What is the therapeutic dose of Effexor (venlafaxine) for adults?

Effexor (Venlafaxine) Therapeutic Dose

For major depressive disorder in adults, start venlafaxine at 75 mg/day in divided doses and titrate to an effective therapeutic range of 150-225 mg/day, with a maximum dose of 375 mg/day for severe or treatment-resistant depression. 1

Standard Dosing Algorithm

Initial Dosing

• Starting dose: 75 mg/day administered in two or three divided doses with food 1
• This initial dose is effective for moderately depressed outpatients 1

Dose Titration

• Increase to 150 mg/day if tolerability allows and further clinical effect is needed 1
• Further titration up to 225 mg/day can be implemented based on response 1
• Dose increments of up to 75 mg/day should be made at intervals of no less than 4 days 1
• The therapeutic efficacy range of 150-225 mg/day typically requires 2-4 weeks to achieve 2

Higher Doses for Severe Depression

• Doses up to 375 mg/day (maximum) may be necessary for more severely depressed patients, particularly inpatients 1
• More severely depressed inpatients responded to a mean dose of 350 mg/day in clinical trials 1
• Doses greater than 225 mg/day showed no additional benefit in moderately depressed outpatients, but severely depressed inpatients may respond to higher doses 1

Special Populations

Hepatic Impairment

• Reduce total daily dose by 50% in patients with mild to moderate hepatic impairment 1
• Individual variability is substantial; some patients with cirrhosis may require dose reductions exceeding 50% 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
• Administer after dialysis sessions 1

Elderly Patients

• No specific dose adjustment required based on age alone 1
• Exercise caution and use slower titration when increasing doses 1

Context-Specific Dosing

Neuropathic Pain

When used as a coanalgesic for neuropathic pain (off-label):

• Starting dose: 37.5 mg once or twice daily 2
• Titration: Increase by 75 mg each week 2
• Target therapeutic dose: 150-225 mg/day 2
• Maximum dose: 225 mg/day 2
• Duration of adequate trial: 4-6 weeks at therapeutic dose 2

Venlafaxine has demonstrated efficacy in painful diabetic peripheral neuropathy and painful polyneuropathies of various origins, though not in postherpetic neuralgia 2

Important Clinical Considerations

Monitoring Requirements

• Blood pressure monitoring is essential, particularly at doses >200 mg/day, as dose-dependent blood pressure increases can occur 2
• Cardiac conduction abnormalities have been reported in a small number of patients; prescribe with caution in those with cardiac disease 2

Discontinuation

• Always taper when discontinuing venlafaxine, as withdrawal syndrome has been described 2
• Abrupt discontinuation should be avoided 2

Formulation Considerations

• Venlafaxine is available in both immediate-release and extended-release preparations 2
• The extended-release formulation allows for once-daily dosing and may improve tolerability 3

Common Pitfalls to Avoid

• Inadequate titration time: Allow at least 4 days between dose increases to assess tolerability 1
• Underdosing: Many patients require 150-225 mg/day for optimal response; don't stop at 75 mg/day if response is inadequate 1
• Ignoring blood pressure: Monitor BP especially when exceeding 200 mg/day, as 7-13% of patients may experience dose-dependent elevations 4
• Forgetting dose adjustments: Always reduce doses in hepatic and renal impairment to avoid toxicity 1