Tapering Schedule for Venlafaxine XR 225mg
When discontinuing venlafaxine XR 225mg, a gradual tapering schedule reducing the dose by 10% of the original dose per month is recommended to minimize withdrawal symptoms.
Recommended Tapering Schedule
The most effective approach for tapering venlafaxine XR 225mg is to reduce the dose gradually over several months:
Initial Phase (Months 1-3)
- Month 1: Reduce from 225mg to 200mg daily (approximately 10% reduction)
- Month 2: Reduce to 175mg daily
- Month 3: Reduce to 150mg daily
Middle Phase (Months 4-6)
- Month 4: Reduce to 125mg daily
- Month 5: Reduce to 100mg daily
- Month 6: Reduce to 75mg daily
Final Phase (Months 7-10)
- Month 7: Reduce to 50mg daily
- Month 8: Reduce to 37.5mg daily
- Month 9: Reduce to 37.5mg every other day
- Month 10: Discontinue
Monitoring During Tapering
- Schedule follow-up visits every 2-4 weeks during the tapering process to monitor for withdrawal symptoms
- If significant withdrawal symptoms occur:
- Pause the taper at the current dose
- Wait 1-2 weeks for symptoms to stabilize
- Resume tapering at a slower rate (5% reduction instead of 10%)
Managing Withdrawal Symptoms
Common withdrawal symptoms include:
- Physical symptoms: dizziness, headache, nausea, diarrhea, sweating, tremor
- Psychological symptoms: anxiety, irritability, insomnia, mood changes
- Sensory symptoms: "brain zaps" (electric shock-like sensations)
Symptom Management Options
| Symptom | Management |
|---|---|
| Nausea/GI symptoms | Loperamide, small frequent meals |
| Insomnia/anxiety | Temporary use of trazodone or hydroxyzine |
| Headache/pain | Scheduled acetaminophen (max 3000mg daily) |
Special Considerations
- For patients with a history of anxiety disorders, previous withdrawal symptoms, or who have been on venlafaxine for >1 year, consider an even slower taper (5% reduction every 2-4 weeks)
- Never discontinue venlafaxine abruptly due to high risk of withdrawal syndrome
- If withdrawal symptoms are severe despite slow tapering, consider cross-tapering to fluoxetine (which has a longer half-life) before final discontinuation
Common Pitfalls to Avoid
- Tapering too quickly: This is the most common mistake and significantly increases withdrawal symptoms
- Irregular dosing: Maintain consistent timing of doses during the taper
- Lack of monitoring: Regular follow-up is essential to adjust the tapering schedule as needed
- Ignoring breakthrough symptoms: If withdrawal symptoms emerge, slow the taper rather than pushing through
The gradual approach to tapering venlafaxine is essential due to its relatively short half-life and dual action on both serotonin and norepinephrine systems, which creates a higher risk of withdrawal symptoms compared to other antidepressants 1, 2.