What is the starting dose of venlafaxine (Effexor)?

Starting Dose of Venlafaxine (Effexor)

The recommended starting dose for venlafaxine is 75 mg/day, administered in two or three divided doses, taken with food. 1

Dosing Guidelines

• The FDA-approved initial treatment dose is 75 mg/day, divided into two or three doses, and should be taken with food 1
• Depending on tolerability and clinical need, the dose may be increased to 150 mg/day and further to 225 mg/day if needed 1
• When increasing the dose, increments of up to 75 mg/day should be made at intervals of no less than 4 days 1
• For neuropathic pain management, the minimum effective dose is also 75 mg/day, with an efficacious range typically between 150-225 mg/day 2

Special Populations

• For patients with mild to moderate hepatic impairment, the total daily dose should be reduced by 50% 1
• For patients with mild to moderate renal impairment (GFR=10 to 70 mL/min), the total daily dose should be reduced by 25% 1
• For patients undergoing hemodialysis, the total daily dose should be reduced by 50% 1
• No dose adjustment is recommended for elderly patients based on age alone, though caution should be exercised when increasing the dose 1

Clinical Efficacy Considerations

• Clinical studies have established 75 mg/day as the minimum effective dose for depression 3
• A therapeutic response may be evident as early as week 2 of treatment with doses of 75 to 225 mg/day 4
• For more severely depressed inpatients, higher doses (mean of 350 mg/day, up to maximum 375 mg/day) may be required 1, 5
• When used for neuropathic pain, typically 2-4 weeks are required to titrate to an efficacious dosage 2

Safety Considerations

• The most common adverse effects include nausea (which typically resolves within 1-3 weeks), somnolence, insomnia, and dizziness 5
• Blood pressure monitoring is important, particularly at higher doses, as venlafaxine can cause modest increases in blood pressure 2, 5
• At doses ≤200 mg/day, 3-5% of patients experience blood pressure elevation; this increases to 7% at 201-300 mg/day and 13% at >300 mg/day 5
• Abrupt discontinuation should be avoided; the medication should be tapered when discontinuing to prevent withdrawal symptoms 2

Formulation Considerations

• Venlafaxine is available in both immediate-release (requiring multiple daily doses) and extended-release formulations (once-daily dosing) 4
• Extended-release formulation has been shown to be more effective than immediate-release at equivalent doses (75-150 mg/day) in some studies 4

This dosing information provides a clear starting point of 75 mg/day for most patients, with appropriate adjustments based on clinical response, tolerability, and patient-specific factors such as hepatic or renal impairment.