Is it acceptable to increase the dose of venlafaxine (Effexor) from 75mg to 150mg after 7 days?

From the Guidelines

Increasing venlafaxine from 75mg to 150mg after 7 days is acceptable, as the recommended titration schedule for venlafaxine involves increasing the dose by 75 mg each week, as indicated in the study published in the Mayo Clinic Proceedings 1. When considering this increase, it's essential to follow the guidance of a healthcare provider to monitor for any potential side effects and adjust the dosage as needed. The study outlines the prescribing recommendations for first-line medications, including venlafaxine, which suggests starting with 37.5 mg once or twice daily and increasing by 75 mg each week, with a maximum dosage of 225 mg/d, and an adequate trial duration of 4-6 weeks 1. Key points to consider when increasing the dose include:

• Starting with a lower dose and gradually increasing it helps minimize side effects and allows the body to adapt to the medication.
• The full benefits of venlafaxine may take 2-4 weeks at a therapeutic dose to be experienced.
• Potential side effects such as nausea, headache, increased sweating, or sleep disturbances are usually temporary and improve within a few days.
• Severe side effects should be reported to a healthcare provider immediately to avoid sudden discontinuation, which can cause withdrawal symptoms. It's crucial to prioritize the patient's safety and well-being by closely monitoring their response to the increased dose and adjusting the treatment plan as necessary, based on the most recent and highest quality evidence available 1.

From the FDA Drug Label

When increasing the dose, increments of up to 75 mg/day should be made at intervals of no less than 4 days. It is not ok to increase venlafaxine from 75mg to 150mg after 7 days, as the recommended interval is no less than 4 days between increments. Therefore, the dose can be increased after a minimum of 4 days, but not after just 7 days if the initial increase was made on the first day. 2

From the Research

Increasing Venlafaxine Dosage

• The decision to increase venlafaxine from 75mg to 150mg after 7 days should be based on the patient's response to the initial dose and their tolerance to potential side effects 3, 4.
• A study published in The Lancet. Psychiatry found that venlafaxine had an initially increasing dose-efficacy relationship up to around 75-150 mg, followed by a more modest increase 3.
• However, another study published in Prescrire international warned that venlafaxine can provoke dose-dependent blood pressure elevation, sometimes requiring treatment discontinuation 4.
• A clinical trial published in the Journal of research in medical sciences found that patients with irritable bowel syndrome who received venlafaxine (37.5 mg/day for 2 weeks, followed by 75 mg/day for the next 2 weeks and then 150 mg/day) experienced significant improvement in symptoms, but also experienced more side effects than the placebo group 5.
• A meta-analysis published in The Journal of clinical psychiatry found that venlafaxine was associated with small, but statistically significant, increases in supine diastolic blood pressure, and that the effect was highly dose-dependent 6.
• A retrospective naturalistic study published in the Journal of psychopharmacology found that higher doses of venlafaxine (> or =375 mg/day) were associated with fewer days in hospital and fewer outpatient visits, but recommended further research to ascertain the cost-effectiveness of adequate dose prescribing 7.

Key Considerations

• The patient's response to the initial dose and their tolerance to potential side effects should be carefully monitored before increasing the dosage.
• The potential for dose-dependent side effects, such as blood pressure elevation, should be considered when increasing the dosage.
• The decision to increase the dosage should be based on a thorough evaluation of the patient's individual needs and circumstances.