Medically reviewed on October 3, Antidepressants may increase risk of suicidal thinking and behavior suicidality in children, adolescents, and young adults 18—24 years of age with major depressive disorder and other psychiatric disorders; balance this risk with clinical need.
Depression and certain other psychiatric disorders are themselves associated with an increased risk of suicide. A selective serotonin- and norepinephrine-reuptake inhibitor SNRI ; antidepressant and anxiolytic agent.
Management of major depressive disorder. Efficacy venlafaxine and its metabolites extended-release capsules in hospital settings not established. Management of generalized anxiety disorder. Management of panic disorder with or without agoraphobia. Allow at least 2 weeks to elapse between discontinuance of an MAO inhibitor and initiation of venlafaxine and at least 1 week to elapse between discontinuance of venlafaxine and initiation of an MAO inhibitor.
Monitor for possible worsening of depression, suicidality, or unusual changes in behavior, especially at the beginning of therapy or during periods vitamin c megadoses and skin cancer dosage adjustments.
Consider cautiously tapering dosage during third trimester venlafaxine and its metabolites pregnancy prior to delivery. Sustained therapy may be required; use lowest effective dosage and periodically reassess need for continued therapy. Administer orally with food. Administer conventional tablets twice or 3 times daily with food. Administer extended-release capsules as a single daily dose with food at approximately the same time each day morning or evening.
Alternatively, open capsule s and sprinkle on a small amount of applesauce; swallow immediately without chewing. Available as venlafaxine hydrochloride; dosage expressed in terms of venlafaxine.
Initially, 75 mg daily administered in 2 or 3 divided doses as conventional tablets or as a single daily dose when using the extended-release capsules. If desired, conventional tablets may be switched to the extended-release capsules at the nearest equivalent daily venlafaxine dosage e.
Optimum duration not established; may require several months of therapy or longer. Periodically reassess need for continued therapy and appropriateness of dosage. Initially, 75 mg once daily as extended-release capsules. Optimum duration not established; efficacy demonstrated in a 6-month clinical trial. Maximum mg daily generally in 3 equally divided doses as conventional tablets 1 or mg daily as extended-release capsules.
In patients venlafaxine and its metabolites cirrhosis, may be desirable to individualize dosages. Concurrent or recent i, venlafaxine and its metabolites. Known hypersensitivity to venlafaxine or any ingredient in the formulation.
Venlafaxine overdosage may be associated with an increased risk of fatal outcome compared with SSRI overdosage but lower than that associated with tricyclic antidepressants. Prescribe in smallest quantity consistent with good patient management to reduce risk of overdosage. Appropriately monitor and closely observe patients receiving venlafaxine for any reason, particularly during initiation of therapy i.
Observe these precautions for patients being treated for psychiatric e. Anemia and vitamin and b12 unmask bipolar disorder. Venlafaxine is not approved for use in treating bipolar depression.
Screen for risk of bipolar disorder by obtaining detailed psychiatric history e. Concomitant use with MAO inhibitors associated with serious, sometimes fatal reactions, venlafaxine and its metabolites, including manifestations resembling serotonin syndrome e.
Sustained, dose-dependent hypertension i. Control preexisting hypertension before initiating therapy and regularly monitor BP during therapy. Possibly severe withdrawal reactions e. If intolerable symptoms occur following dosage reduction or discontinuance, reinstitute previously prescribed dosage until symptoms abate, then resume more gradual dosage reductions.
Possible anxiety, nervousness, or insomnia. Weight loss reported in adults and pediatric patients. Anorexia reported in adults venlafaxine and its metabolites pediatric patients. Possible activation of mania and hypomania; use with caution in patients with a venlafaxine and its metabolites of mania.
Possible hyponatremia or SIADH; use with caution in patients who are volume-depleted, elderly, or taking diuretics. Use with caution in patients with a history of seizures. Possible increased risk of bleeding. Consider monitoring serum cholesterol concentrations during long-term treatment.
Interstitial lung disease and eosinophilic pneumonia reported rarely; signs and symptoms may include progressive dyspnea, venlafaxine and its metabolites, cough, or chest discomfort. Limited experience; use with caution in patients with altered metabolism or hemodynamics or conditions that could be compromised by increased heart rate e.
Risk of impaired mental alertness or physical coordination required for performing hazardous tasks e. Effects of concomitant use with ECT have not been systematically evaluated.
Possible complications, sometimes severe and requiring prolonged hospitalization, respiratory support, enteral nutrition, and other forms of supportive care in neonates exposed to venlafaxine and other SNRIs or SSRIs late in the third trimester; may arise immediately upon delivery. Carefully consider the potential risks and benefits of treatment when used during the third trimester of pregnancy.
Distributed into milk; discontinue nursing or the drug. Safety and effectiveness not established in pediatric patients; efficacy of venlafaxine administered as extended-release capsules was not established in placebo-controlled clinical studies in pediatric patients with major depressive disorder or generalized anxiety disorder. Regular monitoring of height and weight is recommended when prescribed for unlabeled off-label uses in pediatric patients, particularly during long-term administration.
Blood pressure elevations considered clinically important observed in children and adolescents similar venlafaxine and its metabolites those observed in adults; observe same precautions as in adults. Carefully consider these findings when assessing potential benefits and risks of venlafaxine in a child or adolescent for any clinical use. No substantial differences in safety and efficacy relative to younger adults, but increased sensitivity cannot be ruled out. Decreased clearance; dosage adjustment recommended.
Potential pharmacokinetic interaction increased plasma venlafaxine concentrations. Potential pharmacokinetic interaction increased substrate plasma concentrations with concomitant use of drugs that are metabolized by CYP2D6. Potential pharmacologic interaction serotonin syndrome with serotonergic agents. No apparent additive cognitive or psychomotor effects; no effects on venlafaxine pharmacokinetics venlafaxine and its metabolites 3. Avoidance of alcohol recommended 1 3. Increased plasma venlafaxine concentrations, but no effect on ODV pharmacokinetics 1 3.
No dosage adjustment required for most patients; use with caution in geriatric patients and patients with hypertension or hepatic impairment 1 3. Potential additive CNS effects 1 3, venlafaxine and its metabolites. Use with caution 1 3. Increased plasma desipramine concentrations 1 3. Pharmacokinetic or pharmacologic interactions unlikely 1 3. Consider risk of hyponatremia 1 3.
Potentially life-threatening serotonin syndrome 1 36 37 38 41 b. Observe carefully if used concomitantly, particularly during treatment initiation, dosage increases, or when another theme lesson plans wild animals agent is initiated 1 36 37 b.
Increased which vitamins and herbs for giardiasis haloperidol concentrations 1 3.
Pharmacokinetic interaction unlikely 1 3, venlafaxine and its metabolites. Decreased plasma indinavir concentrations 1 3. Pharmacokinetic interaction unlikely, but potentially additive serotonergic effects a b.
Caution advised a b. Potentially fatal serotonin syndrome 1 3, venlafaxine and its metabolites. Concomitant use contraindicated 1 3. Venlafaxine and its metabolites at least 2 weeks to elapse between discontinuance of an MAO inhibitor and initiation of venlafaxine; allow at least 1 week to elapse between discontinuance of venlafaxine and initiation of an MAO inhibitor 1 3. Increased plasma risperidone concentrations 1 3. Potentially additive serotonergic effects a b. No effect on tolbutamide pharmacokinetics a b.
Well absorbed following oral administration. Commercially available extended-release capsules provide a slower rate of absorption but the same extent of absorption compared with the conventional tablets. Food does not appear to affect GI absorption of venlafaxine or bioavailability of ODV, its major active metabolite. Extensively metabolized in the liver via CYP2D6 to O -desmethylvenlafaxine ODVits major active metabolite; also metabolized to NO -didesmethylvenlafaxine and other minor metabolites.
Renal elimination of venlafaxine and its metabolites is the primary route of excretion. Elimination half-lives of venlafaxine and ODV are approximately 5 and 11 hours, respectively. Mechanisms of antidepressant and anxiolytic actions are uncertain but appear to be associated with the potentiation of neurotransmitter activity in the CNS.
Venlafaxine and ODV are potent inhibitors of neuronal serotonin and norepinephrine reuptake and weak inhibitors of dopamine reuptake. Risk of suicidality; importance of patients, caregivers, and families being alert to and immediately reporting emergence of suicidality, worsening depression, or unusual changes in behavior, especially during the first few months of therapy or during periods of dosage adjustment.
Importance of consulting a clinician if skin rash, urticaria hivesor a related allergic phenomenon occurs. Risk of concomitant use with alcohol. Importance of avoiding some activities e. Importance of patients informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs and herbal products, as well as concomitant illnesses.
Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.