If I stopped taking venlafaxine (Effexor) 225mg for a week, can I just restart at this dose or should I gradually increase it?

Restarting Venlafaxine After a One-Week Discontinuation

You should gradually restart venlafaxine rather than immediately resuming your previous 225mg dose to avoid potentially severe adverse effects. 1

Why Gradual Reintroduction is Necessary

Venlafaxine has one of the most pronounced discontinuation syndromes among antidepressants, and abrupt reintroduction at a high dose after stopping for a week can cause significant problems:

• After a week without venlafaxine, your body has likely adjusted to the absence of the medication
• Restarting at the full 225mg dose may cause excessive side effects similar to starting the medication for the first time
• The FDA drug label specifically recommends gradual dosing when initiating treatment 1

Recommended Restart Protocol

Follow this gradual reintroduction schedule:

1. Days 1-3: Start with 37.5mg or 75mg once daily
2. Days 4-7: Increase to 75mg-150mg daily (if tolerated)
3. Days 8-14: Increase to 150mg-225mg daily (if tolerated)
4. After day 14: Return to your previous stable dose of 225mg daily

This approach allows your body to readjust to the medication gradually while minimizing adverse effects.

Potential Risks of Immediate Full-Dose Restart

Restarting immediately at 225mg may cause:

• Nausea, vomiting, diarrhea
• Dizziness, headache
• Anxiety, agitation
• Insomnia or somnolence
• Elevated blood pressure (venlafaxine can cause dose-dependent increases in blood pressure) 2
• Excessive sweating

What to Monitor During Restart

• Blood pressure and pulse (venlafaxine can increase both in a dose-dependent manner)
• Emergence of anxiety or agitation
• Sleep disturbances
• Gastrointestinal symptoms
• Any unusual neurological symptoms

Important Considerations

• If you experience severe symptoms during the restart process, contact your healthcare provider immediately
• Never combine venlafaxine with MAOIs as this can cause potentially fatal serotonin syndrome 1
• If you've started any new medications during your week off venlafaxine, check for potential interactions before restarting

Why This Happened

Venlafaxine has a relatively short half-life (5 hours for the parent compound, 12 hours for its active metabolite) 3, which contributes to its pronounced discontinuation syndrome. When you stopped taking it for a week, your body began adapting to its absence. Restarting gradually helps your system readjust to the medication's effects on serotonin and norepinephrine neurotransmission.

Remember that discontinuation symptoms from venlafaxine can be severe and in some cases may resemble serious neurological conditions like stroke 4. This is why a careful, gradual reintroduction is strongly recommended rather than immediately resuming your previous dose.