy meds business know about really important interactions (e.g. MAOIs and a lot of stuff, warfarin and everything on the planet) doesn’t mean the person who prescribed your meds told you about them, or the pharmacist has all the meds you take at their fingertips like they’re supposed to. Or they have the time to do their jobs properly when not dealing with complete idiots or playing Angry Farmers on teh Faecesbooks.
Learn more about drug-everything interactions on our page of tips about taking crazy meds.

Name, Address, Serial Number (Generic and Overseas Availability)

Available in the US as a generic? Yes

Other Trade Names and Overseas Availability

  • Altven: Australia
  • Efexor: Australia, EU, Ireland, New Zealand, UK
  • Elaxine: Australia
  • Enlafax: Australia

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Shapes & Sizes (How Supplied)

Extended-release capsules; Immediate-release, shield-shaped tablets

Effexor XR capsule and Effexor tablets
From left: Effexor XR 37.5 mg, Effexor 75 mg, Effexor 25 mg
 

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Comments, PI Sheet, Ratings, Reviews and More

Comments

There are two last resorts among the modern, first-line meds to cure the deepest, blackest depression when your doctor is just switching you from one horsie to another on the med-go-round: Effexor and Remeron (mirtazapine)8. Either in combination with an antipsychotic, especially Geodon would really get you out of that hole of despair, but first you should throw away every mirror and scale in your house and buy expandable clothing. Weight gain usually isn’t too bad with Effexor alone, but when coupled with Remeron and/or most antipsychotics…well…prepare yourself for being a jolly fatty.

Effexor has to be the. most. loathed. drug by those for whom it didn’t work. While it can be an absolute lifesaver for many people with the most severe form of whaleshit-on-the-bottom-of-the-ocean depression, with or without anxiety, as well as for those with various forms of anxiety without depression, when it doesn’t work well enough, and the side effects suck to much, the discontinuation syndrome can be such a nightmare that people will fire their doctors who didn’t work out a discontinuation schedule or otherwise prepare them for what it would be like.

A bit more on its pharmacology for the pharmageeks:
The active metabolite (o-desmethylvenlafaxine) does most of the work, and is now available in a refined form as Pristiq (desvenlafaxine). The half-life of venlafaxine HCl is 3–7 hours, and o-desmethylvenlafaxine’s is 9–13 hours. That means it takes two days for one and five days for the other to clear out of your system. Having two parts with short half-lives is a huge part of why the discontinuation syndrome is so freaking harsh.
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Rate Effexor

Give your overall impression of Effexor on a scale of 0 to 5. Detailed ratings and reviews are available on the Effexor Ratings & Reviews Page.

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If you’re still feeling judgmental as well as just mental9, please boost or destroy my self-confidence by honestly (and anonymously) rating this article on a scale of 0 to 5. The more value-judgments the better, even if you can criticize my work only once.

Get all judgmental about the Effexor (venlafaxine) Synopsis

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Full US PI sheet, Global SPCs & PILs, Other Consumer Review & Rating Sites, and Other Sites that may be of Interest

Discussion board

If you have any questions not answered here, please see the Crazymeds Effexor discussion board.
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References

  1. Mood switch in bipolar depression: comparison of adjunctive venlafaxine, bupropion and sertraline. The British Journal of Psychiatry (2006) 189:124-131 R. M. Post, MD; L. L. Altshuler, MD; G. S. Leverich, MSW; M. A. Frye, MD; W. A. Nolen, MD; R. W. Kupka, MD, PhD; T. Suppes, MD; S. McElroy, MD and P. E. Keck, MD; K. D. Denicoff, MD; H. Grunze, MD; J. Walden, MD; C. M. R. Kitchen, PhD; J. Mintz, PhD
  2. Antidepressants in Bipolar Disorder: No Benefit, Possible Harm medscape.com May 30, 2013 Caroline Cassels
  3. Randomized, Double-Blind, Placebo-Controlled Crossover Trials of Venlafaxine for Hot Flashes After Breast Cancer The Oncologist January 2007 vol. 12 no. 1 124-135 Janet S. Carpenter, Anna Maria Storniolo, Shelley Johns, Patrick O. Monahan, Faouzi Azzouz, Julie L. Elam, Cynthia S. Johnson and Richard C. Shelton
  4. Prophylaxis of migraine: open study with venlafaxine in 42 patients Arq. Neuro-Psiquiatr. vol.56 n.4 São Paulo Dec. 1998 Dr. Estevão Demétrio Nascimento
  5. Venlafaxine versus amitriptyline in the prophylactic treatment of migraine: randomized, double-blind, crossover study Clinical Neurology and Neurosurgery 107 (2004) 44–48 Serpil Bulut, M. Said Berilgen, Aslihan Baran, Aslan Tekatas, Murad Atmaca, Bulent Mungen
  6. Psychopharmacology Research Tutorial for Practitioners - Antidepressant Drugs: Is a Dual Mechanism Better? Primary Psychiatry 2004;11(8):17-18 Donald S. Robinson, MD
  7. Stahl, Stephen M. Stahl’s Essential Psychopharmacology: Neuroscientific Basis and Practical Applications (Essential Psychopharmacology Series) Third edition Cambridge University Press 2008. ISBN:978–0521673761
  8. Julien, Robert M. Ph.D, Claire D. Advokat, and Joseph Comaty Primer of Drug Action: A comprehensive guide to the actions, uses, and side effects of psychoactive drugs 12th edition Worth Publishers 2011. ISBN:978–1429233439
  9. Diamond, Ronald J., MD Instant Psychopharmacology 2nd Edition W.W. Norton 2002. ISBN:978–0393703917
  10. Drummond, Edward, MD The Complete Guide to Psychiatric Drugs John Wiley & Sons 2000. ISBN:0471353701
  11. Effexor Prescribing Information
  12. Mosby’s Drug Consult 2007 (Generic Prescription Physician’s Reference Book Series) © 2007 An imprint of Elsevier.
  13. PDR: Physicians’ Desk Reference 2010 64th edition
  14. Healing Anxiety & Depression Daniel G. Amen, M.D., and Lisa C. Routh, M.D. © 2003. Published by G.P. Putnam’s Sons.


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1 Although this may have something to do with the hypothesis that SSRIs & SNRIs work better for women while TCAs work better for men. While I buy into it, it is a fringe hypothesis, the data are still a bit sketchy, and it may be more truthiness than fact.

2 Although it doesn't taste anywhere near as good as lithium citrate syrup, but it is on par with chewable Lamictal.

3 While classified as a serotonin and norepinephrine reuptake inhibitor, the data are mixed when it comes to dopamine. Effexor may or may not have a therapeutic effect, albeit a minor one, on dopamine at a dosage above 300mg a day.

4 That's the term for a substance that isn't a chemical salt, such as venlafaxine hydrochloride or citalopram hydrobromide. Most antidepressants are salts, while most antiepileptic drugs and antipsychotics are not.

5 Seriously. They're practically psychopharmaceutical homeopathic remedies.

6 Based on Julien's calculations from A Primer of Drug Action, the half-life multiplied by five is the generally accepted estimate of how long it takes a single dose of any given drug to be eliminated from the blood stream/plasma of someone with a normal metabolism. That's also the rough estimate for steady state if they can't get, or won't provide a number for that.

7 For crazy meds. I have no idea what the average complete clearance is for other types of medications. For all I know there are drugs that utterly vanish from your system in under five passes, and others that won't let go of your squishy bits for years after you stop taking them.

8 Stahl will combine it with Remeron - a cocktail he calls "California Rocket Fuel" - for his patients who are truly, and dangerously alt.depressed.as.fuck, and who have not responded to anything else.

9 Thank you! I'll be here all weak. Be sure to tip your content provider. And don't try the veal, it's cruelicious!


If you have any questions not answered here, please see the Crazymeds Effexor discussion board. We welcome criticisms of the articles, notifications of bad links, site problems, consumer experiences with medications, etc. I’m not always able to write back. Hence I never answer questions about meds via e-mail that are answered by this or other articles. Especially if they have been repeatedly asked on the forum. That’s why we write these damn things. Questions about which meds are best for your condition should also be asked on the forum; because this is a free site, so the price of admission is making things easier for somebody else searching for the same answer. We don’t deal with children on the forum or in private because after doing this for ten years I don’t have the emotional stamina to deal with kids who have brain cooties. How to contact Crazymeds. — Jerod Poore, CME, Publisher crazymeds.us


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1 While there are plenty of books to help you with hypochondria, for some reason there’s not much in the way of websites. Then again, staying off of the Internet is a large part of curing/managing the disorder.

2 Remember kids, Microsloth operating systems are like TOS Star Trek movies with in that every other one sucks way, way more. With TOS Star Trek movies you don’t want to bother watching the odd-numbered ones. With Microsloth OS you don’t want to buy and install the even-numbered ones. Anyone who remembers ME and Vista knows what I mean.

3 Have I mentioned how open source operating systems for commercial applications is one of the dumbest ideas in the history of dumb ideas? I don’t even need my big-ass rant any more. Heartbleed has made my case for me. And that’s just the one that got all the media attention. The very nature of an open source operating system makes security as much of an illusion of anonymity. Before you flip out too much: the domain Crazymeds is hosted on uses a version of SSL that is not affected by the Heartbleed bug. That’s one of the many reasons why I pay a lot of money and keep this site on Lunarpages.

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