VENLAFAXINE (Systemic)
Some commonly used brand names are:
In the U.S.?
In Canada?
Category
- Antidepressant
- Anti-anxietyagent
- antipanic agent
Description
Venlafaxine (ven-la-FAX-een) is used to treat mentaldepression. It is also used to treat certain anxiety disorders or to relievethe symptoms of anxiety. However, it usually is not used for anxiety or tensioncaused by the stress of everyday life. Venlafaxine is also used to treat panicdisorders.
This medicine is available only with your doctor's prescription, in thefollowing dosage forms:
Oral- Extended-release capsules (U.S. and Canada)
- Tablets (U.S. and Canada)
Before Using This Medicine
In deciding to use a medicine,the risks of taking the medicine must be weighed against the good it willdo. This is a decision you and your doctor will make. For venlafaxine, thefollowing should be considered:
Allergies?Tell your doctor if you have ever had any unusual orallergic reaction to venlafaxine. Also tell your health care professionalif you are allergic to any other substances, such as foods, preservatives,or dyes.
Pregnancy?Studies have not been done in pregnant women. However,when pregnant rats were given venlafaxine in doses much larger than the usualhuman dose, some of their pups died before or soon after birth. Before takingthis medicine, make sure your doctor knows if you are pregnant (especiallyif it is the third trimester) or if you may become pregnant.
Breast-feeding?This medicine passes into breast milk and may causeunwanted effects. It may be necessary for you to take another medicine orto stop breast-feeding during treatment. Be sure you have discussed the risksand benefits of this medicine with your doctor.
Children?Venlafaxine must be used with caution in childrenwith depression. Studies have shown occurrences of children thinking aboutsuicide or attempting suicide in clinical trials for this medicine. More studyis needed to be sure venlafaxine is safe and effective in children.
Older adults?In studies done to date that have included elderlypeople, venlafaxine did not cause different side effects or problems in olderpeople than it did in younger adults.
Other medicines?Although certain medicines should not be usedtogether at all, in other cases two different medicines may be used togethereven if an interaction might occur. In these cases, your doctor may want tochange the dose, or other precautions may be necessary. When you are takingvenlafaxine, it is especially important that your health care professionalknow if you are taking the following:
- Buspirone (e.g., BuSpar) or
- Bromocriptine (e.g., Parlodel) or
- Certain tricyclic antidepressants (amitriptyline [e.g., Elavil],clomipramine [e.g., Anafranil], or imipramine [e.g., Tofranil]) or
- Dextromethorphan (cough medicine) or
- Levodopa (e.g., Sinemet) or
- Lithium (e.g., Eskalith) or
- Meperidine (e.g., Demerol) or
- Nefazodone (e.g., Serzone) or
- Pentazocine (e.g., Talwin) or
- Selective serotonin reuptake inhibitors (fluoxetine [e.g., Prozac],fluvoxamine [e.g., Luvox], paroxetine [e.g., Paxil], sertraline [e.g., Zoloft])or
- Street drugs (LSD, MDMA [e.g., ecstasy], marijuana) or
- Sumatriptan (e.g., Imitrex) or
- Tramadol (e.g., Ultram) or
- Trazodone (e.g., Desyrel) or
- Tryptophan?Using these medicines with venlafaxine may increasethe chance of developing a rare, but very serious, unwanted effect known asthe serotonin syndrome; symptoms of this syndrome include confusion, diarrhea,fever, poor coordination, restlessness, shivering, sweating, talking or actingwith excitement you cannot control, trembling or shaking, or twitching; ifyou experience these symptoms contact your doctor as soon as possible
- Clozapine (e.g., Clozaril)?Taking venlafaxine with clozapinemay increase amounts of clozapine in the body which could cause serious unwantedeffects including seizures.
- Moclobemide (e.g., Manerex)?Taking moclobemide and venlafaxinetogether or less than 3 days apart may increase the chance of developing seriousunwanted effects, including the serotonin syndrome, and is not recommended
- Monoamine oxidase (MAO) inhibitor activity (isocarboxazid [e.g.,Marplan], phenelzine [e.g., Nardil], procarbazine [e.g., Matulane], selegiline[e.g., Eldepryl], tranylcypromine [e.g., Parnate])? Do not take venlafaxine while you are taking or within 2 weeks of taking anMAO inhibitor; if you do, you may develop confusion, agitation, restlessness,stomach or intestinal symptoms, sudden high body temperature, extremely highblood pressure, and severe convulsions; at least 14 days should be allowedbetween stopping treatment with an MAO inhibitor and starting treatment withvenlafaxine, and at least 7 days should be allowed between stopping treatmentwith venlafaxine and starting treatment with an MAO inhibitor
- Warfarin (e.g., Coumadin)?Taking venlafaxine with warfarinmay increase the chance of developing serious unwanted effects.
Other medical problems?The presence of other medicalproblems may affect the use of venlafaxine. Make sure you tell your doctorif you have any other medical problems, especially:
- Bipolar disorder (mood disorder with alternating episodes of maniaand depression) or risk of?May make condition worse. Your doctor willcheck you for this condition.
- Brain disease or damage, or mental retardation or
- Seizures (history of)?The risk of seizures may be increased
- Dehydration?Venlafaxine may cause serious problems in patientswho are dehydrated.
- Glaucoma or
- Pressure within the eye?Venlafaxine may cause abnormal dilationof the pupil or other eye problems in these patients.
- Heart disease or
- High or low blood pressure?Venlafaxine may make these conditionsworse
- Heart attack or
- Heart failure or
- Hyperthyroidism (overactive thyroid)?Venlafaxine may causean increase in heart rate and should be used with caution in these patients.
- Kidney disease or
- Liver disease or
- Cirrhosis of the liver?Higher blood levels of venlafaxine mayoccur, increasing the chance of side effects; your doctor may need to adjustyour venlafaxine dose.
- Mania (history of)?The risk of developing mania may be increased
- Weight loss?Venlafaxine may cause weight loss; this weightloss is usually small, but if a large weight loss occurs, it may be harmfulin some patients
Proper Use of This Medicine
Take this medicine only as directed by your doctor to benefit yourcondition as much as possible. Do not take more of it, do not take it moreoften, and do not take it for a longer time than your doctor ordered.
You may have to take venlafaxine for 4 weeks or longerbefore you begin to feel better. Also, you will probably need to keeptaking this medicine for at least 6 months, even if you feel better, to helpprevent your depression from returning. Your doctor should check your progressat regular visits during this time.
Venlafaxine should be taken with food or on a full stomach to lessen thechance of stomach upset. However, if your doctor tells you to take the medicinea certain way, take it exactly as directed.
If you are taking the extended-release capsule dosageform, swallow the capsule whole with fluid; do not break, crush, chew,or place the capsule in liquid.
Dosing?The dose of venlafaxine will be different fordifferent patients. Follow your doctor's orders or thedirections on the label. The following information includes only theaverage doses of venlafaxine. If your dose is different,do not change it unless your doctor tells you to do so.
The number of capsules or tablets that you take depends on the strengthof the medicine. Also, the number of doses you take eachday, the time allowed between doses, and the length of time you take the medicinedepend on your special needs.
- For mental depression:
- For oral extended-release capsule dosageform:
- Adults?At first, 75 milligrams (mg) a day, taken in one dosein the morning or evening. Your doctor may increase your dose if needed. However,the dose is usually not more than 225 mg a day.
- Children?Use and dose must be determined by your doctor.
- For oral tablet dosage form:
- Adults?At first, a total of 75 mg a day, taken in smaller dosestwo or three times during the day. Your doctor may increase your dose if needed.However, the dose is usually not more than 375 mg a day.
- Children up to 18 years of age?Use and dose must be determinedby your doctor.
- For anxiety:
- For oral extended-release capsule dosageform:
- Adults?At first, 75 mg a day, taken in one dose in the morningor evening. Your doctor may increase your dose if needed. However, the doseis usually not more than 225 mg per day.
- Children?Use and dose must be determined by your doctor.
- For panic disorder:
- For oral extended-release capsule dosageform:
- Adults?At first, 37.5 mg a day, taken in one dose in the morningor evening for 7 days. Your doctor may increase your dose if needed. However,the dose is usually not more than 225 mg per day.
- Children?Use and dose must be determined by your doctor.
Missed dose?If you are taking the tabletform of venlafaxine and you miss a dose, take it as soon as possible.However, if it is within 2 hours of your next dose, skip the missed dose andgo back to your regular dosing schedule. Do not double doses.
If you are taking the extended-release capsule formof venlafaxine and you miss a dose, take it as soon as possible. However,if you do not remember the missed dose until the next day, skip the misseddose and go back to your regular dosing schedule. Do not double doses.
Storage?To store this medicine:
- Keep out of the reach of children.
- Store away from heat and direct light.
- Do not store in the bathroom, near the kitchen sink, or in otherdamp places. Heat or moisture may cause the medicine to break down.
- Do not keep outdated medicine or medicine no longer needed. Be surethat any discarded medicine is out of the reach of children.
Precautions While Using This Medicine
It isimportant that your doctor check your progress at regular visits, to allowfor changes in your dose and to help reduce any side effects.
Tell your doctor right away if you develop any allergicreactions, such as skin rash or hives, while taking venlafaxine.
Venlafaxine may cause some people to be agitated, irritable or displayother abnormal behaviors. It may also cause some people to have suicidal thoughtsand tendencies or to become more depressed. If you or your caregiver noticeany of these adverse effects, tell your doctor right away.
Do not stop taking this medicine without first checking with your doctor.Your doctor may want you to reduce gradually the amount you are taking beforestopping completely. This is to decrease the chance of side effects.
It is not known how venlafaxine will interact with alcohol and other centralnervous system (CNS) depressants (medicines that may make you drowsy or lessalert). Some examples of CNS depressants are antihistamines or medicine forhay fever, other allergies, or colds; sedatives, tranquilizers, or sleepingmedicine; prescription pain medicine or narcotics; barbiturates; medicinefor seizures; muscle relaxants; or anesthetics, including some dental anesthetics.Check with your doctor before taking any of the above while you are usingthis medicine.
Venlafaxine may cause some people to become drowsy or have blurred vision. Make sure you know how you react to this medicine before youdrive, use machines, or do anything else that could be dangerous if you arenot alert or able to see clearly.
Dizziness, lightheadedness, or fainting may occur,especially when you get up from a lying or sitting position. Getting up slowlymay help. If this problem continues or gets worse, check with your doctor.
Side Effects of This Medicine
Along with its needed effects, a medicine may cause some unwanted effects.Although not all of these side effects may occur, if they do occur they mayneed medical attention.
Check with your doctoras soon as possible if any of the following side effects occur:
Rare
Convulsions (seizures); itching or skinrash; lightheadedness or fainting, especially whengetting up suddenly from a sitting or lying position; lockjaw; menstrual changes; problems in urinating or in holding urine; swelling; talking, feeling, and acting with excitement andactivity you cannot control; trouble in breathing
Incidence not known
Abdominal or stomach pain; agitation; black, tarry stools; bleeding gums; blistering, peeling, loosening ofskin; bloating of abdomen; blood in eye; bloody urine; bloody, black, or tarry stools; blue-green to blackskin; chest pain or discomfort; coma; confusion; confusionas to time, place, or person; cough or hoarseness; coughing up blood; darkurine; decreased awareness or responsiveness; decreased frequency/amount of urine; depression; difficulty in breathing or swallowing; discoloration, pain, redness, or sloughing of skinat place of injection; dry cough; extra heartbeats; eye pain; fast, pounding, or irregular heartbeat or pulse; fast, slow or irregular heartbeat; fever with orwithout chills; general feeling of tiredness or weakness; hallucinations; hearingloss; high fever; hives; holding false beliefs that can not be changed byfact; hostility; increasedmenstrual flow or vaginal bleeding; increased thirst; indigestion; involuntarymovements; irregular heartbeat; irritability; joint or muscle pain; lethargy; light-colored stools; lip smacking or puckering; low bloodpressure; lower back or side pain; mimicry of speech or movements; muscle cramps orspasms; muscle pain or stiffness; muscle twitching; mutism; negativism; nosebleeds; overactive reflexes; pain, redness or swelling inarm or leg; painful or difficult urination; pains in stomach, side, or abdomen, possibly radiating to theback; palpitations; panic; paralysis; peculiar posturesor movements, mannerisms, or grimacing; poor coordination; pounding or rapid pulse; prolonged bleeding from cuts; puffiness or swellingof the eyelids or around the eyes, face, lips, or tongue; puffing of cheeks; rapid breathing; rapid or worm-like movements of tongue; rapid weight gain; rash; recurrent fainting; red or dark brown urine; red skin lesions, often with a purple center; red, irritated eyes; redness in whites of eyes; restlessness; seizures; severe muscle stiffness; severe sleepiness; shivering; shock-likeelectrical sensations; sore throat; sores, ulcers, or white spots in mouth or on lips; stupor; sweating; swelling of face, lower legs, ankles, hands, or fingers; swollen or painful glands; talking or acting withexcitement you cannot control; tightness in chest; tiredness; twitching; twitching, twisting, uncontrolled repetitive movements of tongue,lips, face, arms, or legs; uncontrolled chewing movements; uncontrolled movements of arms and legs; unexplained bleeding or bruising; unpleasantbreath odor; unusual excitement, nervousness, orrestlessness; unusually pale skin; vomiting of blood or material that looks like coffee grounds; weight gain; wheezing; yellow eyes or skin
This medicine may also cause the following side effect that your doctorwill watch for:
Other side effects may occur that usually donot need medical attention. These side effects may go away during treatmentas your body adjusts to the medicine. However, check with your doctor if anyof the following side effects continue or are bothersome:
More common
Abnormal dreams; anxiety or nervousness; chills; constipation; decrease in sexual desire or ability; diarrhea; dizziness; drowsiness; dryness of mouth; heartburn; increased sweating; lossof appetite; nausea; stuffyor runny nose; stomach pain or gas; tingling, burning, or prickly sensations; trembling or shaking; trouble in sleeping; unusual tiredness or weakness; vomiting; weight loss
After you stop using this medicine, your bodymay need time to adjust. The length of time this takes depends on the amountof medicine you were using and how long you used it. During this period oftime check with your doctor if you notice any of the following side effects:
Actions that are out of control; anxiety; changes in dreaming; continuing ringing or buzzing or other unexplained noise in ears; convulsions; crying; depersonalization; diarrhea; difficulty with coordination; dizziness; dryness of mouth; dysphoria; euphoria; fear; feeling of constant movement of self or surroundings; feeling unwell or unhappy; headache; hearing loss; hyperventilation; increased sweating; irregular heartbeats; irritability; lightheadedness; loss of appetite; lossof bladder control; mental depression; mood or mental changes; muscle spasmor jerking of all extremities; nausea; nervousness; nightmares; paranoia; quick to react or overreactemotionally; rapidly changing moods; restlessness; sensation of spinning; sensory disturbances (including shock-like electricalsensations; shakiness in legs, arms, hands, feet; shaking; shaking of handsor feet; shortness of breath; sleeping or unusual drowsiness; sudden loss of consciousness; talking, feeling, and acting with excitement; trembling or shaking of hands or feet; trouble in sleeping; twitches of the muscle visibleunder the skin; unusual drowsiness, dullness or feelingof sluggishness; unusual tiredness or weakness; vomiting; weight loss
Other side effects not listed above may also occur insome patients. If you notice any other effects, check with your doctor.
Additional Information
Once a medicine has been approved for marketingfor a certain use, experience may show that it is also useful for other medicalproblems. Although this use is not included in product labeling, venlafaxineis used in certain patients with the following medical condition:
Other than the above information, there is no additional information relatingto proper use, precautions, or side effects for these uses.
Revised: 12/01/2005
