Initial Dosing of Effexor XR (Venlafaxine) for Adults
The recommended starting dose for Effexor XR (venlafaxine) in adults is 75 mg once daily, which can be taken with food. 1
Dosing Guidelines and Titration
Venlafaxine XR (extended-release) is typically initiated at a lower dose and then titrated based on clinical response and tolerability:
- Initial dose: 75 mg once daily
- Titration: Dose may be increased in increments of up to 75 mg/day at intervals of no less than 4 days
- Target dose range: 75-225 mg/day for most patients
- Maximum dose: 375 mg/day, though doses above 225 mg/day may be needed for more severely depressed patients 1
Special Populations
Hepatic Impairment
- Mild to moderate impairment: Reduce total daily dose by 50%
- Severe impairment: May require more than 50% reduction and individualized dosing 1
Renal Impairment
- Mild to moderate impairment (GFR 10-70 mL/min): Reduce total daily dose by 25%
- Hemodialysis patients: Reduce total daily dose by 50%
- Individualization may be necessary due to variability in clearance 1
Elderly Patients
- No specific dose adjustment based on age alone
- Extra caution when increasing the dose in elderly patients 1
Administration Considerations
- Take with food to improve tolerability
- For Effexor XR (extended-release), administer once daily, preferably at the same time each day
- Swallow capsules whole; do not crush, chew, or divide
Common Side Effects
The most frequently reported side effects include:
- Nausea
- Dizziness
- Somnolence
- Insomnia
- Dry mouth
- Sweating
Monitoring Recommendations
- Blood pressure should be monitored regularly, as venlafaxine can cause dose-dependent increases in blood pressure, particularly at higher doses 2, 3
- Monitor for signs of serotonin syndrome, especially when initiating therapy or increasing doses
- Assess clinical response within 2-4 weeks of starting treatment
Cautions
- Blood pressure increases can occur, especially at higher doses; use with caution in patients with cardiovascular disease 4
- A withdrawal syndrome may occur if discontinued abruptly; taper gradually when discontinuing 4
- Cardiac conduction abnormalities have been reported in a small number of patients 4
Venlafaxine's efficacy in depression is well-established, with some studies suggesting a more rapid onset of action at higher doses, though this must be balanced against the potential for increased side effects 5, 6.