Venlafaxine XR Dose Escalation from 150mg
The next dose increase for a patient on Effexor XR 150mg is 225mg daily. 1, 2
Standard Dose Titration Algorithm
- Increase by 75mg increments when escalating from the current 150mg dose 2
- Wait at least 4 days between dose increases to assess tolerability and response 2
- The therapeutic efficacy range is 150-225mg/day, which typically requires 2-4 weeks to achieve full effect 1
Maximum Dosing Considerations
- The maximum recommended dose is 225mg/day for most outpatient settings 2
- More severely depressed patients, particularly inpatients, may require higher doses up to 375mg/day in divided doses 2, 3
- Doses above 225mg/day showed benefit primarily in severely depressed inpatients (mean effective dose 350mg/day) 2
Critical Monitoring Requirements
- Blood pressure monitoring is mandatory, especially at doses >200mg/day, as dose-dependent hypertension occurs in 3-5% at ≤200mg/day, 7% at 201-300mg/day, and 13% at >300mg/day 3
- In older adults (≥60 years), orthostatic hypotension develops in 20% of patients, with higher rates (22.4%) at doses ≥225mg/day, significantly increasing fall risk 4
- Monitor both sitting and standing blood pressure before each dose escalation 4
Common Pitfalls to Avoid
- Never increase doses faster than every 4 days - this increases risk of adverse effects without improving efficacy 2
- Do not abruptly discontinue - venlafaxine has a high risk of severe withdrawal syndrome, even after missing a single dose 5
- Avoid doses >225mg/day in outpatients unless there is clear evidence of treatment resistance, as efficacy data beyond this dose is limited to inpatient populations 2