Venlafaxine Tapering Schedule Using Compounded Liquid Formulation
For tapering venlafaxine from 150mg using a compounded liquid formulation, implement a gradual 5% reduction schedule calculated from the most recent dose to minimize withdrawal symptoms and optimize patient outcomes.
Rationale for Gradual Tapering
Venlafaxine requires careful tapering when discontinuing treatment because it inhibits both serotonin and norepinephrine reuptake, with withdrawal symptoms potentially affecting both neurotransmitter systems 1. Standard tapering schedules often recommend reducing by fixed amounts (e.g., 37.5mg every 1-2 weeks), but this can be too rapid for many patients, especially at lower doses.
5% Reduction Schedule from 150mg Starting Dose
| Week | Dose (mg) | Reduction from Previous Dose |
|---|---|---|
| 1 | 150.0 | Starting dose |
| 2 | 142.5 | 7.5mg (5% of 150mg) |
| 3 | 135.4 | 7.1mg (5% of 142.5mg) |
| 4 | 128.6 | 6.8mg (5% of 135.4mg) |
| 5 | 122.2 | 6.4mg (5% of 128.6mg) |
| 6 | 116.1 | 6.1mg (5% of 122.2mg) |
| 7 | 110.3 | 5.8mg (5% of 116.1mg) |
| 8 | 104.8 | 5.5mg (5% of 110.3mg) |
| 9 | 99.5 | 5.3mg (5% of 104.8mg) |
| 10 | 94.5 | 5.0mg (5% of 99.5mg) |
| 11 | 89.8 | 4.7mg (5% of 94.5mg) |
| 12 | 85.3 | 4.5mg (5% of 89.8mg) |
| 13 | 81.0 | 4.3mg (5% of 85.3mg) |
| 14 | 77.0 | 4.0mg (5% of 81.0mg) |
| 15 | 73.1 | 3.9mg (5% of 77.0mg) |
| 16 | 69.5 | 3.6mg (5% of 73.1mg) |
| 17 | 66.0 | 3.5mg (5% of 69.5mg) |
| 18 | 62.7 | 3.3mg (5% of 66.0mg) |
| 19 | 59.6 | 3.1mg (5% of 62.7mg) |
| 20 | 56.6 | 3.0mg (5% of 59.6mg) |
Continue with 5% reductions until reaching approximately 5-10mg, then consider final discontinuation
Implementation Guidelines
Compounding Instructions
- Request a compounded liquid formulation of venlafaxine with a concentration that allows for precise measurement of the calculated doses (e.g., 5mg/mL)
- Ensure the pharmacy provides appropriate measuring devices (oral syringes) for accurate dosing
Monitoring Protocol
Weekly assessment of withdrawal symptoms during the taper:
Adjustment strategy if withdrawal symptoms occur:
- Hold at current dose until symptoms resolve
- Consider slowing the taper to 2.5% reductions if symptoms are persistent
- For severe symptoms, temporarily increase dose to the previous level 1
Common Pitfalls to Avoid
Tapering too quickly is the most common error and can lead to unnecessary suffering 1
- The 5% reduction schedule is designed to minimize this risk
Using fixed dose reductions throughout the taper
- The percentage-based approach ensures proportionally smaller reductions as the dose decreases
Mistaking withdrawal symptoms for relapse of depression
- Withdrawal symptoms typically emerge within days of dose reduction and include dizziness and sensory symptoms
- Relapse symptoms develop more gradually and mirror the original depressive symptoms
Special Considerations
- For patients who have been on venlafaxine for longer periods (>1 year), consider extending the time between reductions to 2 weeks 1
- Non-pharmacological approaches such as regular exercise, stress management techniques, and sleep hygiene practices can help manage withdrawal symptoms 1
- Symptomatic treatment with NSAIDs, antihistamines, or anti-nausea remedies may be needed for specific withdrawal symptoms 1
This tapering schedule using a compounded liquid formulation allows for precise, gradual dose reductions that minimize the risk of withdrawal symptoms while providing a clear path to discontinuation.