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Effexor withdrawal. Effexor withdrawal side effects, Effexor withdrawal warnings, Effexor withdrawal precautions, Effexor withdrawal adverse effects, overdose, withdrawal symptoms and Effexor natural alternatives. Before you begin the spiral down with Effexor, try giving your body what it really wants.

Your patients will be experiencing head symptoms when attempting to discontinue Effexor. Fatigue, nausea and flu like symptoms are also common. At times anxiety and insomnia will be an issue during withdrawal or normal usage of Effexor.

Whether you want your patient to remain on Effexor or discontinue Effexor, they do not have to suffer the ADR's. How to Get Off Effexor, is written for the patient, physician and pharmacists. The book provides the patient a step-by-step process to eliminate the side effects. The AMA acknowledges up to 20% of patients attempting to taper off an antidepressant will not complete the process due to withdrawal side effects. Let's handle the 20% that need to additional help. Click here to read free copy on The Road Back site.

Effexor Withdrawal
Effexor Side Effects

Effexor - Alert from the F.D.A.

FDA ALERT [07/2005]: Suicidal Thoughts or Actions in Children and Adults

Patients with depression or other mental illnesses often think about or attempt suicide. Closely watch anyone taking antidepressants, especially early in treatment or when the dose is changed. Patients who become irritable or anxious, or have new or increased thoughts of suicide or other changes in mood or behavior (or their care givers) should contact their healthcare professional right away.

Children

Taking antidepressants may increase suicidal thoughts and actions in about 1 out of 50 people 18 years or younger. FDA has approved Zoloft for use in children only if they have obsessive-compulsive disorder.

Adults

Several recent scientific publications report the possibility of an increased risk for suicidal behavior in adults who are being treated with antidepressant medications. Even before these reports became available, FDA began a complete review of all available data to determine whether there is an increased risk of suicidal thinking or behavior in adults being treated with antidepressant medications. It is expected that this review will take a year or longer to complete. In the meantime, FDA is highlighting that adults being treated with antidepressant medication, particularly those being treated for depression, should be watched closely for worsening of depression and for increased suicidal thinking or behavior.

This information reflects FDA’s preliminary analysis of data concerning this drug. FDA is considering, but has not reached a final conclusion about, this information. FDA intends to update this sheet when additional information or analyses become available.

Fatal venlafaxine overdose with acinar zone 3 liver cell necrosis.

Shaw MW, Sheard JD.

Department of Cellular Pathology, University Hospital Aintree, Liverpool, UK.

We present a case of fatal venlafaxine overdose in a 34-year-old male with a history of depression and previous suicide attempts. He presented unwell, and his condition deteriorated with the development of rhabdomyocytolysis and renal failure. Although treatment was provided, this was unsuccessful, and he died within a day of his admission. A postmortem examination was performed, and the findings included an acinar zone 3 pattern of liver cell necrosis and a very high level of serum venlafaxine in the deceased. No other elevated drug levels were detected. From this case, it is clear that venlafaxine overdose was the primary cause of a fatal acinar zone 3 pattern of liver cell necrosis. As far as we are aware, this is the first reported case of fatal acinar zone 3 liver necrosis caused by venlafaxine overdose alone.

Serotonin syndrome and rhabdomyolysis in venlafaxine poisoning: a case report.

Hanekamp BB, Zijlstra JG, Tulleken JE, Ligtenberg JJ, van der Werf TS, Hofstra LS.

Intensive and Respiratory Care, Groningen University Medical Centre, Groningen, the Netherlands. b.b.hanekamp@int.umcg.nl

Newer, more selective, antidepressant agents are increasingly being used as first-line treatment. However, clinical experience in patients after a deliberate overdose is limited. We present a case of venlafaxine intoxication complicated by a late rise in creatine kinase, seizures and serotonin syndrome. Rhabdomyolysis prolonged the hospital stay in our patient but had no other serious consequences. Physicians should be aware of this late phenomenon in patients with venlafaxine poisoning.

Severe rhabdomyolysis following venlafaxine overdose.

Pascale P, Oddo M, Pacher P, Augsburger M, Liaudet L.

Division of Critical Care, Department of Internal Medicine, University Hospital, Lausanne 1011, Switzerland.

Venlafaxine is a recently developed serotoninergic antidepressant whose reported toxicity at overdose levels includes central nervous system depression, seizures, and cardiovascular toxicity. The authors now present a case of venlafaxine overdose in a young woman complicated by a rise in plasma creatine kinase activity up to 52,600 U/L. Immediate therapy with intravenous fluids, bicarbonate, and furosemide was administered, and there were no further complications, notably no renal failure. This case supports the notion that venlafaxine can induce direct skeletal muscle toxicity leading to severe rhabdomyolysis. Therefore, clinicians should monitor muscle enzymes in patients with venlafaxine overdose to detect the development of rhabdomyolysis at an early stage and to initiate appropriate therapy rapidly.

Effects of paroxetine and venlafaxine XR on heart rate variability in depression.

Davidson J, Watkins L, Owens M, Krulewicz S, Connor K, Carpenter D, Krishnan R, Nemeroff C.

Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA.

Depressed patients may exhibit reduced heart rate variability (HRV), and antidepressants which block norepinephrine uptake may also lower HRV. This study compared paroxetine (PAR) and venlafaxine XR (VEN-XR) on HRV. Outpatients were randomly assigned to double-blind treatment with PAR up to 40 mg or VEN-XR up to 225 mg daily. HRV measures of parasympathetic control consisted of change in R-R interval during forced 10-second breaths and respiratory sinus arrhythmia (RSA) during paced breathing. Ex vivo estimates of serotonin and norepinephrine transporter occupancy were obtained before and after treatment, as were measures of depression, anxiety, and resilience. Plasma drug concentrations were measured at end point. Forty-nine patients entered treatment; 44 of whom were evaluable (n = 22 per group). Significant within-group reductions were noted in R-R interval variation and in RSA after VEN-XR only. Between-group analyses showed significant group-by-time interaction, with greater reduction in R-R interval variation and in RSA for VEN-XR compared with PAR. Improvement in resiliency correlated significantly with norepinephrine transporter occupancy for VEN-XR. Further comparisons of selective serotonin reuptake inhibitor and serotonin and norepinephrine reuptake inhibitor drugs on HRV are warranted.

Effexor withdrawal Body

Effexor withdrawal Dry Mouth - The usual amount to moisture in the mouth is noticeably less.

Effexor withdrawal Sweating Increased - A large quantity of perspiration that is medically caused.

Effexor withdrawal Cardiovascular (Involving the heart and the blood vessels)

Effexor withdrawal Palpitation - Unusual and not normal heartbeat, that is sometimes irregular, but rapid and forceful thumping or fluttering. It can be brought on by shock, excitement, exertion, or medical stimulants. A person is normally unaware of his/her heartbeat.

Effexor withdrawal Hypertension - is high blood pressure, which is a symptom of disease in the blood vessels leading away from the heart. Hypertension is known as the “silent killer”. The symptoms are usually not obvious, however it can lead to damage to the heart, brain, kidneys and eye, and even to stroke and kidney failure. Treatment includes dietary and lifestyle changes.

Effexor withdrawal Bradycardia - The heart rate is slowed from 72 beats per minute, which is normal, to below 60 beats per minute in an adult.

Effexor withdrawal Tachycardia - The heart rate is speeded up to above 100 beats per minute in an adult. Normal adult heart rate is 72 beats per minute.

Effexor withdrawal ECG Abnormal - A test called an electrocardiogram (ECG) that records the activity of the heart. It measures heartbeats as will as the position and size of the heart’s four chambers. It also measures if there is damage to the heart and the effects of drugs or mechanical devices like a pacemaker on the heart. When the test is abnormal this means that one or more of the following are present: heart disease, defects, beating too fast or too slow, disease of the blood vessels leading from the heart or of the heart valves, and/or a past or about to occur heart attack.

Effexor withdrawal Flushing - The skin all over the body turns red.

Effexor withdrawal Varicose Vein - Unusually swollen veins near the surface of the skin that sometimes appear twisted and knotted, but always enlarged. They are called hemorrhoids when they appear around the rectum. The cause is attributed to hereditary weakness in the veins aggravated by obesity, pregnancy, pressure from standing, aging, etc. Severe cases may develop swelling in the legs, ankles and feet, eczema and/or ulcers in the affected areas.

Effexor withdrawal Gastrointestinal (Involving the stomach and the intestines)

Effexor withdrawal Abdominal Cramp/Pain - Sudden, severe, uncontrollable and painful shortening and thickening of the muscles in the belly. The belly includes the stomach as well as the intestines, liver, kidneys, pancreas, spleen, gall bladder, and urinary bladder.

Effexor withdrawal Belching - Noisy release of gas from the stomach through the mouth; a burp.

Effexor withdrawal Bloating - Swelling of the belly caused by excessive intestinal gas.

Effexor withdrawal Constipation - Difficulty in having a bowel movement where the material in the bowels is hard due to a lack of exercise, fluid intake, and roughage in the diet, or due to certain drugs.

Effexor withdrawal Diarrhea - Unusually frequent and excessive, runny bowel movements that may result in severe dehydration and shock.

Effexor withdrawal Dyspepsia - Indigestion. This is the discomfort you experience after eating. It can be heartburn, gas, nausea, a bellyache or bloating.

Effexor withdrawal Flatulence - More gas than normal in the digestive organs.

Effexor withdrawal Gagging - Involuntary choking and/or involuntary throwing up.

Effexor withdrawal Gastritis - A severe irritation of the mucus lining of the stomach either short in duration or lasting for a long period of time.

Effexor withdrawal Gastroenteritis - A condition where the membranes of the stomach and intestines are irritated.

Effexor withdrawal Gastroesophageal Reflux - A continuous state where stomach juices flow back into the throat causing acid indigestion and heartburn and possibly injury to the throat.

Effexor withdrawal Heartburn - A burning pain in the area of the breastbone caused by stomach juices flowing back up into the throat.

Effexor withdrawal Hemorrhoids - Small rounded purplish swollen veins that either bleed, itch or are painful and appear around the anus.

Effexor withdrawal Increased Stool frequency - Diarrhea.

Effexor withdrawal Indigestion - Unable to properly consume and absorb food in the digestive tract causing constipation, nausea, stomach ache, gas, swollen belly, pain and general discomfort or sickness.

Effexor withdrawal Nausea - Stomach irritation with a queasy sensation similar to motion sickness and a feeling that one is going to vomit.

Effexor withdrawal Polyposis Gastric - Tumors that grow on stems in the lining of the stomach, which usually become cancerous.

Effexor withdrawal Swallowing Difficulty - A feeling that food is stuck in the throat or upper chest area and won’t go down, making it difficult to swallow.

Effexor withdrawal Toothache - Pain in a tooth above and below the gum line.

Effexor withdrawal Vomiting - Involuntarily throwing up the contents of the stomach and usually getting a nauseated, sick feeling just prior to doing so.

Effexor withdrawal General

Effexor withdrawal Allergy - The extreme sensitivity of body tissues triggered by substances in the air, drugs, or foods causing a reaction like sneezing, itching, asthma, hay fever, skin rashes, nausea and/or vomiting.

Effexor withdrawal Anaphylaxis - A violent, sudden, and severe drop in blood pressure caused by a re-exposure to a foreign protein or a second dosage of a drug that may be fatal unless emergency treatment is given right away.

Effexor withdrawal Asthenia - A physically weak condition.

Effexor withdrawal Chest Pains - Severe discomfort in the chest caused by not enough oxygen going to the heart because of narrowing of the blood vessels or spasms.

Effexor withdrawal Chills - Appearing pale while cold and shivering; sometimes with a fever.

Effexor withdrawal Edema of Extremities - Abnormal swelling of the body’s tissue caused by the collection of fluid.

Effexor withdrawal Fall - To suddenly lose your normal standing upright position as if you were shot.

Effexor withdrawal Fatigue - Loss of normal strength so as to not be able to do the usual physical and mental activities.

Effexor withdrawal Fever - Abnormally high body temperature, the normal being 98 degrees Fahrenheit or 37 degrees Centigrade in humans, which is a symptom of disease or disorder in the body. The body is affected by feeling hot, chilled, sweaty, weak and exhausted. If the fever goes too high, death can result.

Effexor withdrawal Hot Flashes - Brief, abnormal enlargement of the blood vessels that causes a sudden heat sensation over the entire body. Women in menopause will sometimes experience this.

Effexor withdrawal Influenza-like Symptoms - Demonstrating irritation of the respiratory tract (organs of breathing) such as a cold, sudden fever, aches and pains, as well as feeling weak and seeking bed rest, which is similar to having the flu.

Effexor withdrawal Leg Pain - A hurtful sensation in the legs that is caused by excessive stimulation of the nerve endings in the legs and results in extreme discomfort.

Effexor withdrawal Malaise - The somewhat unclear feeling of discomfort you get when you start to feel sick.

Effexor withdrawal Pain in Limb - Sudden, sharp and uncontrolled leg discomfort.

Effexor withdrawal Syncope - A short period of light headedness or unconsciousness (black-out) also know as fainting caused by lack of oxygen to the brain because of an interruption in blood flowing to the brain.

Effexor withdrawal Tightness of Chest - Mild or sharp discomfort, tightness or pressure in the chest area (anywhere between the throat and belly). The causes can be mild or seriously life-threatening because they include the heart, lungs and surrounding muscles.

Effexor withdrawal Hemic and Lymphatic Disorders (Involving the blood and the clear fluids in the tissues that contain white blood cells)

Effexor withdrawal Bruise - Damage to the skin resulting in a purple-green-yellow skin coloration that’s caused by breaking the blood vessels in the area without breaking the surface of the skin.

Effexor withdrawal Anemia - A condition where the blood is no longer carrying enough oxygen, so the person looks pale and easily gets dizzy, weak and tired. More severely, a person can end up with an abnormal heart, as well as breathing and digestive difficulties. The causes of anemia are not enough protein in the red blood cells, or missing and chemically destroyed red blood cells, as well as diseased or destroyed bone marrow.

Effexor withdrawal Nosebleed - Blood lost from the part of the face that has the organs of smell and is where the body takes in oxygen.

Effexor withdrawal Hematoma - Broken blood vessels that cause a swelling in an area on the body.

Effexor withdrawal Lymphadenopathy Cervical - The lymph nodes in the neck, which are part of the body’s immune system get swollen and enlarge by reacting to the presence of a drug. The swelling is the result of the white blood cells multiplying in order to fight the invasion of the drug.

Effexor withdrawal Metabolic and Nutritional Disorders (Energy and health)

Effexor withdrawal Arthralgia - Sudden sharp nerve pain in one or more joints.

Effexor withdrawal Arthropathy - Having joint disease or abnormal joints.

Effexor withdrawal Arthritis - Painfully inflamed and swollen joints. The reddened and swollen condition is brought on by a serious injury or shock to the body either from physical or emotional causes.

Effexor withdrawal Back Discomfort - Severe physical distress in the area from the neck to the pelvis along the backbone.

Effexor withdrawal Bilirubin Increased - Bilirubin is a waste product of the breakdown of old blood cells. Bilirubin is sent to the liver to be made water-soluble so it can be eliminated from the body through emptying the bladder. A drug can interfere with or damage this normal liver function creating liver disease.

Effexor withdrawal Decreased Weight - Uncontrolled and measured loss of heaviness or weight.

Effexor withdrawal Gout - A severe arthritis condition that is caused by the dumping of a waste product called uric acid in the tissues and joints. It can become worse and cause the body to develop a deformity after going through stages of pain, inflammation, severe tenderness, and stiffness.

Effexor withdrawal Hepatic Enzymes Increased - An increase in the amount of paired liver proteins that regulate liver processes causing a condition where the liver functions abnormally.

Effexor withdrawal Hypercholesterolemia - Too much cholesterol in the blood cells.

Effexor withdrawal Hyperglycemia - An unhealthy amount of sugar in the blood.

Effexor withdrawal Increased Weight - A concentration and storage of fat in the body accumulating over a period of time caused by unhealthy eating patterns, that can predispose the body to many disorders and diseases.

Effexor withdrawal Jaw Pain - The pain due to irritation and swelling of the nerves associated with the mouth area where it opens and closes just in front of the ear. Some of the symptoms are pain when chewing, head aches, losing your balance, stuffy ears or ringing in the ears, and teeth grinding.

Effexor withdrawal Jaw Stiffness - The result of squeezing and grinding the teeth while asleep that can cause your teeth to deteriorate as well as the muscles and joints of the jaw.

Effexor withdrawal Joint Stiffness - A loss of free motion and easy flexibility where any two bones come together.

Effexor withdrawal Muscle Cramp - When muscles contract uncontrollably without warning and do not relax. The muscles of any of the body’s organs can cramp.

Effexor withdrawal Muscle Stiffness - Tightening of muscles making it difficult to bend.

Effexor withdrawal Muscle Weakness - Loss of physical strength.

Effexor withdrawal Myalgia - A general widespread pain and tenderness of the muscles.

Effexor withdrawal Thirst - A strong, unnatural craving for moisture/water in the mouth and throat.

Effexor withdrawal Nervous System (Sensory channels)

Effexor withdrawal Carpal Tunnel Syndrome - A pinched nerve in the wrist that causes pain, tingling, and numbing.

Effexor withdrawal Coordination Abnormal - A lack of normal, harmonious interaction of the parts of the body when it is in motion.

Effexor withdrawal Dizziness - Losing one’s balance while feeling unsteady and lightheaded which may lead to fainting.

Effexor withdrawal Disequilibrium - Lack of mental and emotional balance.

Effexor withdrawal Faintness - A temporary condition where one is likely to go unconscious and fall.

Effexor withdrawal Headache - A sharp or dull persistent pain in the head

Effexor withdrawal Hyperreflexia - A not normal and involuntary increased response in the tissues connecting the bones to the muscles.

Effexor withdrawal Light-headed Feeling – Uncontrolled and usually brief loss of consciousness caused by lack of oxygen to the brain.

Effexor withdrawal Migraine - Reoccurring severe head pain usually with nausea, vomiting, dizziness, flashes or spots before the eyes, and ringing in the ears

Effexor withdrawal Muscle Contractions Involuntary - Spontaneous and uncontrollable tightening reaction of the muscles caused by electrical impulses from the nervous system.

Effexor withdrawal Muscular Tone Increased - Uncontrolled and exaggeration muscle tension. Muscles are normally partially tensed and this is what gives us muscle tone.

Effexor withdrawal Paresthesia - Burning, prickly, itchy, or tingling skin with no obvious or understood physical cause.

Effexor withdrawal Restless Legs - A need to move the legs without any apparent reason. Sometimes there is pain, twitching, jerking, cramping, burning, or a creepy-crawly sensation associated with the movements. It worsens when a person is inactive and can interrupt one’s sleep so one feels the need to move to gain some relief.

Effexor withdrawal Shaking - Uncontrolled quivering and trembling as if one is cold and chilled.

Effexor withdrawal Sluggishness - Lack of alertness and energy, as well as being slow to respond or perform in life.

Effexor withdrawal Tics - A contraction of a muscle causing a repeated movement not under the control of the person usually on the face or limbs.

Effexor withdrawal Tremor - A nervous and involuntary vibrating or quivering of the body.

Effexor withdrawal Twitching - Sharp, jerky and spastic motion sometimes with a sharp sudden pain.

Effexor withdrawal Vertigo - A sensation of dizziness with disorientation and confusion.

Effexor withdrawal Psychiatric Disorders (Mental and emotional)

Effexor withdrawal Aggravated Nervousness - A progressively worsening, irritated and troubled state of mind.

Effexor withdrawal Agitation - Suddenly violent and forceful, emotionally disturbed state of mind.

Effexor withdrawal Amnesia - Long term or short term, partial or full memory loss created by emotional or physical shock, severe illness, or a blow to the head where the person was caused pain and became unconsciousness.

Effexor withdrawal Anxiety Attack - Sudden and intense feelings of fear, terror, and dread physically creating shortness of breath, sweating, trembling and heart palpitations.

Effexor withdrawal Apathy - Complete lack of concern or interest for things that ordinarily would be regarded as important or would normally cause concern.

Effexor withdrawal Appetite Decreased - Having a lack of appetite despite the ordinary caloric demands of living with a resulting unintentional loss of weight.

Effexor withdrawal Appetite Increased - An unusual hunger causing one to overeat.

Effexor withdrawal Auditory Hallucination - Hearing things without the voices or noises being present.

Effexor withdrawal Bruxism - Grinding and clenching of teeth while sleeping.

Effexor withdrawal Carbohydrate Craving - A drive and craving to eat foods rich in sugar and starches (sweets, snacks and junk foods) that intensifies as the diet becomes more and more unbalanced due to the unbalancing of the proper nutritional requirements of the body.

Effexor withdrawal Concentration Impaired - Unable to easily focus your attention for long periods of time.

Effexor withdrawal Confusion - Not able to think clearly and understand in order to make a logical decision.

Effexor withdrawal Crying Abnormal - Unusual and not normal fits of weeping for short or long periods of time for no apparent reason.

Effexor withdrawal Depersonalization - A condition where one has lost a normal sense of personal identity.

Effexor withdrawal Depression - A hopeless feeling of failure, loss and sadness that can deteriorate into thoughts of death.

Effexor withdrawal Disorientation - A loss of sense of direction, place, time or surroundings as well as mental confusion on personal identity.

Effexor withdrawal Dreaming Abnormal - Dreaming that leaves a very clear, detailed picture and impression when awake that can last for a long period of time and sometimes be unpleasant.

Effexor withdrawal Emotional Lability - Suddenly breaking out in laughter or crying or doing both without being able to control the outburst of emotion. These episodes are unstable as they are caused by things that normally would not have this effect on an individual.

Effexor withdrawal Excitability - Uncontrollably responding to stimuli.

Effexor withdrawal Feeling Unreal - The awareness that one has an undesirable emotion like fear but can’t seem to shake off the irrational feeling. For example, feeling like one is going crazy but rationally knowing that it is not true. The quality of this side effect resembles being in a bad dream and not being able to wake up.

Effexor withdrawal Forgetfulness - Unable to remember what one ordinarily would remember.

Effexor withdrawal Insomnia - Sleeplessness caused by physical stress, mental stress or stimulants such as coffee or medications; it is a condition of being abnormally awake when one would ordinarily be able to fall and remain asleep.

Effexor withdrawal Irritability - Abnormally annoyed in response to a stimulus.

Effexor withdrawal Jitteriness - Nervous fidgeting without an apparent cause.

Effexor withdrawal Lethargy - Mental and physical sluggishness and apathy that can deteriorate into an unconscious state resembling deep sleep. A numbed state of mind.

Effexor withdrawal Libido Decreased - An abnormal loss of sexual energy or desire.

Effexor withdrawal Panic Reaction - A sudden, overpowering, chaotic and confused mental state of terror resulting in being doubt ridden often accompanied with hyperventilation, and extreme anxiety.

Effexor withdrawal Restlessness Aggravated - A constantly worsening troubled state of mind characterized by the person being increasingly nervous, unable to relax, and easily angered.

Effexor withdrawal Somnolence - Feeling sleepy all the time or having a condition of semi-consciousness.

Effexor withdrawal Suicide Attempt - An unsuccessful deliberate attack on one’s own life with the intention of ending it.

Effexor withdrawal Suicidal Tendency - Most likely will attempt to kill oneself.

Effexor withdrawal Tremulousness Nervous - Very jumpy, shaky, and uneasy while feeling fearful and timid. The condition is characterized by thoughts of dreading the future, involuntary quivering, trembling, and feeling distressed and suddenly upset.

Effexor withdrawal Yawning - involuntary opening of the mouth with deep inhalation of air.

Effexor withdrawal Reproductive Disorder Female

Effexor withdrawal Breast Neoplasm - A tumor or cancer, of either of the two milk-secreting organs on the chest of a woman.

Effexor withdrawal Menorrhagia - Abnormally heavy menstrual period or a menstrual flow that has continued for an unusually long period of time.

Effexor withdrawal Menstrual Cramps - Painful, involuntary uterus contractions that women experience around the time of their menstrual period, sometimes causing pain in the lower back and thighs.

Effexor withdrawal Menstrual Disorder - A disturbance or derangement in the normal function of a woman’s menstrual period.

Effexor withdrawal Pelvic Inflammation - The reaction of the body to infectious, allergic, or chemical irritation, which in turn causes tissue irritation, injury, or bacterial infection characterized by pain, redness, swelling, and sometimes loss of function. The reaction usually begins in the uterus and spreads to the fallopian tubes, ovaries, and other areas in the hipbone region of the body.

Effexor withdrawal Premenstrual Syndrome - Various physical and mental symptoms commonly experienced by women of childbearing age usually 2 to 7 days before the start of their monthly period. There are over 150 symptoms including eating binges, behavioral changes, moodiness, irritability, fatigue, fluid retention, breast tenderness, headaches, bloating, anxiety, and depression. The symptoms cease shortly after the period begins, and disappear with menopause.

Effexor withdrawal Spotting Between Menses - Abnormal bleeding between periods. Unusual spotting between menstrual cycles.

Effexor withdrawal RESPIRATORY SYSTEM (Organs involved in breathing)

Effexor withdrawal Asthma - A disease of the breathing system initiated by and allergic reaction or a chemical with repeated attacks of coughing, sticky mucus, wheezing, shortness of breath, and a tight feeling in the chest. The disease can reach a state where it stops a person from exhaling, leading to unconsciousness and death.

Effexor withdrawal Breath Shortness - Unnatural breathing using a lot off effort resulting in not enough air taken in by the body.

Effexor withdrawal Bronchitis - Inflammation of the two main breathing tubes leading from the windpipe to the lungs. The disease is marked with coughing, a low-grade fever, chest pains, and hoarseness, caused by an allergic reaction.

Effexor withdrawal Coughing - A cough is the response to an irritation, such as mucus, that causes the muscles controlling the breathing process to expel air from the lungs suddenly and noisily to keep the air passages free from the irritating material.

Effexor withdrawal Laryngitis - Inflammation of the voice box characterized by hoarseness, sore throat, and coughing. It can be cause by straining the voice or exposure to infectious, allergic or chemical irritation.

Effexor withdrawal Nasal Congestion - The presence of an abnormal amount of fluid in the nose.

Effexor withdrawal Pneumonia Tracheitis - Bacterial infection of the air passageways and lungs that causes redness, swelling and pain in the windpipe. Other symptoms are high fever, chills, pain in the chest, difficulty in breathing, and coughing with mucus discharge.

Effexor withdrawal Rhinitis - Chemical irritation causing pain, redness and swelling in the mucus membranes of the nose.

Effexor withdrawal Sinus Congestion - The mucus-lined areas of the bones in the face that are thought to help warm and moisten air to the nose. These areas become clogged with excess fluid or infected.

Effexor withdrawal Sinus Headache - The abnormal amount of fluid in the hollows of the face bone area especially around the nose. This excess fluid creates pressure, causing pain in the head.

Effexor withdrawal Sinusitis - The body reacting to chemical irritation causing redness, swelling and pain in the area of the hollows in the facial bones especially around the nose.

Effexor withdrawal SKELETAL

Effexor withdrawal Neck/Shoulder Pain - Hurtful sensations of the nerve endings caused by damage to the tissues in the neck and shoulder signaling danger of disease.

Effexor withdrawal SKIN and APPENDAGES DISORDERS (Skin, legs and arms)

Effexor withdrawal Acne - Eruptions of the oils glands of the skin, especially on the face, marked by pimples, blackheads, whiteheads, bumps, and more severely, by cysts and scarring.

Effexor withdrawal Alopecia - The loss of hair or baldness.

Effexor withdrawal Eczema - A severe or continuing skin disease marked by redness, crusting and scaling with watery blisters and itching. It is often difficult to treat and will sometimes go away only to reappear again.

Effexor withdrawal Dermatitis - Generally irritated skin that can be caused by any of a number of irritating things such as parasites, fungus, bacteria, or foreign substances causing an allergic reaction. It is a general inflammation of the skin.

Effexor withdrawal Dry Lips - The lack of normal moisture in the fleshy folds that surround the mouth.

Effexor withdrawal Dry Skin - The lack of normal moisture/oils in the surface layer of the body. The skin is the body’s largest organ.

Effexor withdrawal Folliculitis - Inflammation of a follicle (small body sac) especially a hair follicle. A hair follicle contains the root of a hair.

Effexor withdrawal Furunculosis - Skin boils that show up repeatedly.

Effexor withdrawal Lipoma - A tumor of mostly fat cells that is not health endangering.

Effexor withdrawal Pruritus - Extreme itching of often-undamaged skin.

Effexor withdrawal Rash - A skin eruption or discoloration that may or may not be itching, tingling, burning, or painful. It may be caused by an allergy, an skin irritation, a skin disease.

Effexor withdrawal Skin Nodule - A bulge, knob, swelling or outgrowth in the skin that is a mass of tissue or cells.

Effexor withdrawal SPECIAL SENSES

Effexor withdrawal Conjunctivitis - Infection of the membrane that covers the eyeball and lines the eyelid, caused by a virus, allergic reaction, or an irritating chemical. It is characterized by redness, a discharge of fluid and itching.

Effexor withdrawal Dry Eyes - Not enough moisture in the eyes.

Effexor withdrawal Earache - Pain in the ear.

Effexor withdrawal Eye Infection - The invasion of the eye tissue by a bacteria, virus, fungus, etc, causing damage to the tissue, with toxicity. Infection spreading in the body progresses into disease.

Effexor withdrawal Eye Irritation - An inflammation of the eye.

Effexor withdrawal Metallic Taste - A range of taste impairment from distorted taste to a complete loss of taste.

Effexor withdrawal Pupils Dilated - Abnormal expansion of the blace circular opening in the center of the eye.

Effexor withdrawal Taste alteration - Abnormal flavor detection in food.

Effexor withdrawal Tinnitus - A buzzing, ringing, or whistling sound in one or both ears occurring from the internal use of certain drugs.

Effexor withdrawal Vision Abnormal - Normal images are seen differently by the viewer.

Effexor withdrawal Vision Blurred - Eyesight is dim or indistinct and hazy in outline or appearance.

Effexor withdrawal Visual Disturbance - Eyesight is interfered with or interrupted. Some disturbances are light sensitivity and the inability to easily distinguish colors.

Effexor withdrawal URINARY SYSTEM DISORDER

Effexor withdrawal Blood in Urine - Blood is present when one empties liquid waste product of the kidneys through the bladder by urinating in the toilet turning the water pink to bright red. Or you could see pots of blood in the water after urinating.

Effexor withdrawal Dysuria - Difficult or painful urination.

Effexor withdrawal Kidney Stone - Small hard masses of salt deposits that the kidney forms.

Effexor withdrawal Urinary Frequency - Having to urinate more often than usual or between unusually short time periods.

Effexor withdrawal Urinary Tract Infection - An invasion of bacteria, viruses, fungi, etc., of the system in the body that starts with the kidneys and eliminates urine from the body. If the invasion goes unchecked it can injure tissue and progress into disease.

Effexor withdrawal Urinary Urgency - A sudden compelling urge to urinate, accompanied by discomfort in the bladder.

Effexor withdrawal UROGENITAL (Urinary tract and genital structures or functions)

Effexor withdrawal Anorgasmia - Failure to experience an orgasm.

Effexor withdrawal Ejaculation Disorder - Dysfunction of the discharge of semen during orgasm.

Effexor withdrawal Menstrual Disorder - Dysfunction of the discharge during the monthly menstrual cycle.

Effexor withdrawal Acute Renal Failure - The kidneys stop functioning properly to excrete wastes.

Effexor withdrawal Angioedema - Intensely itching and swelling welts on the skin called hives caused by an allergic reaction to internal or external agents. The reaction is common to a food or a drug. Chronic cases can last for a long period of time.

Effexor withdrawal Toxic Epidermal Necrolysis - An abnormal condition where a large portion of skin becomes intensely red and peels off like a second-degree burn. Often the symptoms include blistering.

Effexor withdrawal Gastrointestinal Hemorrhage - Stomach and intestinal excessive internal bleeding.

Effexor withdrawal Grand Mal Seizures (or Convulsions) - A recurring sudden violent and involuntary attack of muscle spasms with a loss of consciousness.

Effexor withdrawal Neuroleptic Malignant Syndrome - A life threatening, rare reaction to an anti-psychotic drug marked by fever, muscular rigidity, changed mental status, and dysfunction of the autonomic nervous system.

Effexor withdrawal Pancreatitis - Chemical irritation with redness, swelling, and pain in the pancreas where digestive enzymes and hormones are secreted.

Effexor withdrawal QT Prolongation - A very fast heart rhythm disturbance that is too fast for the heart to beat effectively so the blood to the brain falls causing a sudden loss of consciousness and may cause sudden cardiac death.

Effexor withdrawal Rhabdomyolysis - The breakdown of muscle fibers that releases the fibers into the circulatory system. Some of the fibers are poisonous to the kidney and frequently result in kidney damage.

Effexor withdrawal Serotonin Syndrome - A disorder brought on by excessive levels of serotonin caused by drugs and can be fatal as death from this side effect can come very rapidly.

Effexor withdrawal Thrombocytopenia - An abnormal decrease in the number of blood platelets in the circulatory system. A decrease in platelets would cause a decrease in the ability of the blood to clot when necessary.

Effexor withdrawal Torsades de Pointes - Unusual rapid heart rhythm starting in the lower heart chambers. If the short bursts of rapid heart rhythm continue for a prolonged period it can degenerate into a more rapid rhythm and can be fatal.

Effexor Clinical Trials

Duloxetine: a review of its use in the treatment of generalized anxiety disorder.

Carter NJ, McCormack PL.

CNS Drugs. 2009;23(6):523-41. doi: 10.2165/00023210-200923060-00006.

Effexor Withdrawal Effexor Side Effects: 19480470 [Effexor - in process]

[Horner's syndrome unmasked by venlafaxine]

Mingo-Botín D, Ancochea G, Muñoz-Negrete FJ, Rebolleda-Fernández G.

Rev Neurol. 2009 Jun 1-15;48(11):612-3. Spanish. No abstract available.

Effexor Withdrawal Effexor Side Effects: 19472162 [Effexor - in process]

Impaired detrusor contractility due to venlafaxine use.

Torgovnick J, Sethi NK, Sethi PK, Arsura E.

Indian J Urol. 2008 Oct;24(4):581-2. No abstract available.

Effexor Withdrawal Effexor Side Effects: 19468526 [Effexor - in process]

Venlafaxine treatment stimulates expression of BDNF protein in frontal cortex and inhibits LTP in hippocampus.

Cooke JD, Grover LM, Spangler PR.

Neuroscience. 2009 May 20. [Epub ahead of print]

Effexor Withdrawal Effexor Side Effects: 19464349 [Effexor - as supplied by publisher]

Maternal use of venlafaxine near term: correlation between neonatal effects and plasma concentrations.

Boucher N, Koren G, Beaulac-Baillargeon L.

Ther Drug Monit. 2009 Jun;31(3):404-9.

Effexor Withdrawal Effexor Side Effects: 19455083 [Effexor - in process]

Mirtazapine: a review of its use in major depression and other psychiatric disorders.

Croom KF, Perry CM, Plosker GL.

CNS Drugs. 2009;23(5):427-52. doi: 10.2165/00023210-200923050-00006.

Effexor Withdrawal Effexor Side Effects: 19453203 [Effexor - in process]

Placental transfer of SSRI and SNRI antidepressants and effects on the neonate.

Rampono J, Simmer K, Ilett KF, Hackett LP, Doherty DA, Elliot R, Kok CH, Coenen A, Forman T.

Pharmacopsychiatry. 2009 May;42(3):95-100. Epub 2009 May 18.

Effexor Withdrawal Effexor Side Effects: 19452377 [Effexor - in process]

Predictors of nonresponse to cognitive behavioural therapy or venlafaxine using glucose metabolism in major depressive disorder.

Konarski JZ, Kennedy SH, Segal ZV, Lau MA, Bieling PJ, McIntyre RS, Mayberg HS.

J Psychiatry Neurosci. 2009 May;34(3):175-80.

Effexor Withdrawal Effexor Side Effects: 19448846 [Effexor - in process]

Depression in children and adolescents.

Hazell P.

Clin Evid (Online). 2009 Jan 7;2009. pii: 1008.

Effexor Withdrawal Effexor Side Effects: 19445770 [Effexor - in process]

10:

Fabrication of Triple-Layer Matrix Tablets of Venlafaxine Hydrochloride Using Xanthan Gum.

Gohel MC, Bariya SH.

AAPS PharmSciTech. 2009 May 15. [Epub ahead of print]

Effexor Withdrawal Effexor Side Effects: 19444618 [Effexor - as supplied by publisher]

11:

[Venlafaxine-induced cholestatic hepatitis.]

Collados Arroyo V, Hallal H, Rodrigo Agudo JL, Plaza Aniorte J.

Gastroenterol Hepatol. 2009 May;32(5):382-383. Epub 2009 May 13. Spanish. No abstract available.

Effexor Withdrawal Effexor Side Effects: 19442411 [Effexor - as supplied by publisher]

12:

Melatonin receptor agonist agomelatine: a new drug for treating unipolar depression.

Bourin M, Prica C.

Curr Pharm Des. 2009;15(14):1675-82.

Effexor Withdrawal Effexor Side Effects: 19442180 [Effexor - in process]

13:

Treatment-emergent sexual dysfunction related to antidepressants: a meta-analysis.

Serretti A, Chiesa A.

J Clin Psychopharmacol. 2009 Jun;29(3):259-66.

Effexor Withdrawal Effexor Side Effects: 19440080 [Effexor - in process]

14:

Effect of Date of Drug Marketing on Disproportionality Measures in Pharmacovigilance: The Example of Suicide with SSRIs Using Data From the UK MHRA.

Pariente A, Daveluy A, Laribière-Bénard A, Miremont-Salame G, Begaud B, Moore N.

Drug Saf. 2009;32(5):441-7. doi: 10.2165/00002018-200932050-00007.

Effexor Withdrawal Effexor Side Effects: 19419238 [Effexor - in process]

15:

Nontricyclic antidepressants for neuropathic pain #187.

Hawley P.

J Palliat Med. 2009 May;12(5):476-7.

Effexor Withdrawal Effexor Side Effects: 19416046 [Effexor - in process]

16:

Sociodemographic correlates of antidepressant utilisation in Australia.

Page AN, Swannell S, Martin G, Hollingworth S, Hickie IB, Hall WD.

Med J Aust. 2009 May 4;190(9):479-83.

Effexor Withdrawal Effexor Side Effects: 19413517 [Effexor - in process]

17:

Antidepressant switching among adherent patients treated for depression.

Marcus SC, Hassan M, Olfson M.

Psychiatr Serv. 2009 May;60(5):617-23.

Effexor Withdrawal Effexor Side Effects: 19411348 [Effexor - in process]

18:

Aripiprazole augmentation in major depressive disorder: a double-blind, placebo-controlled study in patients with inadequate response to antidepressants.

Berman RM, Fava M, Thase ME, Trivedi MH, Swanink R, McQuade RD, Carson WH, Adson D, Taylor L, Hazel J, Marcus RN.

CNS Spectr. 2009 Apr;14(4):197-206.

Effexor Withdrawal Effexor Side Effects: 19407731 [Effexor - in process]

19:

Antidepressants at Environmentally Relevant Concentrations Affect Predator Avoidance Behavior of Larval Fathead Minnows (Pimephales promelas).

Painter MM, Buerkley MA, Julius ML, Vajda AM, Norris DO, Barber LB, Furlong ET, Schultz MM, Schoenfuss HL.

Environ Toxicol Chem. 2009 Apr 30:1. [Epub ahead of print]

Effexor Withdrawal Effexor Side Effects: 19405782 [Effexor - as supplied by publisher]

20:

Venlafaxine-induced complex visual hallucinations in a 17-year-old boy.

Jacob MK, Ash P.

J Clin Psychiatry. 2009 Apr;70(4):601-3. No abstract available.

Effexor Withdrawal Effexor Side Effects: 19403099 [Effexor - in process]

21:

[Severe forms of depression: The efficacy of escitalopram.]

Spadone C.

Encephale. 2009 Apr;35(2):152-9. Epub 2009 Mar 31. French.

Effexor Withdrawal Effexor Side Effects: 19393384 [Effexor - in process]

22:

Rapid and reliable genotyping procedure for detection of alleles with mutations, deletion, or/and duplication of the CYP2D6 gene.

Arneth B, Shams M, Hiemke C, Härtter S.

Clin Biochem. 2009 Apr 22. [Epub ahead of print]

Effexor Withdrawal Effexor Side Effects: 19393232 [Effexor - as supplied by publisher]

23:

In vitro and in vivo reproduction toxicology of 12 monoaminergic reuptake inhibitors: Possible mechanisms of infrequent cardiovascular anomalies.

Sloot WN, Bowden HC, Yih TD.

Reprod Toxicol. 2009 Apr 19. [Epub ahead of print]

Effexor Withdrawal Effexor Side Effects: 19383541 [Effexor - as supplied by publisher]

24:

Dose-finding study of fluoxetine and venlafaxine for the treatment of self-injurious and stereotypic behavior in rhesus macaques (Macaca mulatta).

Fontenot MB, Musso MW, McFatter RM, Anderson GM.

J Am Assoc Lab Anim Sci. 2009 Mar;48(2):176-84.

Effexor Withdrawal Effexor Side Effects: 19383215 [Effexor - indexed for Effexor Withdrawal Effexor Side Effects]

25:

Acute tamoxifen-induced depression and its prevention with venlafaxine.

Bourque F, Karama S, Looper K, Cohen V.

Psychosomatics. 2009 Mar-Apr;50(2):162-5.

Effexor Withdrawal Effexor Side Effects: 19377026 [Effexor - in process]

26:

Postpartum depression co-occurring with lactation-related osteoporosis.

Ozcelik B, Ozcelik A, Debre M.

Psychosomatics. 2009 Mar-Apr;50(2):155-8.

Effexor Withdrawal Effexor Side Effects: 19377024 [Effexor - in process]

27:

Insomnia in patients with depression: some pathophysiological and treatment considerations.

Jindal RD.

CNS Drugs. 2009;23(4):309-29. doi: 10.2165/00023210-200923040-00004.

Effexor Withdrawal Effexor Side Effects: 19374460 [Effexor - in process]

28:

Escitalopram versus other antidepressive agents for depression.

Cipriani A, Santilli C, Furukawa TA, Signoretti A, Nakagawa A, McGuire H, Churchill R, Barbui C.

Cochrane Database Syst Rev. 2009 Apr 15;(2):CD006532.

Effexor Withdrawal Effexor Side Effects: 19370639 [Effexor - in process]

29:

Improvement of cognition in a patient with Cotard's delusions and frontotemporal atrophy receiving electroconvulsive therapy (ECT) for depression.

Fàzzari G, Benzoni O, Sangaletti A, Bonera F, Nassini S, Mazzarini L, Pacchiarotti I, Sani G, Koukopoulos AE, Sanna L, Gasparotti R, De Rossi P, Lazanio S, Savoja V, Girardi P.

Int Psychogeriatr. 2009 Jun;21(3):600-3. Epub 2009 Apr 16.

Effexor Withdrawal Effexor Side Effects: 19368757 [Effexor - in process]

30:

Treatment with venlafaxine in six cases of children with narcolepsy and with cataplexy and hypnagogic hallucinations.

Møller LR, Østergaard JR.

J Child Adolesc Psychopharmacol. 2009 Apr;19(2):197-201.

Effexor Withdrawal Effexor Side Effects: 19364297 [Effexor - in process]

31:

A double-blind, placebo-controlled, parallel-group, flexible-dose study of venlafaxine extended release capsules in adult outpatients with panic disorder.

Liebowitz MR, Asnis G, Mangano R, Tzanis E.

J Clin Psychiatry. 2009 Apr;70(4):550-61. Epub 2009 Apr 7.

Effexor Withdrawal Effexor Side Effects: 19358784 [Effexor - in process]

32:

Chronic post-surgical pain.

Akkaya T, Ozkan D.

Agri. 2009 Jan;21(1):1-9. Review.

Effexor Withdrawal Effexor Side Effects: 19357994 [Effexor - indexed for Effexor Withdrawal Effexor Side Effects]

33:

Desvenlafaxine: a new antidepressant or just another one?

Pae CU.

Expert Opin Pharmacother. 2009 Apr;10(5):875-87.

Effexor Withdrawal Effexor Side Effects: 19351235 [Effexor - in process]

34:

Comparison of the antidepressant effects of venlafaxine and dosulepin in a naturalistic setting.

Bukh JD, Jørgensen MB, Dam H, Plenge P.

Nord J Psychiatry. 2009 Apr 6:1-5. [Epub ahead of print]

Effexor Withdrawal Effexor Side Effects: 19347769 [Effexor - as supplied by publisher]

35:

Teenaged, depressed, and treatment resistant: what predicts self-harm?

Weissman MM.

Am J Psychiatry. 2009 Apr;166(4):385-7. No abstract available.

Effexor Withdrawal Effexor Side Effects: 19339360 [Effexor - indexed for Effexor Withdrawal Effexor Side Effects]

36:

Duloxetine in the treatment of generalized anxiety disorder.

Norman TR, Olver JS.

Neuropsychiatr Dis Treat. 2008 Dec;4(6):1169-80.

Effexor Withdrawal Effexor Side Effects: 19337457 [Effexor - in process]

Venlafaxine
Brand name (Effexor)

Pharmacology

Antidepressant

Venlafaxine is a phenethylamine bicyclic derivative, chemically unrelated to tricyclic, tetracyclic or other available antidepressant agents.

The mechanism of venlafaxine's antidepressant action in humans is believed to be associated with its potentiation of neurotransmitter activity in the CNS. Preclinical studies have shown that venlafaxine and its major metabolite, O-desmethylvenlafaxine (ODV), are potent inhibitors of neuronal serotonin and norepinephrine reuptake and weak inhibitors of dopamine reuptake.

Venlafaxine and ODV have no significant affinity for muscarinic, histaminergic, or alpha1-adrenergic receptors in vitro. Pharmacologic activity at these receptors is hypothesized to be associated with the various anticholinergic, sedative, and cardiovascular effects seen with other psychotropic drugs. Venlafaxine and ODV do not possess monoamine oxidase (MAO) inhibitory activity.

Pharmacokinetics:
Venlafaxine is well absorbed, with peak plasma concentrations occurring approximately 2 hours after dosing. Venlafaxine is extensively metabolized, with O-desmethylvenlafaxine, (ODV, the only major active metabolite) peak plasma levels occurring approximately 4 hours after dosing. Following single doses of 25 to 75 mg, mean (+/- SD) peak plasma concentrations of venlafaxine range from 34+/-14 to 96+/-43 ng/mL, respectively, and are reached in 2+/-1 hours, and mean peak ODV plasma concentrations range from 58+/-18 to 178+/-40 ng/mL and are reached in 4+/-2 hours. Approximately 87% of a single dose of venlafaxine is recovered in the urine within 48 hours as either unchanged venlafaxine (5%), unconjugated ODV (30%), conjugated ODV (26%), or other minor metabolites (27%).

Multiple-Dose Pharmacokinetic Profile:
Steady-state concentrations of both venlafaxine and ODV in plasma were attained after approximately 3 days of multiple dose therapy. The clearance of venlafaxine is slightly (15%) lower following multiple doses than following a single dose.

Venlafaxine and ODV exhibited linear kinetics over the dose range of 75 to 450 mg total daily dose administered t.i.d.

The mean +/- SD steady-state plasma clearances of venlafaxine and ODV are 1.3+/-0.6 and 0.4+/-0.2 L/h/kg, respectively; elimination half-life is 5+/-2 and 11+/-2 hours, respectively.

Venlafaxine and ODV renal clearances are 49+/-27 and 94+/-56 mL/h/kg, respectively, which correspond to 5+/-3.0% and 25+/-13% of an administered venlafaxine dose recovered in urine as venlafaxine and ODV, respectively. Similar steady-state volumes of distribution are exhibited for venlafaxine (7+/-4 L/kg) and ODV (6+/-2 L/kg).

Venlafaxine and ODV are less than 35% bound to plasma proteins. Therefore, protein-binding-induced drug interactions with venlafaxine are not expected.

Food has no significant effect on the absorption of venlafaxine.

When equal daily doses of venlafaxine were administered either b.i.d. or t.i.d., drug exposure (AUC) and fluctuation in plasma levels were comparable.

Age and Gender:
Age and sex do not significantly affect the pharmacokinetics of venlafaxine. A 20% reduction in clearance was noted for ODV in subjects over 60 years old; this was possibly caused by the decrease in renal function that typically occurs with aging. Dosage adjustment based upon age or gender is generally not necessary (See Dosage).

Hepatic Disease:
In 9 patients with hepatic cirrhosis, the pharmacokinetic disposition of both venlafaxine and ODV were significantly altered. Venlafaxine elimination half-life was prolonged by about 30%, and clearance was decreased by about 50%. ODV elimination half-life was also prolonged (by about 60%) and its clearance decreased by about 30%. Three patients with more severe cirrhosis had a 90% decrease in venlafaxine clearance. Dosage adjustment is necessary in patients with liver disease (See Dosage).

Renal Disease:
In patients with moderate to severe impairment of renal function (GFR=10-70 mL/min), venlafaxine elimination half-life was prolonged by 50%, and clearance was deceased by about 24%. ODV elimination half-life was prolonged by about 40%, but clearance was unchanged. In dialysis patients, venlafaxine elimination half-life was prolonged by about 180% and clearance was decreased by about 56%. Dosage adjustment is necessary in patients with renal disease (See Dosage).

Indications

For the symptomatic relief of depressive illness.

The effectiveness of venlafaxine in long-term use (i.e., for more than 4 to 6 weeks) has not been systematically evaluated in controlled trials. Therefore, the physician who elects to use venlafaxine for extended periods should periodically reevaluate the long-term usefulness of the drug for the individual patient.

Contraindications

Patients with known hypersensitivity to venlafaxine or to any of the components of the formulation.

MAO Inhibitors:
There have been reports of serious, sometimes fatal reactions in patients receiving antidepressants with pharmacological properties similar to those of venlafaxine in combination with a MAO inhibitor. Therefore, venlafaxine should not be used in combination with MAO inhibitors or within two weeks of terminating treatment with MAO inhibitor's. Treatment with MAO inhibitors should not be started until two weeks after discontinuation of venlafaxine therapy.

Warnings

Sustained Hypertension:
Treatment with venlafaxine was associated with modest but sustained increases in blood pressure during premarketing studies. Sustained hypertension, defined as treatment-emergent supine diastolic blood pressure (SDBP) >= 90 mm Hg and 10 mm Hg above baseline for 3 consecutive visits, showed the following incidence and dose-relationship in Table I.

-----------------------------------------------
Table I
Probability of Sustained Elevation in SDBP
(Pool of Premarketing Studies with venlafaxine)
-----------------------------------------------
Treatment Group     Incidence of Sustained
                      Elevation in SDBP
-----------------------------------------------
Venlafaxine
      <100 mg/day                3%
   101-200 mg/day             5%
   201-300 mg/day             7%
      >300 mg/day              13%
        Placebo                      2%
-----------------------------------------------

An analysis of the blood pressure increases in patients with sustained hypertension and in the 19 patients who were discontinued from treatment because of hypertension (<1% of total venlafaxine-treated group) showed that most of the blood pressure increases were in the range of 10 to 15 mm Hg, SDBP. Since in individual patients sustained increases of this magnitude could have adverse consequences, it is recommended that patients receiving venlafaxine have their blood pressure monitored regularly.

For patients who experience a sustained increase in blood pressure during treatment with venlafaxine, either a dose reduction or discontinuation of venlafaxine should be considered.

Precautions

General:
Suicide:
The possibility of a suicide attempt in seriously depressed patients is inherent to the illness and may persist until significant remission occurs. Close supervision of high-risk patients should accompany initial drug therapy, and consideration should be given to the need for hospitalization. In order to reduce the risk of overdose, prescriptions for venlafaxine should be written for the smallest quantity of tablets consistent with good patient management.

Seizures:
During premarketing testing, seizures were reported in 8 out of 3082 venlafaxine-treated patients (0.26%). In 5 of the 8 cases, patents were receiving doses of 150 mg/day or less. However, patients with a history of convulsive disorders were excluded from most of these studies. venlafaxine should be used cautiously in patents with a history of seizures, and should be promptly discontinued in any patient who develops seizures.

Activation of Mania/Hypomania:
During Phase II and III trials, mania or hypomania occurred in 0.5% of venlafaxine-treated patients. Activation of mania/hypomania has also been reported in a small proportion of patients with major affective disorder who were treated with other marketed antidepressants. As with all antidepressants, venlafaxine should be used cautiously in patients with a history of mania.

Patients with Concomitant Illness:
Clinical experience with venlafaxine in patients with concomitant systemic illness is limited. Caution is advised in administering venlafaxine to patients with diseases or conditions that could affect hemodynamic responses or metabolism. Patients should be questioned about any prescripton or "over the counter drugs" that they are taking, or planning to take, since there is a potential for interactions.

Cardiac Disease:
Venlafaxine has not been evaluated or used to any appreciable extent in patients with a recent history of myocardial infarction or unstable heart disease. Patients with these diagnoses were systematically excluded from many clinical studies during the product's clinical trials. Evaluation of the electrocardiograms for 769 patients who received venlafaxine in 4- to 6 week double-blind trials showed that the incidence of trial-emergent conduction abnormalities did not differ from that with placebo. The mean heart rate was increased by about 4 beats per minute during treatment. Venlafaxine treatment has been associated with sustained hypertension (see Warnings).

Hepatic and Renal Disease:
In patients with hepatic or renal disease the pharmacokinetic disposition of both venlafaxine and ODV are significantly altered. Dosage adjustment is necessary in these patients (See Dosage).

Occupational Hazards:
Any psychoactive drug may impair judgement, thinking or motor skills. Therefore, patients should be cautioned about operating hazardous machinery, including automobiles, until they are reasonably certain that the drug treatment does not affect them adversely.

Pregnancy, Labor and Delivery:
There are no adequate and well controlled studies with venlafaxine in pregnant women. Therefore, venlafaxine should only be used during pregnancy if clearly needed.

Lactation:
It is not known whether venlafaxine or its metabolites are excreted in human milk. Because many drugs are excreted in human milk, lactating women should not nurse their infants while receiving venlafaxine.

Children:
Safety and efficacy in children below the age of 18 have not been established.

Geriatrics:
Of the 2,897 patients in Phase II and III trials, 357 (12%) were 65 years of age or older. No overall differences in effectiveness and safety were observed between these patients and younger patients. However, greater sensitivity of some older individuals cannot be ruled out.

Discontinuation Symptoms:
While the discontinuation effects of venlafaxine have not been systematically evaluated in controlled clinical trials, a retrospective survey of new events occurring during taper or following discontinuation revealed the following six events that occurred at an incidence of at least 5%, and for which the incidence for venlafaxine was at least twice the placebo incidence: asthenia, dizziness, headache, insomnia, nausea and nervousness. Therefore, it is recommended that the dosage be tapered gradually and the patient monitored (See Dosage).

Drug Interactions:
As with all drugs, the potential for interaction by a variety of mechanisms is a possibility.

Lithium:
The steady-state pharmacokinetics of venlafaxine administered as 50 mg every 8 hours was not affected when a single 600 mg oral dose of lithium was administered to 12 healthy male subjects. Venlafaxine had no effect on the pharmacokinetics of lithium. It should be noted that the venlafaxine dose was in the low end of the therapeutic dosage, as was the single lithium dose. The potential interaction of venlafaxine and lithium in clinical practice is unknown.

Diazepam:
The steady-state pharmacokinetics of venlafaxine administered as 50 mg every 8 hours was not affected when a single 10 mg oral dose of diazepam was administered to 18 healthy male subjects. Venlafaxine had no effect on the pharmacokinetics of diazepam or its active metabolite, desmethyidiazepam. It should be noted that the venlafaxine dose was in the low end of the therapeutic dosage, as was the single diazepam dose. The potential interaction of venlafaxine and diazepam in clinical practice is unknown.

Cimetidine:
Concomitant administration of cimetidine and venlafaxine in a steady-state study for both drugs in 18 healthy male subjects resulted in inhibition of first-pass metabolism of venlafaxine. The oral clearance of venlafaxine was reduced by about 43%, and the exposure (AUC) and maximum concentration (Cmax) of the drug were increased by about 60%. However, there was no effect on the pharmacokinetics of ODV. The overall pharmacological activity of venlafaxine plus ODV is expected to rise only slightly, and no dosage adjustment should be necessary for most subjects.

However, for patients with pre-existing hypertension, for elderly patients and for patients with hepatic or renal dysfunction, the interaction associated with the concomitant use of cimetidine and venlafaxine is not known and potentially could be more pronounced. Therefore, caution is advised in these patients.

Other CNS-Active Drugs:
The risk of using venlafaxine in combination with other CNS-active drugs (including alcohol) has not been systematically evaluated. Consequently, caution is advised if the concomitant administration of venlafaxine and such drugs is required.

Electroconvulsive Therapy:
There are no clinical data on the use of electroconvulsive therapy combined with venlafaxine treatment.

Cytochrome P450 IID6:
Venlafaxine is metabolized to its active metabolite, ODV, by cytochrome P450 IID6 Therefore, the potential exists for a drug interaction between venlafaxine and drugs that inhibit cytochrome P450-IID6 metabolism. Venlafaxine is a relatively weak inhibitor of cytochrome P450 IID6, however, the clinical significance of this finding is unknown.

Drug Abuse and Dependence:
Physical and Psychological Dependence:
In vitro studies revealed that venlafaxine has virtually no affinity for opiate, benzodiazepine, phencyclidine (PCP), or N-methyl-D-aspartic acid (NMDA) receptors. It has no significant CNS stimulant activity in rodents. In primate drug discrimination studies, venlafaxine showed no significant stimulant or depressant abuse liability.

While venlafaxine has not been systematically studied in clinical trials for its potential for abuse, there was no indication of drug-seeking behaviour in the clinical trials. However, it is not possible to predict on the basis of premarketing experience the extent to which a CNS active drug will be misused, diverted, and/or abused once marketed. Consequently, physicians should carefully evaluate patients for history of drug abuse and follow such patients closely, observing them for signs of misuse or abuse of venlafaxine (e.g., development of tolerance incrementation of dose, drug-seeking behaviour).

Adverse Effects

Commonly Observed Adverse Reactions:
The most commonly observed adverse events associated with the use of venlafaxine (incidence of 5% or greater) and not seen at an equivalent incidence among placebo-treated patients (i.e., incidence for venlafaxine at least twice that for placebo), derived from the 1% incidence Table III, were asthenia, sweating, nausea, constipation, anorexia, vomiting, somnolence, dry mouth, dizziness nervousness, anxiety, tremor, blurred vision, and abnormal ejaculation/orgasm and impotence in men.

Adverse Reactions Associated with Discontinuation of Treatment:
Nineteen percent (537/2897) of venlafaxine-treated patients in Phase II and III depression studies discontinued treatment due to an adverse reaction (see Table II). The more common events (>=1%) associated with discontinuation of treatment and considered to be drug-related (i.e., those events associated with dropout at a rate approximately twice or greater for venlafaxine compared to placebo) included Table II.

---------------------------------------------------------------
Table II
Adverse Reactions Associated with Discontinuation of Treatment
---------------------------------------------------------------
                      Venlafaxine   Placebo
---------------------------------------------------------------
CNS
  Somnolence              3%           1%
  Insomnia                    3%           1%
  Dizziness                   3%           --
  Nervousness             2%           --
  Dry Mouth                  2%           --
  Anxiety                       2%           1%
Gastrointestinal
  Nausea                      6%           1%
Urogenital
  Abnormal Ejaculation*   3%           --
Other
  Headache                  3%           1%
  Asthenia                    2%           --
 Sweating                    2%           --

 *  percentages based on the number of males.
 -- Less than 1%
---------------------------------------------------------------

Incidence in Controlled Trials:
Table III that follows enumerates adverse events that occurred at an incidence of 1% or more, and were more frequent than in the placebo group, among venlafaxine-treated patients who participated in 4- to 8-week placebo-controlled trials in which patients were administered doses in the range of 75 to 375 mg/day. Reported adverse events were classified using a standard COSTART-based Dictionary terminology.

Dose Dependency of Adverse Events:
A comparison of adverse event rates in a fixed-dose study comparing Effexor 75, 225, and 375 mg/day with placebo revealed a dose dependency for some of the more common adverse events associated with Effexor use, as shown in Table IV. The rule for including events was to enumerate those that occurred at an incidence of 5% or more for at least one of the venlafaxine groups and for which the incidence was at least twice the placebo incidence for at least one Effexor group. Tests for potential dose relationships for these events (Cochran-Armitage Test, with a criterion of exact 2-sided p-value <= 0.05) suggested a dose-dependency for several adverse events in this list, including chills, hypertension, anorexia, nausea, agitation, dizziness, somnolence, tremor, yawning, sweating, and abnormal ejaculation .

-------------------------------------------------------------------------
Table III
Treatment-Emergent Adverse Experience Incidence in 4-to 8-Week
Placebo-Controlled Clinical Trials (Percentage)
-------------------------------------------------------------------------
                                             Effexor   Placebo
Body System          Preferred Term          (n=1033)  (n=609)
-------------------------------------------------------------------------
Body as a whole      
                  Headache                    25        24
                     Asthenia                    12         6
                     Infection                       6         5
                     Chills                            3        --
                     Chest Pain                  2         1
                     Trauma                        2         1

Cardiovascular       
                  Vasodilatation               4         3
                     Increased blood/pressure
                       hypertension             2        --
                     Tachycardia                2        --
                     Postural hypotension 1        --

Dermatological       
                Sweating                    12         3
                     Rash                         3         2
                     Pruritus                     1        --

Gastrointestinal     
                     Nausea                   37        11
                     Constipation          15         7
                     Anorexia                 11         2
                     Diarrhoea                 8         7
                     Vomiting                   6         2
                     Dyspepsia                5         4
                     Flatulence                 3         2

Metabolic            
                  Weight loss                  1        --

Nervous              
                     Somnolence             23         9
                     Dry mouth                 22        11
                     Dizziness                  19         7
                     Insomnia                   18        10
                     Nervousness            13         6
                     Anxiety                        6         3
                     Tremor                        5         1
                     Abnormal Dreams     4         3
                     Hypertonia                  3         2
                     Paraesthesia              3         2
                     Libido decreased      2        --
                     Agitation                     2        --
                     Confusion                   2         1
                     Thinking abnormal     2         1
                     Depersonalization     1        --
                     Depression                1        --
                     Urinary retention         1        --
                     Twitching                     1        --

Respiration          
                        Yawn                         3        --

Special Senses       
                     Blurred vision              6         2
                     Taste perversion         2        --
                     Tinnitus                         2        --
                     Mydriasis                      2        --

Urogenital           
                     Abnormal ejaculation/
                      orgasm                       12 [2]     2
                     Impotence                      6 [2]     2
                     Urinary frequency          3         2
                     Urination impaired        2        --
                     Orgasm disturbance     2 [3]    -- [3]
                     Menstrual disorder        1 [3]    -- [3]
-------------------------------------------------------------------------

[1] Events reported by at least 1% of patients treated with Effexor are
    included, and are rounded to the nearest %. Events for which the 
    Effexor incidence was equal to or less than placebo are not listed 
    in the table, but included the following: abdominal pain, pain, back
    pain, flu syndrome, fever, palpitation, increased appetite, myalgia,
    arthralgia, amnesia, hypaesthesia, rhinitis pharyngitis, sinusitis 
    cough increased urinary tract infection and dysmenorrhoea [3]

--  Incidence less than 1%
[2] Incidence based on number of male patients.
[3] Incidence based on number of female patients.
-------------------------------------------------------------------------

Adaptation to Certain Adverse Events:
Over a 6-week period, there was evidence of adaptation to some adverse events with continued therapy (e.g., dizziness and nausea), but less to other effects (e.g., abnormal ejaculation and dry mouth).

Vital Sign Changes:
Venlafaxine treatment (averaged over all dose groups) in clinical trials was associated with a mean increase in pulse rate of approximately 3 beats per minute, compared to no change for placebo. It was associated with mean increases in diastolic blood pressure ranging from 0.7 to 2.5 mm Hg averaged over all dose groups, compared to mean decreases ranging from O.9 to 3.8 mm Hg for placebo. However, there is a dose dependency for blood pressure increase (see Warnings).

Laboratory Changes:
Of the serum chemistry and hematology parameters monitored during clinical trials with venlafaxine, a statistically significant difference with placebo was seen only for serum cholesterol, i.e., patients treated with venlafaxine had mean increases from baseline of 3 mg/dL, a change of unknown clinical significance.

-----------------------------------------------------------------
Table IV
Treatment-Emergent Adverse Experience Incidence
   in a Dose Comparison Trial
-----------------------------------------------------------------
                                     Effexor (mg/day)
Body System/              Placebo     75        225       375
Preferred Term            (n=92)    (n=89)    (n=89)    (n=88)
-----------------------------------------------------------------
Body as Whole
  Abdominal pain            3.3%      3.4%      2.2%      8.0%
  Asthenia                        3.3%     16.9%     14.6%     14.8%
  Chills                              1.1%      2.2%      5.6%      6.8%
  Infection                         2.2%      2.2%      5.6%      2.3%

Cardiovascular
  Hypertension                 1.1%      1.1%      2.2%      4.5%
  Vasodilatation               0.0%      4.5%      5.6%      2.3%

Digestive System
  Anorexia                        2.2%     14.6%     13.5%     17.0%
  Dyspepsia                     2.2%      6.7%      6.7%      4.5%
  Nausea                        14.1%     32.6%     38.2%     58.0%
  Vomiting                        1.1%      7.9%      3.4%      6.8%

Nervous
  Agitation                       0.0%      1.1%      2.2%      4.5%
  Anxiety                          4.3%     11.2%      4.5%      2.3%
  Dizziness                      4.3%     19.1%     22.5%     23.9%
  Insomnia                       9.8%     22.5%     20.2%     13.6%
  Libido decreased        1.1%      2.2%      1.1%      5.7%
  Nervousness                4.3%     21.3%     13.5%     12.5%
  Somnolence                 4.3%     16.9%     18.0%     26.1%
  Tremor                           0.0%      1.1%      2.2%     10.2%

Respiratory
  Yawn                               0.0%      4.5%      5.6%      8.0%

Skin and Appendages
  Sweating                        5.4%      6.7%     12.4%     19.3%

Special Senses
  Abnormality of
    accommodation           0.0%      9.1%      7.9%      5.6%

Urogenital System
  Abnormal ejaculation/
    orgasm                        0.0%      4.5%      2.2%     12.5%
  Impotence                     0.0%      5.8%      2.1%      3.6%
  (number of men)          (n=63)    (n=52)    (n=48)    (n=56)
-----------------------------------------------------------------

ECG Changes:
In an analysis of ECGs obtained in 769 patients treated with venlafaxine and 450 patients treated with placebo in controlled clinical trials, the only statistically significant difference observed was for heart rate, i.e., a mean increase from baseline of 4 beats per minute for venlafaxine.

Other Events Observed During the Premarketing Evaluation of Venlafaxine:
During its premarketing assessment, multiple doses of venlafaxine were administered to 2,181 patients in phase II and III studies. The conditions and duration of exposure of venlafaxine varied greatly, and included (in overlapping categories) open and double-blind studies, uncontrolled and controlled studies, inpatient and outpatient studies, fixed-dose and titration studies. Untoward events associated with this exposure were recorded by clinical investigators using terminology of their own choosing. Consequently, it is not possible to provide a meaningful estimate of the proportion of individuals experiencing adverse events without first grouping similar types of untoward events into a smaller number of standardized event categories.

In the tabulations that follow, reported adverse events were classified using a standard COSTART-based dictionary terminology . The frequencies presented, therefore, represent the proportion of the 2,181 patients exposed to multiple doses of venlafaxine who experienced an event of the type cited on at least one occasion while receiving venlafaxine. All reported events are included except those already listed in Table III and those events for which a drug cause was remote. If the COSTART term for an event was so general as to be uninformative, it was replaced with a more informative term. It is important to emphasize that, although the events reported occurred during treatment with venlafaxine, they were not necessarily caused by it.

Events are further classified by body system and listed in order of decreasing frequency according to the following definitions: frequent adverse events are those occurring on one or more occasions in at least 1/100 patients (only those not already listed in the tabulated results from placebo controlled trials appear in this listing); infrequent adverse events are those occurring in 1/100 to 1/1000 patients; rare events are those occurring in fewer than 1/1000 patients. The frequent adverse events have been provided below.

Body as a whole: accidental injury, malaise, neck pain.
Cardiovascular: migraine.
Digestive: dysphagia, eructation.
Hemic and lymphatic: ecchymosis.
Metabolic and nutritional: peripheral edema, weight gain.
Nervous: emotional lability, trismus, vertigo.
Respiratory: bronchitis, dyspnea.
Special senses: abnormal vision, ear pain.
Urogenital: anorgasmia, dysuria, hematuria, metrorrhagia*, urination impaired, vaginitis*.

* Based on the number of male or female patients as appropriate.

Overdose

Symptoms and Treatment:

Human Experience:
There were 14 reports of acute overdose with venlafaxine, either alone or in combination with other drugs and/or alcohol, among the patients included in the premarketing evaluation. The majority of the reports involved ingestions in which the total dose of venlafaxine taken was estimated to be no more than several-fold higher than the usual therapeutic dose. The 3 patients who took the highest doses were estimated to have ingested approximately 6.75 g, 2.75 g and 2.5 g. The resultant peak plasma levels of venlafaxine for the latter 2 patients were 6.24 and 2.35 mcg/mL, respectively and the peak plasma levels of O-desmethylvenlafaxine were 3.37 and 1.30 mcg/mL, respectively. Plasma venlafaxine levels were not obtained for the patient who ingested 6.75 g of venlafaxine. All 14 patients recovered without sequelae. Most patients reported no symptoms. Among the remaining patients, somnolence was the most commonly reported symptom. The patient who ingested 2.75 g of venlafaxine was observed to have 2 generalized convulsions and a prolongation of QTc to 500 msec, compared with 405 msec at baseline. Mild sinus tachycardia was reported in 2 of the other patients.

Overdosage Management:
Treatment should consist of those general measures employed in the management of overdosage with any antidepressant. Ensure an adequate airway, oxygenation, and ventilation. Monitoring of cardiac rhythm and vital signs is recommended. General supportive and symptomatic measures are also recommended. Use of activated charcoal, induction of emesis, or gastric lavage should be considered. Due to the large volume of distribution of venlafaxine hydrochloride, forced diuresis, dialysis, hemoperfusion and exchange transfusion are unlikely to be of benefit. No specific antidotes for venlafaxine are known.

In managing overdosage, consider the possibility of multiple drug involvement. The physician should consider contacting a poison control centre on the treatment of any overdose.

Dosage

Adults:
The recommended treatment dose is 75 mg per day, administered in two or three divided doses, taken with food. If the expected clinical improvement does not occur after a few weeks, a gradual dose increase to 150 mg/day may be considered. If needed, the dose may be further increased up to 225 mg/day. Increments of up to 75 mg/day should be made at intervals of no less than 4 days. In outpatient settings there was no evidence of the usefulness of doses greater than 225 mg/day for moderately depressed patients. More severely depressed inpatients have responded to higher doses, between 350 and 375 mg/day, given in 3 divided doses.

Maximum:
The maximum dose recommended is 375 mg per day (in an inpatient setting).

Patients With Hepatic Impairment:
Given the decrease in clearance and increase in elimination half-life for both venlafaxine and ODV that is observed in patients with hepatic cirrhosis compared to normal subjects (see Pharmacology), it is recommended that the total daily dose be reduced by about 50% in patients with moderate hepatic impairment. Since there was much individual variability in clearance between patients with cirrhosis, it may be necessary to reduce the dose even more than 50%, and individualization of dosing may be desirable in some patients.

Patients with Renal Impairment:
Given the decrease in clearance for venlafaxine and increase in elimination half-life for both venlafaxine and ODV that is observed in patients with renal impairment (GFR = 10 to 70 mL/min) compared to normals (see Pharmacology), it is recommended that the total daily dose be decreased by 25% in patients with mild to moderate renal impairment. It is recommended that the total daily dose be reduced by 50% and the dose be withheld until the dialysis treatment is completed (4 hrs) in patients undergoing hemodialysis. Since there was so much individual variability in clearance between patients with renal impairment, individualization of dosing may be desirable in some patients.

Geriatrics:
No dose adjustment is recommended for elderly patients on the basis of their age. As with any antidepressant, however, caution should be exercised in treating the elderly. When individualizing the dosage, extra care should be taken when increasing the dose.

Discontinuing Venlafaxine:
When venlafaxine therapy that has been administered for more than 1 week is stopped, it is generally recommended that the dose be tapered gradually to minimize the risk of discontinuation symptoms. Patients who have received venlafaxine for 6 weeks or more should have their dose tapered gradually over a 2-week period.

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