Effexor Starting Dose
The starting dose of Effexor (venlafaxine) for adults is 75 mg/day, administered in two or three divided doses with food, as specified by the FDA label. 1
Initial Dosing Protocol
- Start at 75 mg/day divided into 2-3 doses for immediate-release venlafaxine, taken with food 1
- For extended-release formulations, start at 37.5 mg once or twice daily 2, 3
- The immediate-release 75 mg/day starting dose is the FDA-approved initial regimen and represents the minimum effective dose demonstrated in clinical trials 1, 4
Dose Titration Strategy
- Increase by 75 mg/day at intervals of no less than 4 days if additional clinical effect is needed 1
- For extended-release, increase by 75 mg weekly as tolerated 2, 3
- The target therapeutic range is 150-225 mg/day, which typically requires 2-4 weeks to achieve 2, 3
- Maximum dose is 375 mg/day for severe or treatment-resistant depression, though outpatient doses rarely exceed 225 mg/day 1, 5
Critical Monitoring Requirements
- Monitor blood pressure at doses >150 mg/day due to dose-dependent hypertension risk (3-5% at ≤200 mg/day; 7% at 201-300 mg/day; 13% at >300 mg/day) 3, 4
- Blood pressure elevation becomes particularly important above 200 mg/day 2
- Exercise caution in patients with pre-existing cardiac disease, as cardiac conduction abnormalities have been reported 2, 3
Special Population Adjustments
- Elderly patients: No dose adjustment required based on age alone, but use slower titration when increasing doses 2, 1
- Hepatic impairment: Reduce total daily dose by 50% in mild-to-moderate impairment; may require greater reduction in cirrhosis 1
- Renal impairment: Reduce by 25% for GFR 10-70 mL/min; reduce by 50% for hemodialysis patients 1
Common Pitfalls to Avoid
- Never discontinue abruptly - always taper gradually to prevent withdrawal syndrome 2, 3
- Nausea is the most common side effect (leading to 6% discontinuation) but typically resolves within 1-3 weeks 4, 6
- Starting at lower doses (e.g., 37.5 mg) may reduce initial nausea but delays reaching therapeutic efficacy 1
- Early responses are more consistently seen at higher dosages (150-225 mg/day range) 4, 6