Venlafaxine ER Dosing Guidelines
The recommended starting dose for Venlafaxine Extended Release (ER) is 75 mg once daily, with potential increases to 150-225 mg daily based on clinical response and tolerability. 1
Initial Dosing
- Start with 75 mg once daily (the minimum effective dose) 1, 2
- Take with food to improve tolerability 1
- For elderly patients or those with hepatic/renal impairment, consider starting at a lower dose 1
Dose Titration
- Dose may be increased to 150 mg/day if needed for better clinical effect 1
- Further increases up to 225 mg/day may be considered for patients with inadequate response 1
- When increasing the dose, make increments of up to 75 mg/day at intervals of no less than 4 days 1
- Maximum recommended dose is 225 mg/day for outpatients with moderate depression 1
- More severely depressed inpatients may respond to higher doses (up to 375 mg/day) 1, 3
Special Populations
Hepatic Impairment
- Reduce total daily dose by 50% in patients with mild to moderate hepatic impairment 1
- Consider further dose reduction in patients with cirrhosis due to individual 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) 1
- Reduce total daily dose by 50% in patients undergoing hemodialysis 1
- Individualize dosing based on patient response due to variability in clearance 1
Elderly Patients
- No specific dose adjustment is recommended based on age alone 1
- However, exercise caution and consider slower titration when increasing the dose 1
Maintenance Treatment
- Long-term treatment is often required for major depressive disorder 1
- Patients should be maintained on the lowest effective dose 1
- Periodically reassess patients to determine the need for continued maintenance treatment 1
Discontinuation
- Gradual dose reduction is strongly recommended rather than abrupt cessation 1
- Monitor for discontinuation symptoms (dizziness, sensory disturbances, anxiety, nausea) 1
- If intolerable symptoms occur during discontinuation, consider resuming the previously prescribed dose and decreasing more gradually 1
Clinical Considerations
- Venlafaxine ER has shown efficacy in both outpatient and inpatient settings 3, 4
- For neuropathic pain, the recommended dosage range is 75-225 mg daily 5
- A positive dose-response relationship has been demonstrated with doses up to 375 mg/day 2
- In treatment-resistant depression, venlafaxine may be more effective than SSRIs, particularly in severely depressed patients 6
Important Precautions
- Do not use concurrently with MAOIs or within 14 days of stopping an MAOI 1
- Wait at least 7 days after stopping venlafaxine before starting an MAOI 1
- Monitor blood pressure regularly, as venlafaxine can cause dose-dependent increases in blood pressure
- Avoid abrupt discontinuation due to risk of withdrawal symptoms 1
Venlafaxine ER offers the advantage of once-daily dosing compared to the immediate-release formulation, which may improve adherence while maintaining similar efficacy 4.