Venlafaxine

DEA Class;  Rx

Common Brand Names; Effexor XR, Venbysi XR, Effexor (DSC)

Hypersensitivity

• Headache (25-38%)
• Nausea (21-58%)
• Insomnia (15-24%)
• Asthenia (16-20%)
• Dizziness (11-24%)
• Ejaculation disorder (2-19%)
• Somnolence (12-26%)
• Dry mouth (12-22%)
• Diaphoresis (7-19%)
• Anorexia (15-17%)
• Nervousness (17-26%)
• Anorgasmia (5-13%)
• Weight loss (1-6%)
• Abnormal vision (4-6%)
• Hypertension (2-5%)
• Impotence (4-6%)
• Paresthesia (2-3%)
• Tremor (1-10%)
• Vasodilation (2-6%)
• Vomiting (3-8%)
• Weight gain (2%)
• Flatulence (3-4%)
• Pruritus (1%)
• Yawning (3-8%)
• Dyspepsia (5-7%)
• Twitching (1-3%)
• Mydriasis (2%)
• Angioedema
• Agranulocytosis
• Anemia
• Anuria
• Aneurism
• Bacteremia
• Myasthenia
• Syncope
• Suicide ideation/attempt

Risk of mydriasis; may trigger angle closure attack in patients with angle closure glaucoma with anatomically narrow angles without a patent iridectomy

Use caution in bipolar mania, history of seizures, and cardiovascular disease

May precipitate mania or hypomania episodes in patients with bipolar disorder; avoid monotherapy in bipolar disorder; screen patients presenting with depressive symptoms for bipolar disorder

Use caution in hepatic or renal impairment

Neonates exposed to serotonin-norepinephrine reuptake inhibitors (SNRIs) or selective serotonin reuptake inhibitors (SSRIs) late in 3rd trimester of pregnancy have developed complications necessitating prolonged hospitalization, respiratory support, and tube feeding

Clinical worsening and suicidal ideation may occur despite medication in adolescents and young adults (18-24 years)

When discontinuing, taper dosage to avoid flulike symptoms

May cause increase in nervousness, anxiety, or insomnia

May impair ability to operate heavy machinery; depresses CNS

Bone fractures reported with antidepressant therapy; consider possibility if patient experiences bone pain

May cause significant increase in serum cholesterol

Dose-dependent anorectic effects and weight loss reported in children and adult patients

Dose-related increase in systolic and diastolic pressure reported

Interstitial lung disease and eosinophilic pneumonia associated with venlafaxine therapy rarely reported; possibility of these events should be considered in patients receiving therapy who present with progressive dyspnea, cough or chest discomfort; such patients should undergo a prompt medical evaluation, and discontinuation of therapy should be considered

There is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to antidepressants, including this drug, during pregnancy

Data from published literature report the presence of venlafaxine and its active metabolite in human milk and have not shown adverse reactions in breastfed infants