side effects, dosage, reviews, how to take & discontinue, uses, pros & cons, and more
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Brand & Generic Names; Drug Classes; Availability & Forms
|US brand name: Effexor|
|Generic name: venlafaxine|
|Primary drug class: Antidepressants|
|Additional drug class(es): Serotonin and Norepinephrine Reuptake Inhibitor (SNRI)|
Generic and Overseas Availability
|Available as a generic? Yes|
Other Trade Names and Overseas Availability
- Altven: Australia
- Efexor: Australia, EU, Ireland, New Zealand, UK
- Elaxine: Australia
- Enlafax: Australia
Shapes & Sizes (How Supplied)Extended-release capsules; Immediate-release, shield-shaped tablets
Approved & Off-Label Uses (Indications)
Effexor’s US FDA Approved Treatment(s)
- Major Depressive Disorder (MDD) - extended release (XR) approved October 1997, immediate-release (IR) approved December 1993
- General Anxiety Disorder (GAD) - XR approved 11 March 1999
- Social Anxiety Disorder (SAnD) - XR approved 11 February 2003
- Panic Disorder - XR approved 18 November 2005
Uses Approved Overseas but not in the US
Off-Label Uses of Effexor
- Bipolar depression
- Hot flashes due to breast cancer therapy (thanks to Betsy!)
- Migraine prevention (prophylaxis)
- Tension-Type Headaches
- Although in this randomized, double-blind trial Effexor didn’t do shit for the pain of fibromyalgia. It was still effective for other fibro symptoms.
- Chronic Fatigue, along with every other drug on the planet.
- Adult ADD/ADHD
- Eating Disorders:
When & If Effexor Will Work
Effexor’s Usual Onset of Action (when it starts working)
Three weeks to a month.
Likelihood of Working
Taking and Discontinuing
How to Take Effexor
Effexor comes in immediate-release (IR) and extended release (XR) flavors, although hardly anyone takes the IR form anymore. Just be sure to check your prescription for that XR to make sure you are getting the extended release form. For the XR flavor, you start at 37.5 to 75mg a day, taken with food, at either breakfast or dinner, depending on if you’re apt to get wired or tired. Once you get the wired/tired issue straightened out, you take the med all at once at the same time every day. If you start at 37.5mg you can move up to 75mg after a week. As with any serotonergic antidepressant, it may take up to a month to feel any positive effect, so give it a month. Seriously, don’t move up above 75mg a day unless you feel it doing something positive or it’s been about a month. You’ll know if it’s going to do anything then. If you feel nothing, give up and take a med with a much easier discontinuation (i.e. anything that’s not an SNRI). After that you can move up in 37.5–75 mg increments, allowing at least a week between each increase until you reach the maximum of 375mg a day for the most severely depressed of patients. Or 450mg a day if you and your doctor have the balls for it. If the two of you are sure you are a rapid metabolizer of some medications, there are people who take 600mg a day, but roughly 1% of people on the planet, if that many, would metabolize it at a rate fast enough to need 600mg a day, and need to take the XR form twice a day. If you’re reading this site because you take your XR capsule in the morning and feel dizzy, confused, have headaches and feel like you’re wearing an electric eel for a hat after dinner every night, you may need to take a once-a-day pill twice a day.
The older immediate release version is pretty much the same, except that the dose is divided into two or three doses a day.
How to Stop Taking Effexor (discontinuation / withdrawal)
Unless you need to discontinue the XR flavor at a more rapid rate due to a nasty side effect, your doctor should be recommending that you reduce your dosage by 37.5mg a day every week if you need to stop taking it, if not more slowly than that. You shouldn’t be doing it any faster than that unless it’s an emergency. Yes, that means if you’ve maxed out at 375mg a day it could take up to 10 weeks to get off of it. You can try it faster and hope it works out, and since the odds are actually with you it’s worth doing at the higher dosages and reduce the rate once you’re down to half of what you used to take, but it’s hardly a sure thing. Once you get down to that last 37.5mg a day you have several options:
- If the discontinuation symptoms you’re experiencing are mild, if you’re experiencing any at all, then you may as well stop taking it. You’re in the plurality of people who have taken either version of Effexor who could stop taking it without too much of a hassle.
- If the brain zaps or shivers and other discontinuation symptoms are still bad you can try taking one 37.5mg capsule every other day, or getting a prescription for generic venlafaxine IR and working your way down. As IR comes in a variety of dosages you have all sorts of ways you and your doctor can work out a discontinuation schedule from there.
- If you still can’t stop taking it at a low dosage, you and your doctor may want to try Prozac (fluoxetine) prescription or samples. Generic fluoxetine will even do. 10mg a day is all you should need. Even with the proper discontinuation stopping the last 37.5mg can be hellish. Taking two weeks worth of Prozac (fluoxetine) will make the discontinuation a lot easier. So when you’re off of it and you cannot function, get on the Prozac for a week or two, then stop taking the Prozac. By that time you should find you’ll have either no discontinuation syndrome, or it won’t be nearly as bad.
- If worse comes to worst, there’s always the liquid Prozac. Then you can work your way down from the equivalent of 10mg, or higher if 10mg was too low, to ever-so-slowly try to wean yourself off of the serotonergic part of Effexor that had its claws in you. Unlike most liquid medications of any type, Prozac’s oral solution tastes pretty good2, somewhere between really good mint-flavored mouthwash and so-so peppermint schnapps.
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Effexor’s Pros and Cons
- For deep, despairing, clinical depression that will only respond to the standard tweaking of at least two out of the three most popular neurotransmitters3, Effexor often pulls people out of the abyss when SSIs, other SNRIs, Wellbutrin, and TCAs have failed.
- Because it’s works on more than one neurotransmitter, it is far less likely to poop-out than an SSRI.
- For many people Effexor has the absolute worst discontinuation syndrome of any antidepressant.
- It is a medication people utterly loathe to have taken.
- It is not uncommon for someone to fire their doctor during or immediately after they quit taking Effexor because the discontinuation syndrome can be that bad.
Interesting Stuff your Doctor Probably didn’t Tell YouRaw, freebase4 venlafaxine is actually one of, if not the least potent of all the antidepressants on the market.
It could be that it’s like bupropion, another weak-as-water5 drug that is surprisingly effective. According to Dr. Stahl, bupropion might be transformed into one or more of its three (so far known) active metabolites by the CYP450 genes in your brain instead of in your liver. So what it doesn’t have in the way of raw, pharmacological power, it makes up for by being undiluted by plasma. Perhaps venlafaxine HCl does the same thing.
Best Known for
The discontinuation syndrome from hell.
Effexor’s Side Effects
Typical Side Effects
Although an SNRI, because its effect on norepinephrine usually isn’t noticeable until you reach a dosage somewhere north of 150mg a day, its initial, and mostly short-term, side effects are more like an SSRI. Not that there’s all that much difference between the two classes. So expect a few of:headache, nausea, dry mouth, sweating, sleepiness or insomnia (with insomnia a little more likely), constipation or diarrhea (constipation is somewhat more likely), weight gain (although less likely and severe than most SSRIs), and assorted sexual dysfunctions. While sexual dysfunction is also a little less likely than SSRIs, some women will get a sexual boost at the higher dosages instead of a sexual dampening. It’s neither as frequent nor as pronounced (usually) as with the other SNRIs or the NSRIs (Strattera and reboxetine), but it does happen.
Sorry guys, but a higher dosage usually means whatever problems you had in that area will probably just get worse.
Uncommon Side Effects
- increased or lowered blood pressure
- shock-like sensations (while you’re still taking it)
- alcohol intolerance and/or alcohol abuse
- making it just the thing to talk about at AA meetings
Freaky Rare Side Effects
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What You Really Need to be Careful About
C-Use with caution
Effexor’s Half-Life & How Long Until It Clears Your System
Plasma half-life: The half-life of venlafaxine is 3–7 hours, and o-desmethylvenlafaxine’s is 9–13 hours. That means it takes two days for one and five days for the other to clear out of your system.
Half-life is the average time it takes for you to process half of the drug’s active ingredient. If a drug has a half-life of around 24 hours and you take a dose of 100mg, you’ll have roughly the equivalent a 50mg dose after one day, a 25mg dose after two days, and so on. The rule of thumb is: multiply the half-life by five and you get how long it is for the dose you took to be cleared from your bloodstream6, so there’s nothing swimming around to attach itself to your brain and start doing stuff. That’s called “plasma clearance.” Complete clearance is a complex equation based on a lot of factors which may or may not: be published in the PI sheet, include personal data like your weight, or even completely figured out by corporate and independent researchers. It usually winds up being 2–5 days after plasma clearance no matter what7, but can take weeks. Sometimes a drug will clear from your brain and other organs before it clears from your blood.
Steady state is the flipside of half-life. This is when you can expect to get over side effects caused by fluctuating amounts of a medication in your bloodstream. Often, but not always the same amount of time as the plasma clearance above.
How venlafaxine Works
the current best guess at any rateBased upon the monoamine hypothesis of depression (i.e. you’re messed up due to an imbalance of one or more of three of the best understood neurotransmitters: serotonin, norepinephrine, and/or dopamine), Effexor attempts to balance your brain juices by inhibiting the reuptake (in English: delaying the breaking down and recycling) of serotonin and norepinephrine at their receptors in various (i.e. depending on which studies and books you’ve read and fancy brain scans you’ve looked at) locations in your brain. It may do a lot of other things that address depression, anxiety, other brain cooties and some off-label uses by encouraging the growth of new neurons, affecting hormones and CYP450 genes in your brain, and who knows what else. You also have serotonin and norepinephrine receptors throughout your body, especially in your GI and renal systems, which is why SSRIs & SNRIs are used to treat various conditions like IBS and incontinence. As it doesn’t really affect norepinephrine until you reach a dosage of at least 225mg a day (or 175–200 for IR), it is practically an SSRI, and thus not as effective for pain and pain-related conditions like fibromyalgia as other SNRIs like Cymbalta and Pristiq.
The active ingredient is usually the same as the generic name, but more often than not it’s a chemical salt of the substance identified as the generic. E.g. Fluoxetine is the generic for Prozac, but the active ingredient is fluoxetine hydrochloride (or HCl). It usually doesn’t make much of a difference outside of the more esoteric aspects of a drug’s pharmacology, but not always.
Noted Drug-Drug & Drug-Food Interactions
Check for Other Drug-Drug & Drug-Food Interactions
It’s always a good idea to check for drug-drug interactions yourself. Just because most people in the crazy meds business know about really important interactions (e.g. MAOIs and a lot of stuff, warfarin and everything on the planet) doesn’t mean the person who prescribed your meds told you about them, or the pharmacist has all the meds you take at their fingertips like they’re supposed to. Or they have the time to do their jobs properly when not dealing with complete idiots or playing Angry Farmers on te Faecesbooks.
Comments, PI Sheet, Ratings, Reviews and More
CommentsThere are two last resorts among the modern, first-line meds to cure the deepest, blackest depression when your doctor is just switching you from one horsie to another on the med-go-round: Effexor and Remeron (mirtazapine)8. Either in combination with an antipsychotic, especially Geodon would really get you out of that hole of despair, but first you should throw away every mirror and scale in your house and buy expandable clothing. Weight gain usually isn’t too bad with Effexor alone, but when coupled with Remeron and/or most antipsychotics…well…prepare yourself for being a jolly fatty.
Effexor has to be the. most. loathed. drug by those for whom it didn’t work. While it can be an absolute lifesaver for many people with the most severe form of whaleshit-on-the-bottom-of-the-ocean depression, with or without anxiety, as well as for those with various forms of anxiety without depression, when it doesn’t work well enough, and the side effects suck to much, the discontinuation syndrome can be such a nightmare that people will fire their doctors who didn’t work out a discontinuation schedule or otherwise prepare them for what it would be like.
A bit more on its pharmacology for the pharmageeks:
The active metabolite (o-desmethylvenlafaxine) does most of the work, and is now available in a refined form as Pristiq (desvenlafaxine). The half-life of venlafaxine HCl is 3–7 hours, and o-desmethylvenlafaxine’s is 9–13 hours. That means it takes two days for one and five days for the other to clear out of your system. Having two parts with short half-lives is a huge part of why the discontinuation syndrome is so freaking harsh.
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Full US PI sheet, Global SPCs & PILs, Other Consumer Review & Rating Sites, and Other Sites that may be of Interest
Prescribing Information and Patient Information from Around the World
- Australian Altven Product Information
- Australian Efexor XR Consumer Medical Information
- Canadian Effexor XR Product Monograph
- Irish Efexor XL SPC - What doctors read.
- Irish Efexor XL Patient Information Leaflet
- New Zealand Efexor XR Medicine Data Sheet - What doctors read.
- UK Efexor XL SPC - What doctors read.
- UK Efexor XL Patient Information Leaflet
Other Review Sites
- Everyday Health Reviews
- AskaPatient Drug Ratings
- PatientsLikeMe Treatment Report
- DailyStrength Reviews
- WebMD User Reviews & Ratings
- Drugs.com User Reviews
Other Sites of Interest
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BibliographyStahl’s Essential Psychopharmacology: Neuroscientific Basis and Practical Applications (Essential Psychopharmacology Series) Third edition by Stephen M. Stahl © 2008 Published by Cambridge University Press. Primer of Drug Action 12th edition by Robert M. Julien Ph.D., Claire D. Advokat, Joseph Comaty © 2011 Published by Worth Publishers. Mosby’s Drug Consult 2007 (Generic Prescription Physician’s Reference Book Series) © 2007 An imprint of Elsevier. Also the 2004 edition, but only on pages that haven’t been fully updated yet. Instant Psychopharmacology 2nd Edition Ronald J. Diamond M.D. © 2002. Published by W.W. Norton The Complete Guide to Psychiatric Drugs Edward Drummond, M.D. © 2000. Published by John Wiley & Sons, Inc. PDR: Physicians’ Desk Reference 2010 64th edition back through to 53rd edition of 1999. Old copies of the PDR come in handy for PI sheets that are no longer available and difficult to find, as well as to track the changes in both indications and adverse effects. Healing Anxiety & Depression Daniel G. Amen, M.D., and Lisa C. Routh, M.D. © 2003. Published by G.P. Putnam’s Sons.
2 Although it doesn't taste anywhere near as good as lithium citrate syrup, but it is on par with chewable Lamictal.
3 While classified as a serotonin and norepinephrine reuptake inhibitor, the data are mixed when it comes to dopamine. Effexor may or may not have a therapeutic effect, albeit a minor one, on dopamine at a dosage above 300mg a day.
4 That's the term for a substance that isn't a chemical salt, such as venlafaxine hydrochloride or citalopram hydrobromide. Most antidepressants are salts, while most antiepileptic drugs and antipsychotics are not.
5 Seriously. They're practically psychopharmaceutical homeopathic remedies.
6 Based on Julien's calculations from A Primer of Drug Action, the half-life multiplied by five is the generally accepted estimate of how long it takes a single dose of any given drug to be eliminated from the blood stream/plasma of someone with a normal metabolism. That's also the rough estimate for steady state if they can't get, or won't provide a number for that.
7 For crazy meds. I have no idea what the average complete clearance is for other types of medications. For all I know there are drugs that utterly vanish from your system in under five passes, and others that won't let go of your squishy bits for years after you stop taking them.
8 Stahl will combine it with Remeron - a cocktail he calls "California Rocket Fuel" - for his patients who are truly, and dangerously alt.depressed.as.fuck, and who have not responded to anything else.
9 Thank you! I'll be here all weak. Be sure to tip your content provider. And don't try the veal, it's cruelicious!
I welcome criticisms of the articles, notifications of bad links, site problems, consumer experiences with medications, etc. I’m not always able to write back. Hence I never answer questions about meds via e-mail that are answered by this or other articles. Especially if they have been repeatedly asked on the forum. That’s why I write these damn things. I’m frustrated enough as it is. Questions about which meds are best for your condition should also be asked on the forum; because this is a free site, so the price of admission is making things easier for somebody else searching for the same answer. We don’t deal with children on the forum or in private because after doing this for ten years I don’t have the emotional stamina to deal with kids who have brain cooties. How to contact Crazymeds.
|Last modified on Friday, 07 March, 2014 at 21:36:01 by SomeMedCritic||Page Author: JerodPoore||Date created Monday, 25 April, 2011 at 11:53:36|
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Almost all of the material on this site is by Jerod Poore and is copyright © 2004, 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, and 2014 Jerod Poore. Except, of course, the PI sheets - those are the property of the drug companies who developed the drugs the sheets are about - and any documents that are written by other people which may be posted to this site will remain the property of the original authors. You cannot reproduce this page or any other material on this site outside of the boundaries of fair use copying without the express permission of the copyright holder. That’s usually me, so just ask first. That means if want to print out a few pages to take to your doctor, therapist, counselor, support group, non-understanding family members or something like that - then that’s OK to just do. Go for it! Please. As long as you include this copyright notice and the following disclaimer, I’m usually cool with it.
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All information on this site has been obtained through our personal experience and the experiences family, friends, what people have reported on various reputable sites all over teh intergoogles, the medications’ product information / summary of product characteristic (PI/SPC) sheets, and from sources that are referenced throughout the site. As such the information presented here is not intended as a substitute for real medical advice from your real doctor, just a compliment to it. You should never, ever, replace what a real doctor tells you with something from a website on the Internet. The farthest you should ever take it is getting a second opinion from another real doctor. Educate yourself - always read the PI/SPC sheet or patient information leaflet (PIL) that comes with your medications and never ever throw them away.
Crazymeds is not responsible for the content of sites we provide links to. We like them, or they’re paid advertisements, or they’re something else we think you should read to help you make an informed decision about a particular med. Sometimes they’re more than one of those things. But what’s on those sites is their business, not ours.
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1 While there are plenty of books to help you with hypochondria, for some reason there’s not much in the way of websites. Then again, staying off of the Internet is a large part of curing/managing the disorder.
2 Remember kids, Microsloth operating systems are like TOS Star Trek movies with in that every other one sucks way, way more. With TOS Star Trek movies you don’t want to bother watching the odd-numbered ones. With Microsloth OS you don’t want to buy and install the even-numbered ones. Anyone who remembers ME and Vista knows what I mean.
3 Have I mentioned how open source operating systems for commercial applications is one of the dumbest ideas in the history of dumb ideas?
[begin rant] I rent a dedicated server for Crazymeds. It’s sitting on a rack somewhere in Southern California along with a bunch of other servers that other people have rented. The hardware is identical, but no two machines have exactly the same operating systems. I don’t even need to see what is on any of the others to know this. If somebody got their server at the exact same time, with the exact same features as I did, I’m confident that there would be noticeable differences in some aspects of the operating systems. So what does this mean? For one thing it means that no two computers in the same office of a single company have the same operating system, and the techs can spend hours figuring out what the fuck the problem could be based on that alone. It also means that application software like IP board that runs the forum here has to have so many fucking user-configurable bells and whistles that even when I read the manual I can’t find every setting, or every location that every flag needs to be set in order for a feature to run the way I want it to run. And in the real world it means you can get an MBA not only with an emphasis on resource planning, but with an emphasis on using SAP - a piece of software so complex there are now college programs on how to use it. You might think, “But don’t people learn how to use Photoshop or Adobe Illustrator in college?” Sure, in order to create stuff. And in a way you’re creating stuff with SAP. But do you get a Bachelor of Fine Arts degree with an emphasis on Photoshop?
Back in the Big Iron Age the operating systems were proprietary, and every computer that took up an entire room with a raised floor and HVAC system, and had less storage and processing power than an iPhone, had the same operating system as every other one, give or take a release level. But when a company bought application software like SAP, they also got the source code, which was usually documented and written in a way to make it easy to modify the hell out of it. Why? Because accounting principles may be the same the world over, and tax laws the same across each country and state, but no two companies have the same format for their reports, invoices, purchase orders and so forth. Standards existed and were universally ignored. If something went wrong it went wrong the same way for everyone, and was easy to track down. People didn’t need to take a college course to learn how to use a piece of software.
I’m not against the open source concept entirely. Back then all the programmers read the same magazines, so we all had the same homebrew utilities. We even had a forerunner of QR Code to scan the longer source code. Software vendors and computer manufacturers sponsored conventions so we could, among other things, swap recipes for such add-ons and utilities. While those things would make our lives easier, they had nothing to do with critical functions of the operating system. Unless badly implemented they would rarely cause key application software to crash and burn. Whereas today, with open source everything, who the hell knows what could be responsible some part of a system failing. [/end rant]