Venlafaxine

What is Venlafaxine

Venlafaxine is an oral serotonin norepinephrine reuptake inhibitor (SNRI) used in adults for treating major depression, generalized anxiety disorder, social anxiety disorder, and panic disorder.

Venlafaxine is effective for hot flashes due to menopause or breast cancer treatment and is commonly used off-label in women as an alternative to hormonal therapy for vasomotor symptom control. SNRIs are not approved for use in pediatric patients with depression; however, guidelines from the American Academy of Child and Adolescent Psychiatry (AACAP) recommend the use of antidepressants when nonpharmacologic treatment is insufficient or illness severity is high.

Due to limited data in treating pediatric depression, SNRIs are generally reserved for pediatric patients with documented antidepressant treatment failure or intolerability to a selective serotonin reuptake inhibitor (SSRI). Similar to other SNRIs, venlafaxine has been associated with increases in blood pressure and heart rate and caution is recommended when conditions are present that may be adversely affected by increased blood pressure or heart rate.

Product labels for all antidepressants contain a boxed warning related to an increased risk of suicidality in children, adolescents, and young adults during the initial stages of therapy when treating depression or other conditions; therefore, the necessity of pharmacologic therapy versus the potential risks should be carefully considered in these populations.

Brand Names

  • Effexor
  • Effexor XR
  • Venlafaxine

Indications

  1. andropause
  2. depression
  3. diabetic neuropathy
  4. fibromyalgia
  5. generalized anxiety disorder (GAD)
  6. hot flashes
  7. menopause
  8. migraine prophylaxis
  9. obsessive-compulsive disorder (OCD)
  10. panic disorder
  11. premenstrual dysphoric disorder (PMDD)
  12. social phobia (social anxiety disorder)

Side Effects

  1. acne vulgaris
  2. agitation
  3. agranulocytosis
  4. akathisia
  5. akinesia
  6. alopecia
  7. amenorrhea
  8. amnesia
  9. anaphylactoid reactions
  10. anemia
  11. angina
  12. angioedema
  13. anorexia
  14. anuria
  15. anxiety
  16. aphasia
  17. aplastic anemia
  18. apnea
  19. arthralgia
  20. asthenia
  21. ataxia
  22. atrial fibrillation
  23. AV block
  24. bleeding
  25. blurred vision
  26. bone pain
  27. bradycardia
  28. breast discharge
  29. breast enlargement
  30. bundle-branch block
  31. cardiomyopathy
  32. cataracts
  33. cheilitis
  34. chest pain (unspecified)
  35. chills
  36. cholecystitis
  37. cholelithiasis
  38. colitis
  39. confusion
  40. conjunctivitis
  41. constipation
  42. contact dermatitis
  43. cough
  44. delirium
  45. depression
  46. diabetes mellitus
  47. diarrhea
  48. diplopia
  49. dizziness
  50. drowsiness
  51. Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)
  52. dysarthria
  53. dysgeusia
  54. dyskinesia
  55. dyspepsia
  56. dysphagia
  57. dysphonia
  58. dyspnea
  59. dystonic reaction
  60. ecchymosis
  61. edema
  62. ejaculation dysfunction
  63. elevated hepatic enzymes
  64. emotional lability
  65. eosinophilia
  66. eosinophilic pneumonia
  67. epistaxis
  68. eructation
  69. erythema multiforme
  70. esophagitis
  71. euphoria
  72. exfoliative dermatitis
  73. fever
  74. flank pain
  75. flatulence
  76. flushing
  77. galactorrhea
  78. gastritis
  79. GI bleeding
  80. GI obstruction
  81. gingivitis
  82. glossitis
  83. glycosuria
  84. goiter
  85. gout
  86. growth inhibition
  87. Guillain-Barre syndrome
  88. gynecomastia
  89. hallucinations
  90. headache
  91. heart failure
  92. hematemesis
  93. hemoptysis
  94. hemorrhoids
  95. hepatic failure
  96. hepatic necrosis
  97. hepatitis
  98. hirsutism
  99. hostility
  100. hypercalciuria
  101. hypercholesterolemia
  102. hyperesthesia
  103. hyperglycemia
  104. hyperhidrosis
  105. hyperkalemia
  106. hyperkinesis
  107. hyperlipidemia
  108. hyperphosphatemia
  109. hyperprolactinemia
  110. hyperreflexia
  111. hypersalivation
  112. hypertension
  113. hyperthyroidism
  114. hypertonia
  115. hyperuricemia
  116. hyperventilation
  117. hypoglycemia
  118. hypokalemia
  119. hyponatremia
  120. hypophosphatemia
  121. hyporeflexia
  122. hypotension
  123. hypothyroidism
  124. hypotonia
  125. hypoventilation
  126. hypoxia
  127. impotence (erectile dysfunction)
  128. impulse control symptoms
  129. increased urinary frequency
  130. infection
  131. insomnia
  132. jaundice
  133. laryngeal edema
  134. laryngitis
  135. laryngospasm
  136. leukocytosis
  137. leukopenia
  138. libido decrease
  139. lymphadenopathy
  140. lymphocytosis
  141. maculopapular rash
  142. mania
  143. mastalgia
  144. melena
  145. menorrhagia
  146. menstrual irregularity
  147. muscle cramps
  148. muscle paralysis
  149. myasthenia
  150. mydriasis
  151. myocardial infarction
  152. nausea
  153. neonatal abstinence syndrome
  154. nephrolithiasis
  155. neuritis
  156. neuroleptic malignant syndrome
  157. neuropathic pain
  158. neutropenia
  159. night sweats
  160. nocturia
  161. nystagmus
  162. ocular hypertension
  163. oliguria
  164. oral ulceration
  165. orgasm dysfunction
  166. orthostatic hypotension
  167. pallor
  168. pancreatitis
  169. pancytopenia
  170. paranoia
  171. paresis
  172. paresthesias
  173. parotitis
  174. peptic ulcer
  175. peripheral neuropathy
  176. peripheral vasoconstriction
  177. petechiae
  178. phlebitis
  179. photophobia
  180. photosensitivity
  181. platelet dysfunction
  182. polyuria
  183. priapism
  184. proctitis
  185. prolonged bleeding time
  186. prostatic hypertrophy
  187. prostatitis
  188. proteinuria
  189. pruritus
  190. psoriasis
  191. psychosis
  192. pulmonary embolism
  193. purpura
  194. QT prolongation
  195. rash
  196. renal failure (unspecified)
  197. restlessness
  198. rhabdomyolysis
  199. seizures
  200. serotonin syndrome
  201. SIADH
  202. sinus tachycardia
  203. spontaneous fetal abortion
  204. steatosis
  205. Stevens-Johnson syndrome
  206. stomatitis
  207. stroke
  208. suicidal ideation
  209. supraventricular tachycardia (SVT)
  210. syncope
  211. synovitis
  212. tardive dyskinesia
  213. teeth grinding (bruxism)
  214. tendon rupture
  215. thrombocytopenia
  216. tongue discoloration
  217. torsade de pointes
  218. torticollis
  219. toxic epidermal necrolysis
  220. tremor
  221. trismus
  222. urinary incontinence
  223. urinary retention
  224. urinary urgency
  225. urticaria
  226. vaginal bleeding
  227. vaginitis
  228. ventricular fibrillation
  229. ventricular tachycardia
  230. vertigo
  231. vomiting
  232. weakness
  233. weight loss
  234. withdrawal
  235. xerophthalmia
  236. xerosis
  237. xerostomia
  238. yawning

Monitoring Parameters

  • blood pressure
  • serum cholesterol

Contraindications

  • abrupt discontinuation
  • alcoholism
  • anticoagulant therapy
  • bipolar disorder
  • bleeding
  • bradycardia
  • breast-feeding
  • cardiac arrhythmias
  • cardiac disease
  • cerebrovascular disease
  • children
  • closed-angle glaucoma
  • coronary artery disease
  • dehydration
  • desvenlafaxine hypersensitivity
  • diabetes mellitus
  • dialysis
  • driving or operating machinery
  • eclampsia
  • electroconvulsive therapy (ECT)
  • eosinophilic pneumonia
  • females
  • geriatric
  • growth inhibition
  • heart failure
  • hepatic disease
  • hypertension
  • hypocalcemia
  • hypokalemia
  • hypomagnesemia
  • hyponatremia
  • hypovolemia
  • increased intraocular pressure
  • long QT syndrome
  • malnutrition
  • mania
  • MAOI therapy
  • myocardial infarction
  • neonates
  • obstetric delivery
  • pregnancy
  • QT prolongation
  • renal disease
  • renal failure
  • renal impairment
  • seizure disorder
  • seizures
  • suicidal ideation
  • thrombolytic therapy
  • thyroid disease
  • venlafaxine hypersensitivity

Interactions

  • Abciximab
  • Acetaminophen; Aspirin, ASA; Caffeine
  • Acetaminophen; Butalbital; Caffeine; Codeine
  • Acetaminophen; Caffeine; Dihydrocodeine
  • Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine
  • Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide
  • Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
  • Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
  • Acetaminophen; Codeine
  • Acetaminophen; Dextromethorphan
  • Acetaminophen; Dextromethorphan; Doxylamine
  • Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine
  • Acetaminophen; Dextromethorphan; Phenylephrine
  • Acetaminophen; Dextromethorphan; Pseudoephedrine
  • Acetaminophen; Hydrocodone
  • Acetaminophen; Pentazocine
  • Acetaminophen; Tramadol
  • Aclidinium; Formoterol
  • Albuterol
  • Albuterol; Ipratropium
  • Alfuzosin
  • Aminosalicylate sodium, Aminosalicylic acid
  • Amiodarone
  • Amitriptyline
  • Amitriptyline; Chlordiazepoxide
  • Amlodipine; Celecoxib
  • Amoxicillin; Clarithromycin; Lansoprazole
  • Amoxicillin; Clarithromycin; Omeprazole
  • Amphetamine; Dextroamphetamine Salts
  • Anagrelide
  • Antithrombin III
  • Apixaban
  • Apomorphine
  • Aprepitant, Fosaprepitant
  • Arformoterol
  • Argatroban
  • Aripiprazole
  • Arsenic Trioxide
  • Artemether; Lumefantrine
  • Asenapine
  • Aspirin, ASA
  • Aspirin, ASA; Butalbital; Caffeine
  • Aspirin, ASA; Butalbital; Caffeine; Codeine
  • Aspirin, ASA; Caffeine; Dihydrocodeine
  • Aspirin, ASA; Caffeine; Orphenadrine
  • Aspirin, ASA; Carisoprodol
  • Aspirin, ASA; Carisoprodol; Codeine
  • Aspirin, ASA; Citric Acid; Sodium Bicarbonate
  • Aspirin, ASA; Dipyridamole
  • Aspirin, ASA; Omeprazole
  • Aspirin, ASA; Oxycodone
  • Aspirin, ASA; Pravastatin
  • Atazanavir; Cobicistat
  • Atomoxetine
  • Atropine; Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
  • Azithromycin
  • Bedaquiline
  • Benzhydrocodone; Acetaminophen
  • Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
  • Benzphetamine
  • Betrixaban
  • Bismuth Subcitrate Potassium; Metronidazole; Tetracycline
  • Bismuth Subsalicylate
  • Bismuth Subsalicylate; Metronidazole; Tetracycline
  • Bivalirudin
  • Boceprevir
  • Brompheniramine; Dextromethorphan; Guaifenesin
  • Brompheniramine; Guaifenesin; Hydrocodone
  • Brompheniramine; Hydrocodone; Pseudoephedrine
  • Budesonide; Formoterol
  • Buprenorphine
  • Buprenorphine; Naloxone
  • Buspirone
  • Carbinoxamine; Dextromethorphan; Pseudoephedrine
  • Carbinoxamine; Hydrocodone; Phenylephrine
  • Carbinoxamine; Hydrocodone; Pseudoephedrine
  • Celecoxib
  • Ceritinib
  • Cevimeline
  • Chloroquine
  • Chlorpheniramine; Codeine
  • Chlorpheniramine; Dextromethorphan
  • Chlorpheniramine; Dextromethorphan; Phenylephrine
  • Chlorpheniramine; Dihydrocodeine; Phenylephrine
  • Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
  • Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
  • Chlorpheniramine; Hydrocodone
  • Chlorpheniramine; Hydrocodone; Phenylephrine
  • Chlorpheniramine; Hydrocodone; Pseudoephedrine
  • Chlorpromazine
  • Choline Salicylate; Magnesium Salicylate
  • Cilostazol
  • Cimetidine
  • Cinacalcet
  • Ciprofloxacin
  • Cisapride
  • Citalopram
  • Clarithromycin
  • Clofazimine
  • Clomipramine
  • Clopidogrel
  • Clozapine
  • Cobicistat
  • Cocaine
  • Codeine
  • Codeine; Guaifenesin
  • Codeine; Phenylephrine; Promethazine
  • Codeine; Promethazine
  • Crizotinib
  • Cyclobenzaprine
  • Cyproheptadine
  • Dabigatran
  • Dacomitinib
  • Dalteparin
  • Danaparoid
  • Darunavir; Cobicistat
  • Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide
  • Dasatinib
  • Degarelix
  • Delavirdine
  • Desipramine
  • Desirudin
  • Desvenlafaxine
  • Deutetrabenazine
  • Dexchlorpheniramine; Dextromethorphan; Pseudoephedrine
  • Dexmethylphenidate
  • Dextromethorphan
  • Dextromethorphan; Diphenhydramine; Phenylephrine
  • Dextromethorphan; Guaifenesin
  • Dextromethorphan; Guaifenesin; Phenylephrine
  • Dextromethorphan; Guaifenesin; Potassium Guaiacolsulfonate
  • Dextromethorphan; Guaifenesin; Pseudoephedrine
  • Dextromethorphan; Promethazine
  • Dextromethorphan; Quinidine
  • Diclofenac
  • Diclofenac; Misoprostol
  • Diflunisal
  • Dihydrocodeine; Guaifenesin; Pseudoephedrine
  • Diphenhydramine; Hydrocodone; Phenylephrine
  • Diphenhydramine; Ibuprofen
  • Diphenhydramine; Naproxen
  • Dipyridamole
  • Disopyramide
  • Diuretics
  • Dofetilide
  • Dolasetron
  • Dolutegravir; Rilpivirine
  • Donepezil
  • Donepezil; Memantine
  • Doxepin
  • Dronedarone
  • Droperidol
  • Duloxetine
  • Edoxaban
  • Efavirenz
  • Efavirenz; Emtricitabine; Tenofovir
  • Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate
  • Elbasvir; Grazoprevir
  • Eliglustat
  • Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide
  • Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate
  • Emtricitabine; Rilpivirine; Tenofovir alafenamide
  • Emtricitabine; Rilpivirine; Tenofovir disoproxil fumarate
  • Encorafenib
  • Enoxaparin
  • Entrectinib
  • Eptifibatide
  • Ergot alkaloids
  • Eribulin
  • Erythromycin
  • Erythromycin; Sulfisoxazole
  • Escitalopram
  • Esomeprazole; Naproxen
  • Etodolac
  • Everolimus
  • Ezogabine
  • Famotidine; Ibuprofen
  • Fedratinib
  • Fenoprofen
  • Fentanyl
  • Fingolimod
  • Flecainide
  • Fluconazole
  • Fluoxetine
  • Fluoxetine; Olanzapine
  • Fluphenazine
  • Flurbiprofen
  • Fluticasone; Salmeterol
  • Fluticasone; Umeclidinium; Vilanterol
  • Fluticasone; Vilanterol
  • Fluvoxamine
  • Fondaparinux
  • Formoterol
  • Formoterol; Mometasone
  • Foscarnet
  • Gemifloxacin
  • Gemtuzumab Ozogamicin
  • Gilteritinib
  • Givosiran
  • Glasdegib
  • Glycopyrrolate; Formoterol
  • Goserelin
  • Granisetron
  • Guaifenesin; Hydrocodone
  • Guaifenesin; Hydrocodone; Pseudoephedrine
  • Halogenated Anesthetics
  • Haloperidol
  • Heparin
  • Histrelin
  • Homatropine; Hydrocodone
  • Hydrochlorothiazide, HCTZ; Metoprolol
  • Hydrocodone
  • Hydrocodone; Ibuprofen
  • Hydrocodone; Phenylephrine
  • Hydrocodone; Potassium Guaiacolsulfonate
  • Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
  • Hydrocodone; Pseudoephedrine
  • Hydroxychloroquine
  • Hydroxyzine
  • Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate
  • Ibuprofen
  • Ibuprofen; Oxycodone
  • Ibuprofen; Pseudoephedrine
  • Ibutilide
  • Idelalisib
  • Iloperidone
  • Imatinib
  • Imipramine
  • Indacaterol
  • Indacaterol; Glycopyrrolate
  • Indinavir
  • Indomethacin
  • Inotuzumab Ozogamicin
  • Iobenguane I 131
  • Isavuconazonium
  • Isoniazid, INH
  • Isoniazid, INH; Pyrazinamide, PZA; Rifampin
  • Isoniazid, INH; Rifampin
  • Itraconazole
  • Ivosidenib
  • Ketoconazole
  • Ketoprofen
  • Ketorolac
  • Lansoprazole; Naproxen
  • Lapatinib
  • Lasmiditan
  • Lefamulin
  • Lenvatinib
  • Lepirudin
  • Letermovir
  • Leuprolide
  • Leuprolide; Norethindrone
  • Levalbuterol
  • Levobupivacaine
  • Levofloxacin
  • Levomilnacipran
  • Linezolid
  • Lisdexamfetamine
  • Lithium
  • Lofexidine
  • Long-acting beta-agonists
  • Loperamide
  • Loperamide; Simethicone
  • Lopinavir; Ritonavir
  • Lorcaserin
  • Macimorelin
  • Magnesium Salicylate
  • Maprotiline
  • Meclofenamate Sodium
  • Mefenamic Acid
  • Mefloquine
  • Meloxicam
  • Meperidine
  • Meperidine; Promethazine
  • Mesoridazine
  • Metaproterenol
  • Methadone
  • Methamphetamine
  • Methenamine; Sodium Acid Phosphate; Methylene Blue; Hyoscyamine
  • Methylene Blue
  • Methylphenidate
  • Metoprolol
  • Metronidazole
  • Midostaurin
  • Mifepristone
  • Milnacipran
  • Mirabegron
  • Mirtazapine
  • Mitotane
  • Monoamine oxidase inhibitors
  • Morphine
  • Morphine; Naltrexone
  • Moxifloxacin
  • Nabumetone
  • Naproxen
  • Naproxen; Pseudoephedrine
  • Naproxen; Sumatriptan
  • Nefazodone
  • Netupitant, Fosnetupitant; Palonosetron
  • Nilotinib
  • Nonsteroidal antiinflammatory drugs
  • Norfloxacin
  • Nortriptyline
  • Octreotide
  • Ofloxacin
  • Olanzapine
  • Olodaterol
  • Ondansetron
  • Oritavancin
  • Osilodrostat
  • Osimertinib
  • Oxaliplatin
  • Oxaprozin
  • Ozanimod
  • Paliperidone
  • Palonosetron
  • Panobinostat
  • Paroxetine
  • Pasireotide
  • Pazopanib
  • Peginterferon Alfa-2b
  • Pentamidine
  • Pentazocine
  • Pentazocine; Naloxone
  • Pentosan
  • Perphenazine
  • Perphenazine; Amitriptyline
  • Phentermine
  • Phentermine; Topiramate
  • Phenylephrine; Promethazine
  • Pimavanserin
  • Pimozide
  • Pirbuterol
  • Piroxicam
  • Pitolisant
  • Posaconazole
  • Prasugrel
  • Primaquine
  • Procainamide
  • Procarbazine
  • Prochlorperazine
  • Promethazine
  • Propafenone
  • Protriptyline
  • Quetiapine
  • Quinidine
  • Quinine
  • Ranolazine
  • Rasagiline
  • Remifentanil
  • Ribociclib
  • Ribociclib; Letrozole
  • Rilpivirine
  • Risperidone
  • Rivaroxaban
  • Rofecoxib
  • Rolapitant
  • Romidepsin
  • Safinamide
  • Salicylates
  • Salmeterol
  • Salsalate
  • Saquinavir
  • Selpercatinib
  • Serotonin-Receptor Agonists
  • Sertraline
  • Short-acting beta-agonists
  • Sibutramine
  • Siponimod
  • Solifenacin
  • Solriamfetol
  • Sorafenib
  • Sotalol
  • St. John’s Wort, Hypericum perforatum
  • Sulindac
  • Sunitinib
  • Tacrolimus
  • Tamoxifen
  • Tapentadol
  • Tedizolid
  • Telaprevir
  • Telavancin
  • Telithromycin
  • Telotristat Ethyl
  • Terbinafine
  • Terbutaline
  • Tetrabenazine
  • Thiethylperazine
  • Thioridazine
  • Thrombolytic Agents
  • Ticagrelor
  • Ticlopidine
  • Tinzaparin
  • Tiotropium; Olodaterol
  • Tirofiban
  • Tolmetin
  • Tolterodine
  • Toremifene
  • Tramadol
  • Trazodone
  • Tricyclic antidepressants
  • Trifluoperazine
  • Trimipramine
  • Triptorelin
  • Umeclidinium; Vilanterol
  • Valdecoxib
  • Valerian, Valeriana officinalis
  • Vandetanib
  • Vardenafil
  • Vemurafenib
  • Vilazodone
  • Vorapaxar
  • Voriconazole
  • Vorinostat
  • Vortioxetine
  • Warfarin
  • Ziprasidone
  • Zolpidem
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