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Depression: Usual Recommended Starting Dose: 75 mg given once daily.
When required, the dose can be increased in increments of up to 75 mg/day, at intervals of not less than 4 days. The dose can be titrated up to 225 mg/day in moderately depressed patients and 375 mg/day for severely depressed patients.
Antidepressant activity with the 75-mg dose was observed after 2 weeks of treatment.
Generalized Anxiety Disorder: Patients not responding to the initial 75-mg/day dose may benefit from dose increases. The dose may be stepped up (eg, by 37.5-mg increments) to a maximum of 150 mg/day or in some cases 225 mg/day. Extended-release venlafaxine dosage increases can be made at intervals of approximately ≥2 weeks, but not less than 4 days.
Anxiolytic activity with the 75-mg dose was observed after 1 week of treatment.
Social Anxiety Disorder (Social Phobia): Recommended Dose: 75 mg/day administered in a single dose. There was no evidence that higher doses confer any additional benefit.
Panic Disorder: It is recommended that initial single doses of 37.5 mg/day of Efexor XR be used for 7 days. In clinical trials establishing the efficacy of Efexor XR in outpatients with panic disorder, initial doses of 37.5 mg/day for 7 days were followed by doses of 75 mg/day and subsequent weekly dose increases of 75 mg/day to a maximum dose of 225 mg/day. Although a dose-response relationship for effectiveness in patients with panic disorder was not clearly established in fixed-dose studies, certain patients not responding to 75 mg/day may benefit from dose increases to a maximum of approximately 225 mg/day. Dose increases should be in increments of up to 75 mg/day, as needed and should be made at intervals of not less than 7 days.
Switching Patients from Efexor Tablets: Patients who are currently being treated with Efexor may be switched to Efexor XR at the nearest equivalent dose (mg/day). However, individual dosage adjustments may be necessary.
With the exception of patients with social anxiety disorder, patients not responding to the 75-mg/day dose may benefit from dose increases in increments of up to 75 mg/day to a maximum of 225 mg/day. Extended-release venlafaxine dosage increases can be made at intervals of ≥2 weeks, but not less than 4 days.
Patients with Renal Impairment: The total daily dose of venlafaxine should be reduced by 25-50% for patients with renal impairment with a glomerular filtration rate (GFR) of 10-70 mL/min.
The total daily dose of venlafaxine should be reduced by 50% in hemodialysis patients.
Because of individual variability in clearance in these patients, individualization of dosage may be desirable.
Patients with Hepatic Impairment: The total daily dose of venlafaxine should be reduced by 50% in patients with mild to moderate hepatic impairment. Reduction of >50% may be appropriate for some patients.
Because of individual variability in clearance in these patients, individualization of dosage may be desirable.
Children: There is insufficient experience with the use of venlafaxine in patients <18 years (see Use in children under Precautions and Pediatric Patients under Adverse Reactions).
Elderly: No specific dosage adjustments of venlafaxine are recommended based on patient age. As with any drug, however, caution should be exercised in treating the elderly. When individualizing the dosage, extra care should be taken when increasing the dose.
Maintenance/Continuation/Extended Treatment: The physician should periodically re-evaluate the usefulness of long-term Efexor XR treatment for the individual patient. It is generally agreed that acute episodes of major depression require several months or longer of sustained pharmacologic therapy.
Patients with anxiety often suffer over many years and such patients usually require long-term treatment.
Usually, the dosage for prevention of relapse or for prevention of recurrence of a new episode is similar to that used during initial treatment. Patients should be regularly re-assessed in order to evaluate the benefit of long-term therapy.
Efexor was shown to be efficacious during long-term treatment (up to 12 months in depression and up to 6 months in anxiety).
Discontinuing Efexor XR: Dose tapering is recommended when discontinuing venlafaxine therapy (see Precautions and Adverse Reactions). In clinical trials with venlafaxine extended-release capsule, tapering was achieved by reducing the daily dose by 75 mg at 1-week intervals. The period required for tapering may depend on the dose, duration of therapy and the individual patient.
Administration: It is recommended that Efexor XR be taken with food. Each capsule should be swallowed whole with fluid. Do not divide, crush, chew or dissolve. Efexor XR should be administered once daily at approximately the same time either in the morning or in the evening.
