Effexor (venlafaxine hydrochloride)
uses, side effects, dosage, how to take, how to stop taking, and more

US Brand Name: Effexor

generic name: venlafaxine hydrochloride

Other Forms: The old immediate-release version is still available as a generic. Except for the approvals that Effexor XR has that the immediate-release form doesn’t have, everything for Effexor XR applies to generic immediate-release venlafaxine unless specifically stated otherwise.

Class: antidepressants, specifically a Serotonin and Norepinephrine Reuptake Inhibitor (SNRI)

1.  FDA Approved Uses of Effexor

• Major Depressive Disorder - Effexor XR approved October 1997, immediate-release approved December 1993
• General Anxiety Disorder - Effexor XR approved 11 March 1999
• Social Anxiety Disorder - Effexor XR approved 11 February 2003
• Panic Disorder - Effexor XR approved 18 November 2005

2.  Off-Label Uses of Effexor

• Bipolar Depression (dodgy to decent for bipolar 2, generally not a good idea for bipolar 1)
• Fibromyalgia
• Arthritis
• Chronic Fatigue
• Multiple Sclerosis
• Lupus
• Headaches
• Irritable Bowel Syndrome (IBS)
• ADD/ADHD
• Eating Disorders

3.  Effexor’s pros and cons

3.1  Pros

There are two last resorts among the modern 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 XR (venlafaxine hydrochloride) and Remeron (mirtazapine). Either in combination with an antipsychotic 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. But for deep, despairing clinical depression that needs to respond to the standard tweaking of the three most popular neurotransmitters, Effexor XR (venlafaxine hydrochloride) often pulls people out of the abyss.

3.2  Cons

For many people Effexor XR has the absolute worst discontinuation syndrome of an antidepressant. Effexor (venlafaxine hydrochloride) is a medication people utterly loathe to have taken. It is not uncommon for someone to fire doctors during or immediately after they quit taking Effexor XR(venlafaxine hydrochloride).

4.  Side Effects

4.1  Typical Side Effects

The usual: headache, nausea, dry mouth, sweating, sleepiness or insomnia, and diarrhea or constipation, weight gain, loss of libido and a host of other sexual dysfunctions. Most everything but the weight gain and sexual dysfunctions usually goes away within a couple of weeks. Although some women will notice that the sexual side effects will diminish above 200–225mg a day when the norepinephrine kicks in. Maybe.

4.2  Not So Common Side Effects

Increased or lowered blood pressure, sweating, farting, anorexia, twitching, shock-like sensations. Also alcohol intolerance and/or alcohol abuse. So Effexor XR (venlafaxine hydrochloride) is going to be just the thing to talk about at AA meetings. I used to have these last two listed as rare side effects, but I’ve received way too many e-mails and have read far too many similar reports on various other sites after putting up this page about both of them. As is often the case here, the anecdotal evidence will often trump what is in the US PI Sheet. Best guess to date as to why both of these side effects can happen - Paul of Leeds (in the U.K.) posits that Effexor’s broad spectrum use of liver enzymes probably interferes with alcohol clearance and tolerance, thus leading to the type of alcoholism that affects people without the proper enzymes to effectively metabolize alcohol. Between that and the way Effexor XR works your liver, you’re probably better off giving up booze entirely if you’re taking this med.

4.3  Freaky Rare Side Effects

• You hair may change color without Revlon.
• Guys, if you thought everyone freaking out about the Lamictal Rash was bad, I have one word for you: balanitis.

5.  Interesting Stuff Your Doctor Probably Won’t Tell You

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 as compared with the other ADs it would be practically a placebo. Those awesome pharmacokinetics may have something to do with why the discontinuation syndrome sucks so much donkey dong, but that’s just a guess of mine and there’s no research to back it up. On the pharmacokinetic downside, Effexor’s short half-life is a known reason why Effexor withdrawal sucks so much shit.

6.  Effexor’s Dosage and How to Take Effexor

Effexor (venlafaxine hydrochloride) comes in immediate and extended release flavors, although hardly anyone takes the immediate release 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 antidepressant, it takes a month to feel any positive effect, so give it a month. Seriously, don’t move up above 75mg a day for at least a month. You’ll know if it’s going to do anything then. If you feel nothing, give up and take a much easier discontinuation. 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. The older immediate release version is pretty much the same, except that the dose is divided into two or three doses a day.

7.  How Long Effexor Takes to Work

Three weeks to a month.

8.  How to Stop Taking Effexor

Unless you need to discontinue Effexor XR 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 Effexor (venlafaxine hydrochloride). 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 Effexor (venlafaxine) 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 in the immediate-release form and working your way down. As immediate-release venlafaxine 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 Effexor 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.

9.  Effexor’s Half-Life & Average Time to Clear Out of Your System

Effexor (venlafaxine hydrochloride) has an active metabolite (desvenlafaxine) that does most of the work, and is now available as Pristiq. The half-lives are 3–7 hours and 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 Effexor’s discontinuation syndrome is so harsh.

10.  Days to Reach a Steady State

Usually three days.

11.  Discussion board

Crazy Meds’ Effexor discussion board

12.  Your Comments About and Experiences with Effexor

Tell us what you think about Effexor

ok so i just had a baby almost 3 months ago and the past month or so i have started having anxiety and depression my dr gave me 1mg of adivan which helps but short term so today she gave me 37.5mg of effexor and i was just wondering how you did with it?? im terrified to take it bc i have read all these side effects like more anxiety and not sleeping etc… and once b4 i was given dilauted at the hospital and it made me go crazy I had the tremors and couldnt sleep for probably 12hrs or so it was the worst feeling ever it was like i was doped up on a drug….i hope this effexor doesnt effect me that way?? bc it was the scariest thing ever…does anyone have those effects?? how does effexor work 4 you??

started on effexor about 2 months ago and can’t believe how great i feel. who ever knew life was so great without anxiety. did the adivan thing before going on and while it was okay, it was too short term. started at 37.5 mg and now at 150 mg which seems to be enough for me. only side effects have been weight loss (who can complain about that?), more energy (that’s a good thing), constipation (now I’m on top of it) and insomnia. took sleeping pills as needed for the insomnia and don’t have to take them any more. the rest is all good. i was really nervous to go on it because i was treated for a major depression 4–5 years ago and was on SSRI’s for 8 years. the main side effect was tiredness which over time became a real issue — i was always tired and preferred to sleep instead of doing things after work. i just can’t believe how great i feel. i think i have been coping with anxiety for 30 years and it is such a relief not to have it.

i think i have another weird and freaky side effect for you. you mentioned that hair can change color. well, my hair has gotten curly since i started taking effexor. my hairdresser thought i gave myself a perm. i thought it was the humidity. maybe not.

I had been taking two 150mg Effexor XR pills everyday for about a year or so, and it worked beautifully for a while. But a month or two ago, it started to feel less effective as it had been before and my new doc switched me from that to Cymbalta + Depacote. So I basically stopped the effexor cold turkey. Now I’ve experienced the crazy withdrawals from it before (just by missing one measly dose), but they wouldn’t last long because I’d take my effexor as soon as possible. WELL - turns out the symptoms get much worse if you cease to take it altogether. the first day sucked, but I thought it was just my upped vyvanse making me feel nervously sick-like. The next day I woke up loopy as hell, walking around the house aimlessly doing a kind of “inpatient shuffle,” and nauseous as I don’t know what. I threw up everything I tried to eat, and taking phenergran just made it worse. I really didn’t know what was going on until my insides started to shake and I couldn’t stop crying; the same stupid withdrawal symptoms I had when i missed the effexor. I felt like I couldn’t catch my breath and had that icky nervous stomach feeling all day; it hurt to move my eyes or sit up or even think but I still had to keep moving (I kept shaking my head like I had tourettes or something). I honestly couldn’t control my crying or shaking, and eventually my head started pounding from the lack of food/water. I was seriously planning on going to the ER, but by nightfall I was practically too exhausted to speak or even roll over in bed. It was scary as hell. Today wasn’t nearly as bad, but I’m still feeling pretty sick and I’m just praying to baby Jesus that this doesn’t last much longer. I don’t think I could take it!

I have suffered from Major Depressive Disorder my whole life. I then was sexually abused and developed PTSD. I have always been resistant to medication I didn’t want to be drugged up and every time they tried a med for me, I had horrible side effects. I am now with an amazing doctor and after two horrible and Long bouts with flashbacks and severe depression I decided that I needed to try again. Effexor was hard on my system for about a month. I had serious heartburn and a very sick stomach and then it all went away. Other than the fact that I am a little chubby I have no side effects and I have been taking it for 5 months. I found the opposite to be true. My emotional numbing has been lifted, I am able to be very sexual with my husband, my attitude has seriously improved and I am much happier. Oh, I can’t sleep on Effexor though. I didn’t take my meds for 3 days because I didn’t know I was out of refills and it was a 3 day weekend…my doctor was closed. WITHDRAWALS ARE HORRIBLE!!!! I was being Rocked in my mouth, arm and head shocks (they are like biting an electric fence), I stumbled and fell, I was dizzy and I wanted to rip my skin off. I am not a crier and I was sobbing to my husband to make it stop. It is torture. Other than that I am happy. I am going to come off it however because we want to try and have a baby….apprehensive to say the least.

I am a 32 year old woman who was given Effexor 4 years ago. I started at 150 mg, then went up to 300 mg. This was my 1st anti depressant ever. I want to STRANGLE the doctor who prescribed me this drug! First withdrawl symptom occured when I went out of town & forgot my pills. The first day I was fine, but the second day turned into a nightmare of sweating, chills, brain zaps, extreme tiredness & severe headache. I could not get out of bed. By the 3rd day, I felt delerious! I’m surprised I was able to drive back home & I am POSITIVE I shouldn’t have. Anyway, I took my meds & I was fine. However, the withdrawl symptoms really scared me! I decided continue on the meds, though, but after repeated incidents similar to the one above, I decided to get off the med. That was 2 years ago. I am still trying to get off this frickin stupid drug! I stepped down my dosage until I was all the way down to 37.5, then tried to cut that in half every day. I experienced the withdrawls immediately & was stuck at 37.5 for over a year. I am now at 25 mg after dicsovering there is a 25mg version available. I feel that I will be stuck on this drug for the rest of my life! The withdrawls are so severe that to quit would require that I be at home, in bed, for at least 2 weeks. I have spoken to some people who feel that hospitalization is necessary. Bottom line: DO NOT start this medication unless other options have been explored. This should be a LAST RESORT only. If your doctor says they’ve never heard of the withdrawl symptoms, fire them. I am serious. Use this drug with caution unless you plan on taking it for the rest of your life. Not everyone will experience the severity of withdrawls that I have, but the thing is: you won’t know how you will respond until it is too late.

I have been taking venlafaxine on and off for many years. It is a cycle I hope to stop one day, but until I find an anti depressant as effective as venlafaxine or I don’t relapse I accept that this will be the case. Most of the side effects will pass after a couple of months (usually within 4 weeks)personally the side effect that continues for me that I find difficult is night sweats, after about 6 months or so I get so fed up and am so ‘well’ that I come off it, after many times I know that when coming off it I will experience terrible discontinuation symptoms..I also know they will stop. Without doubt it is best to reduce though not necessarily over months - weeks, however it is when trying to stop completely from the last reduction that the worse symptoms are felt - the best way of reducing the severity and intensity of these is to ask to be prescribed a low dose of an ssri - fluoxetine or citalopram have both been excellent for me at 20/10mg doses. After about 3 weeks I come off the ssri. I appear to be unable to manage without an antidepressant over a long period of time, when I get depressed things go downhill quickly, I have tried all of the ssris and in my earlier days tricyclics, none have been as quick and effective as venlafaxine..so thats my choice. But you can get off it, accept the effects and reduce them by cross tapering with an ssri.

I’ve been on Remeron for 4 years for major depressive disorder characterized by severe insomnia and major weight loss (lost 20% of my body weight in 2 months). Remeron was an amazing fix at treating the side effects of my depression - I immediately started sleeping and gained about 30 lbs. But it didn’t do much to cure the underlying depression. At higher doses I couldn’t sleep, so my Dr. took me back down to 15 mg and started adding one SSRI after another. Zoloft, Celexa, Paxil. Nothing worked. Still felt sad and had horrible side effects like nausea, tremors, vomiting, sleeplessness, weight loss. The last two were particularly concerning because this is exactly what I was trying to TREAT.

Then I found a new doc and he put me on Effexor. Holy crap. Within 3 days I felt myself turn the corner, even though everywhere I’ve read it says it should take 3 weeks to a month. Maybe it’s the combination of Remeron with the Effexor that makes it so powerful? Who knows. I am a new person now. I feel alert, like my old self. I never thought I would feel happy again, like, EVER. Now I can’t remember what it felt like to be so despairing.

Side effects were relatively mild for me. The first day I felt a little wired, like I drank 10 espressos. This was much better the following day, and by the third day non-existant. I take the Effexor in the morning, so this is not too troublesome, although, I did have some sleep disturbances, so I now take Restoril (along with the Remeron) at night.

For me, this has been the closest thing to a miracle drug (or combination of drugs) that I can imagine.

I had thought that my symptoms were all situational, that when things changed, I would feel better (lots on my plate). Changes happened and the dark cloud hanging over me didn’t change one iota. I was started on Zoloft twice and I didn’t tolerate the side effects well. Dizziness and a strobe light-like aura kept causing me problems at work, so I titrated myself off of the Zoloft. My dizziness never went away.

I was started on Effexor and within two weeks, I noticed the darkness lifting. I asked for an increase and now, I am excited about springtime, vacation, walking the dog, getting together with friends, quilting….all the things that had quit mattering. I was so slow and tired. I will remain on the Effexor and endeavor to NOT forget it when I travel, NOT forget to refill it, etc. It doesn’t take a lot of effort folks. I have a reminder on my calendar that is about two weeks prior to refill time. My phone rings to remind me to do the refill. I keep a list ready before I go anywhere and I make sure I have what I need.

Thanks for all of your comments. It is interesting how different we all react to various substances. %25bgcolor=yellow%25I REALLY LIKE EFFEXOR.%25%25 I hope I don’t have to discontinue taking it. That sounds nightmarish. I would imagine that like insulin, one needs to take it even when feeling better. Don’t be misguided and stop.

Okay, enough preaching. Woohoo. Time to take a little walk and see what’s popping out of the ground so far….

I am a 45 year old male who is being treated for GAD and Depression. I was on Venlafaxine ER for about 5 months. I was taking 75mg per day. I experienced many of the side effects early on like sleeplessness, sweating, nausea, dizzy, then fatigue, etc.etc.etc. They all eventually went away but the one that hung on like an STD was the delayed ejaculation. I trusted my doc’s advice and continued on and hoped it too would go away. THE PROBLEM STUCK AROUND. At first it was fine and my wife (of 20years) and I had “fun” with it but it got old and started making me more depressed. Finally I got off of the Venlafaxine and I will say that coming off has been difficult. I just finished a few days ago while I am now in my 3rd week of Mirtazapine. It appears to be better for me. The delayed ejaculation has improved. I will go on the forum for Mirtazapine to share side effect experiences…I eat like a horse and have gained 7 pounds in 3 weeks. Back to the withdraw effects of the Venlafaxine…last week it was like I bounced off the wall a few times…so to speak. Coming off the Venlafaxine has not been a pleasant experience. I will say that the Venlafaxine did do it’s job and help take the edge off for me but the sexual side effect was too much for me and my wife. As I write today I seem to be doing much better and feeling more of an energy boost from the Mirtazalpine. I appreciate reading the experiences and it has helped me out. Hopefully mine will help others as well. :)

I have been on Effexor xr 150 mg ( now generic version) for 10 years. This had been very effective for me until my pharmacy switched me to generic a few years ago. ( As per my insurance) I didn’t think anything about it until finding this site. (I live in Canada BTW) My dr. had tweaked my dosage, given me Clonazepam 0.5 mg and the Lorazepam 0.5 mg to take on occasion when really upset. these made me feel really unstable/ emotional. I was then prescribed elvail 10mg to take for pain to help me sleep. These made me gain weight and have a very short fuse during the day (out of character) so I stopped taking them a few days ago. A few weeks ago I was prescribed Wellbutrin 100mg (but generic) to take in combo with the Effexor xr 150mg ( generic). He said there have been a lot of success with taking the two together. Has anyone heard/ taken these together?

I was on Effexor 150 mg for 3 months in 2008. I guess I’m one of those people that got a rare side effect because I became anorexic. I was nauseous all the time. I hardly ever ate anything. The most I had in a day was Vitamin water and jello. Every time I did eat anything I threw up or had diarrhea. And my depression just got worse and worse. It got to the point where I couldn’t go to work, I couldn’t get out of bed. I lost 25lbs in 3 months and I wasn’t overweight. When I called the doctor and left a message on the nurses line she called back and said that the side effects should go away in a couple weeks and that I should keep taking the drug. When I finally went back into the doctor he took me off the Effexor. What is so frustrating is that every psychiatrist I’ve been to says that Effexor works wonders for people who’ve found that other drugs didn’t help. And every one else who has commented has found it to be helpful. I don’t get it.

I’ve been diagnosed with depression and social anxiety. My doctor switched me from Zoloft/Buspirone to Effexor and Buspirone after I told her I was having up and (mostly) down days. For the first few days, I was in bed due to the side effects like severe nausea and light-headedness. Later it was accompanied by heavy sweat, bad BO (regardless of sweat) and hot (and cold) flashes at night (and I’m only 25!). Some of the side effects, like the hot flashes and nausea, gradually went away after a week and that’s when my mood and energy picked up. Unfortunately, the sweating, BO and light-headedness stayed. And after about 2 weeks, the nausea came back and my mood started to fluctuate again. It was just like being on the Zoloft except I had MORE side effects! INCLUDING an extra 10lbs that I can’t seem to shake off as easily as I’m used to. Turning 25 and most likely having a slower metabolism might be a contributing factor. BUT I didn’t have trouble getting my weight down until I took the Effexor. I stopped cold when I ran out of pills and hadn’t felt any withdrawal symptoms.

Enter your own Comments & Experiences with Effexor here.
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13.  Full US PI sheet, Global SPCs & PILs, check for drug-drug interactions

Effexor Full US Prescribing Information / PI Sheet

Check for drug-drug interactions

14.  Bibliography

PDR: Physicians’ Desk Reference 2010 64th edition back through to 53rd edition of 1999. Old copies of the PDR come in handy for PI sheets that are no longer available and difficult to find, as well as to track the changes in both indications and adverse effects.

Instant Psychopharmacology 2nd Edition Ronald J. Diamond M.D. © 2002. Published by W.W. Norton

Primer of Drug Action 12th edition by Robert M. Julien Ph.D., Claire D. Advokat, Joseph Comaty © 2011 Published by Worth Publishers.

The Complete Guide to Psychiatric Drugs Edward Drummond, M.D. © 2000. Published by John Wiley & Sons, Inc.

Healing Anxiety & Depression Daniel G. Amen, M.D., and Lisa C. Routh, M.D. © 2003. Published by G.P. Putnam’s Sons.

Mosby’s Drug Consult 2007 (Generic Prescription Physician’s Reference Book Series) © 2007 An imprint of Elsevier.

Stahl’s Essential Psychopharmacology: Neuroscientific Basis and Practical Applications (Essential Psychopharmacology Series) Third edition by Stephen M. Stahl © 2008 Published by Cambridge University Press.

Date created 25 Apr 2011 - 11:53 Page Author: JerodPoore Last edited by: JerodPoore

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² Have I mentioned how open source operating systems for commercial applications is one of the dumbest ideas in the history of dumb ideas?
[begin rant] I rent a dedicated server for Crazy Meds. It’s sitting on a rack somewhere in Southern California along with a bunch of other servers that other people have rented. The hardware is identical, but no two machines have exactly the same operating systems. I don’t even need to see what is on any of the others to know this. If somebody got their server at the exact same time, with the exact same features as I did, I’m confident that there would be noticeable differences in some aspects of the operating systems. So what does this mean? For one thing it means that no two computers in the same office of a single company have the same operating system, and the techs can spend hours figuring out what the fuck the problem could be based on that alone. It also means that application software like IP board that runs the forum here has to have so many fucking user-configurable bells and whistles that even when I read the manual I can’t find every setting, or every location that every flag needs to be set in order for a feature to run the way I want it to run. And in the real world it means you can get an MBA not only with an emphasis on resource planning, but with an emphasis on using SAP - a piece of software so complex there are now college programs on how to use it. You might think, “But don’t people learn how to use Photoshop or Adobe Illustrator in college?” Sure, in order to create stuff. And in a way you’re creating stuff with SAP. But do you get a Bachelor of Fine Arts degree with an emphasis on Photoshop?
Back in the Big Iron Age the operating systems were proprietary, and every computer that took up an entire room with a raised floor and HVAC system, and had less storage and processing power than an iPhone, had the same operating system as every other one, give or take a release level. But when a company bought application software like SAP, they also got the source code, which was usually documented and written in a way to make it easy to modify the hell out of it. Why? Because accounting principles may be the same the world over, and tax laws the same across each country and state, but no two companies have the same format for their reports, invoices, purchase orders and so forth. Standards existed and were universally ignored. If something went wrong it went wrong the same way for everyone, and was easy to track down. People didn’t need to take a college course to learn how to use a piece of software.
I’m not against the open source concept entirely. Back then all the programmers read the same magazines, so we all had the same homebrew utilities. We even had the forerunner to QR Code to scan the longer source code. Software vendors and computer manufacturers sponsored conventions so we could, among other things, swap recipes for such add-ons and utilities. While those things would make our lives easier, they had nothing to do with critical functions of the operating system. Unless badly implemented they would rarely cause key application software to crash and burn. Whereas today, with open source everything, who the hell knows what could be responsible some part of a system failing. [/end rant]