Venlafaxine Dosage Titration from 37.5 mg Starting Dose
If you started venlafaxine at 37.5 mg, increase the dose to 75 mg after 4-7 days if tolerated, then continue titrating upward by 75 mg increments every 4 days or longer until reaching an effective dose, typically 150-225 mg/day for most patients. 1
Standard Titration Schedule
Week-by-week titration approach:
- Week 1: 37.5 mg daily (your current dose) 1
- Week 2: Increase to 75 mg daily (can be split as 37.5 mg twice daily) 1
- Week 3-4: If needed for further clinical effect, increase to 150 mg daily 1
- Week 5+: May increase up to 225 mg/day based on response and tolerability 1
The FDA label specifies that when increasing the dose, increments of up to 75 mg/day should be made at intervals of no less than 4 days 1. This allows adequate time to assess tolerability before further dose escalation.
Target Dose Considerations
For most outpatients with moderate depression: 150-225 mg/day is typically sufficient, with no evidence of additional benefit beyond 225 mg/day in this population 1, 2.
For more severely depressed patients: Higher doses up to 375 mg/day (maximum recommended) may be necessary, as inpatient studies showed response to mean doses of 350 mg/day 1. Some treatment-resistant patients have tolerated doses up to 600 mg/day in specialized settings, though this exceeds standard recommendations 3.
Monitoring During Titration
Blood pressure monitoring is essential as venlafaxine causes dose-dependent elevations in supine diastolic blood pressure 4. The incidence of sustained blood pressure elevation is:
Check blood pressure at each dose increase, particularly when exceeding 300 mg/day 4.
Common Side Effects During Titration
Nausea is the most frequent side effect (leading to discontinuation in 6% of patients) but typically resolves within 1-3 weeks 2, 5. Other common effects include dizziness (3%), insomnia (3%), somnolence (3%), constipation, sweating, and sexual dysfunction 2, 6.
At higher doses (≥375 mg/day), expect increased frequency and severity of side effects including fatigue (48%), concentration difficulties (48%), sleepiness (37%), and memory complaints (44%), though discontinuation rates remain similar to standard doses 3.
Therapeutic Drug Monitoring
The recommended therapeutic range for venlafaxine plus its active metabolite O-desmethylvenlafaxine is 195-400 ng/mL 7. This can guide dose optimization if clinical response is inadequate despite adequate dosing and duration.
Special Populations Requiring Dose Adjustment
Hepatic impairment: Reduce total daily dose by 50% in mild-to-moderate hepatic impairment; may require >50% reduction in cirrhosis 1.
Renal impairment: Reduce total daily dose by 25% for GFR 10-70 mL/min; reduce by 50% for hemodialysis patients 1.
Elderly patients: No automatic dose reduction required, but exercise extra caution when increasing doses 1.
Onset of Antidepressant Effect
Venlafaxine may demonstrate clinical superiority over placebo as early as Week 1, with some inpatient studies showing benefit by Day 4, particularly at higher doses 2, 6. However, full therapeutic response typically requires 4-6 weeks at an adequate dose 1.