Venlafaxine side effects benefit, dosage, uses by psychiatrists by Ray Sahelian, M.D.
September 15 2015


Venlafaxine hydrochloride is an antidepressant indicated for the treatment of major depressive disorder. The trade name for venlafaxine is Effexor. Venlafaxine hydrochloride is an antidepressant of the serotonin-norepinephrine reuptake inhibitor (SNRI) class rather than the SSRI class.


Generic Venlafaxine hcl
Venlafaxine, a prescription medication made by Wyeth drug company, became available as a generic drug in August of 2006.  Venlafaxine Tablets 25 mg, 37.5 mg, 50 mg, 75 mg and 100 mg are manufactured by TEVA Pharmaceuticals USA (TEVA) in North Wales, PA. This product will carry the same labeling including the black box warning as the originator drug. TEVA is eligible for 180 days of generic drug exclusivity. The FDA may approve other applications for venlafaxine after the exclusivity period has expired.


Venlafaxine hydrochloride alternative
Supplements and nutrients used for depression include 5HTP, SAM-e, and St. John's wort. For more information on the natural treatment for depression see the page on this topic.


Hot flashes in men with prostate cancer, not effective
J Clin Oncol. 2013. Randomized trial to assess the impact of venlafaxine and soy protein on hot flashes and quality of life in men with prostate cancer. In androgen-deprived men, neither venlafaxine nor soy proved effective in reducing hot flashes


Venlafaxine and suicide risk, adverse reactions

Risk of suicide during treatment with venlafaxine, citalopram, fluoxetine, and dothiepin: retrospective cohort study.
BMJ. 2006; Rubino A, Roskell N, Tennis P, Mines D, Weich S, Andrews E. RTI Health Solutions, Manchester Science Park, Manchester.
To compare the risk of suicide in adults using the antidepressant venlafaxine compared with citalopram, fluoxetine, and dothiepin. 219 088 patients, aged 18-89 years, who were prescribed venlafaxine, citalopram, fluoxetine, or dothiepin from 1995 to 2005. Venlafaxine users had a higher burden of risk factors for suicide, including previous suicide attempts and proxies for severe depression or depression that was difficult to treat. Venlafaxine use was consistently associated with higher risk of suicide compared with citalopram, fluoxetine, and dothiepin. Venlafaxine users had a higher burden of suicide risk factors, however, and adjustment for measured confounders substantially reduced the excess risks. Since the secondary data used in this analysis allowed only indirect and partial measurements of potential confounders, it is possible that residual confounding explains much, if not all, of the observed excess risk.


The use of venlafaxine was not associated with an excess risk of sudden cardiac death or near death compared with fluoxetine, dosulepin, or citalopram, in patients with depression or anxiety. Use of venlafaxine compared with other antidepressants and the risk of sudden cardiac death or near death: a nested case-control study; Martinez C, Assimes TL, Mines D, Dell'aniello S, Suissa S; British Medical Journal (BMJ) 340 c249 (2010)


BMJ Case Rep. Feb 6 2014. Pendular nystagmus associated with venlafaxine overdose: a forme fruste of the serotonin syndrome? We describe a case of pendular nystagmus as a previously unreported side effect of venlafaxine, and speculate to its importance in the recognition of the serotonin syndrome. In particular, we discuss the importance of identifying incomplete forms of the syndrome, such as those presenting with predominantly ocular manifestations, as is in our case.


Prescrire Int. 2015. High-strength venlafaxine: best avoided.


Venlafaxine and pregnancy

It may be safe to avoid venlafaxine during pregnancy unless absolutely required.


Effects of selective serotonin reuptake inhibitors and venlafaxine during pregnancy in term and preterm neonates.
Pediatrics. 2007. Department of Pharmacy, CHU Sainte-Justine, Montreal, Quebec, Canada.
Our goals were to (a) describe neonatal behavioral signs in a group of newborns exposed in utero to selective serotonin reuptake inhibitors or venlafaxine at the time of delivery, (b) compare the rate of neonatal behavioral signs, prematurity, and admission to specialized neonatal care between a group of exposed and unexposed newborns, and (c) compare the effects in exposed preterm and term newborns. This was a retrospective cohort study including mothers taking selective serotonin reuptake inhibitors or venlafaxine during the third trimester and mothers who were not taking any antidepressants, psychotropic agents, or benzodiazepines at the time of delivery of their newborns. Neonatal behavioral signs included central nervous, respiratory, and digestive systems, as well as hypoglycemia and the need for phototherapy. Seventy-six mothers taking antidepressants and 90 untreated mothers and their newborns were analyzed. Smoking, alcohol intake, and substance abuse were more frequent among treated mothers. In infants in the exposed group, signs involving the central nervous and the respiratory systems were often observed (63% and 40%, respectively). These signs appeared during the first day of life, with a median duration of 3 days for exposed newborns. The signs resolved in 75% of cases within 3 to 5 days for term and premature newborns, respectively. All exposed premature newborns presented behavioral manifestations compared with 69% of term exposed newborns. Median length of stay was almost 4 times longer for exposed premature newborns than for those who were unexposed (14 vs 3.7 days). Neonatal behavioral signs were frequently found in exposed newborns, but symptoms were transient and self-limited. Premature infants could be more susceptible to the effects of selective serotonin reuptake inhibitors and venlafaxine.


Cochrane Database Syst Rev. 2013 Jul 17;7:CD004185.Fluoxetine versus other types of pharmacotherapy for depression. The present study detected differences in terms of efficacy and tolerability between fluoxetine and certain ADs, but the clinical meaning of these differences is uncertain.Moreover, the assessment of quality with the risk of bias tool showed that the great majority of included studies failed to report details on methodological procedures. Of consequence, no definitive implications can be drawn from the studies' results. The better efficacy profile of sertraline and venlafaxine (and possibly other ADs) over fluoxetine may be clinically meaningful,as already suggested by other systematic reviews. In addition to efficacy data, treatment decisions should also be based on considerations of drug toxicity, patient acceptability and cost.


Hi Docter, i wonder if you could give me some advice? Im currently taking venaflaxine and have started taking 100mg of sam-e as well, could you please let me know your opinion to whether this safe or not?
    This is a decision you and your doctor need to make. Much depends on the dosages used and a person's overall health and other medications or supplements taken, activity level, sleep patterns, etc. As a general rule it is best to learn how each supplement or medication works by itself.


I am currently taking venlafaxine (Effexor .75 2 times a day). Can I in addition also take Macuna Pruriens supplement? In my opinion, at this point I feel its a dopamine loss rather than serotonin one. If so I will be weaning myself off of the venlafaxine.
   Each person is different in their brain chemistry and how they respond to medications and supplements and the reason for the medication, so it is difficult to know and make an accurate prediction.