How to Taper Lexapro While Starting Effexor
When transitioning from Lexapro (escitalopram) to Effexor (venlafaxine), use a gradual cross-tapering approach with a 5-10% reduction of Lexapro every 1-2 weeks while slowly introducing Effexor to minimize withdrawal symptoms and prevent serotonin syndrome.
Cross-Tapering Strategy
Initial Phase
- Begin with the lowest available dose of Effexor (37.5mg daily) while maintaining the current Lexapro dose for the first week
- Monitor closely for signs of serotonin syndrome during the first 24-48 hours after starting the combination 1
Lexapro Tapering Schedule
- Reduce Lexapro by 5-10% of the original dose every 1-2 weeks 2
- For patients on higher doses (>10mg), initial reductions can be larger (10%)
- For patients on lower doses (≤10mg), slower reductions (5% every 2 weeks) are recommended
- Continue tapering until reaching the lowest available dose (5mg), then extend the interval between doses before stopping completely 3
Effexor Introduction Schedule
- Week 1: Start with 37.5mg daily of Effexor while maintaining Lexapro
- Week 2-3: Increase Effexor to 75mg daily if tolerated while reducing Lexapro by 5-10%
- Continue gradually increasing Effexor to target dose as Lexapro is tapered down
- Allow 3-4 weeks between Effexor dose increases to properly assess response 1
Monitoring for Withdrawal Symptoms
Common SSRI Withdrawal Symptoms
- Dizziness, fatigue, lethargy, general malaise, myalgias, chills, headaches
- Nausea, vomiting, diarrhea, insomnia, imbalance, vertigo
- Sensory disturbances, paresthesias, anxiety, irritability, agitation 1
Assessment Before Each Dose Change
- Evaluate for withdrawal symptoms before each Lexapro dose reduction
- If withdrawal symptoms are severe, slow the taper (reduce by only 2.5-5% every 2-4 weeks) 2
- Consider pausing the taper temporarily if withdrawal symptoms are intolerable 1
Monitoring for Serotonin Syndrome
High-Risk Period
- First 24-48 hours after combining medications or changing doses 1
Warning Signs
- Mental status changes: confusion, agitation, anxiety
- Neuromuscular hyperactivity: tremors, clonus, hyperreflexia, muscle rigidity
- Autonomic hyperactivity: hypertension, tachycardia, arrhythmias, tachypnea, diaphoresis 1
Emergency Management
- Discontinue all serotonergic agents immediately if serotonin syndrome is suspected
- Seek emergency medical care for severe symptoms including fever, seizures, or arrhythmias 1
Special Considerations
Hyperbolic Tapering
- Consider hyperbolic tapering (exponential dose reduction) for the final stages of Lexapro discontinuation
- This approach may be more effective than linear tapering for minimizing withdrawal symptoms 3, 4
- Tapering strips (if available) can facilitate precise dose reductions and have shown 70% effectiveness in antidepressant discontinuation 5
Risk Factors for Difficult Discontinuation
- Longer duration of Lexapro use (>5 years)
- Previous failed discontinuation attempts
- Higher baseline anxiety
- Female sex 5
Practical Tips
Use liquid formulation of Lexapro (if available) for more precise tapering in the final stages
Consider temporary symptom management with non-serotonergic medications:
- Hydroxyzine for anxiety
- Trazodone for insomnia
- NSAIDs/acetaminophen for pain 2
Avoid abrupt discontinuation of Lexapro as it can lead to significant withdrawal symptoms 6
If withdrawal symptoms become severe despite slow tapering, consider temporarily returning to the previous dose before attempting a slower taper 2
Remember that successful antidepressant transitions require patience and careful monitoring. The entire process may take several weeks to months depending on the initial Lexapro dose and individual sensitivity to withdrawal effects 7.