What is the recommended dose of venlafaxine (Effexor)?

Recommended Dosage of Venlafaxine (Effexor)

The recommended starting dose for venlafaxine is 75 mg/day, administered in two or three divided doses, taken with food, with a standard therapeutic range of 75-225 mg/day for most patients. 1

Initial Dosing and Titration

• Starting dose: 75 mg/day (in two or three divided doses)
• Titration: Increase by up to 75 mg/day at intervals of no less than 4 days 1
• Standard therapeutic range: 75-225 mg/day 2, 1
• Maximum dose: 375 mg/day (though doses above 225 mg are generally only needed for severely depressed inpatients) 1

For neuropathic pain specifically, the recommended dosage is:

• Starting dose: 50-75 mg daily
• Therapeutic range: 75-225 mg daily 2

Dosage Considerations for Special Populations

Hepatic Impairment

• Reduce total daily dose by 50% in patients with mild to moderate hepatic impairment
• Further individualization may be necessary for patients with cirrhosis due to high variability in clearance 1

Renal Impairment

• Reduce total daily dose by 25% in patients with mild to moderate renal impairment (GFR 10-70 mL/min)
• Reduce total daily dose by 50% in patients undergoing hemodialysis
• Individualization of dosing may be necessary 1

Elderly Patients

• No specific dose adjustment based on age alone is recommended
• However, exercise caution and consider starting at lower doses with more gradual titration 1

Clinical Efficacy Considerations

Venlafaxine demonstrates a dose-dependent mechanism of action:

• At lower doses (≤75 mg/day): Primarily inhibits serotonin reuptake
• At higher doses (>150 mg/day): Also inhibits norepinephrine reuptake, which may provide additional benefits for certain patients 3, 4

Studies indicate that while 75 mg/day is sufficient for many patients, those with more severe illness or treatment-resistant depression may benefit from higher doses 4. The extended-release formulation (Effexor XR) allows for once-daily dosing and may be better tolerated than the immediate-release formulation 5.

Monitoring and Side Effects

Common side effects include:

• Nausea, dry mouth
• Dizziness, somnolence, insomnia
• Sexual dysfunction
• Sweating 3, 5

Blood pressure should be monitored as venlafaxine can cause dose-dependent elevations in both systolic and diastolic blood pressure 3.

Important Clinical Considerations

• Venlafaxine should be taken with food to improve tolerability 1
• When discontinuing, gradual tapering is recommended to avoid withdrawal symptoms
• For patients with cardiovascular disease, careful monitoring is advised, particularly at higher doses
• For neuropathic pain, venlafaxine is often used as a coanalgesic in combination with other agents 2

Venlafaxine offers advantages over tricyclic antidepressants including fewer anticholinergic effects and reduced cardiotoxicity, making it a more attractive option for many patients 6.