Effexor (Venlafaxine) Dosing for Depression and Anxiety
For adults with depression or anxiety disorders, start venlafaxine at 37.5-75 mg daily and titrate by 75 mg weekly to a target dose of 150-225 mg/day, with a maximum of 375 mg/day for severe or treatment-resistant cases. 1
Starting Dose
- Begin with 37.5 mg twice daily (immediate-release) or 75 mg once daily (extended-release) 1, 2
- The extended-release formulation allows for once-daily dosing, which improves tolerability compared to immediate-release 2
Titration Schedule
- Increase by 75 mg per week as tolerated 1
- This gradual titration minimizes adverse effects, particularly nausea, which is most common during the first 2 weeks 2
- Allow 2-4 weeks to reach the efficacious dosage range of 150-225 mg/day 1
Target Therapeutic Dose
- 150-225 mg/day is the standard therapeutic range for most patients with depression 1, 3
- Doses of 75-225 mg/day were superior to placebo in outpatient studies 3
- Therapeutic response may be evident as early as week 2 at doses of 75-225 mg/day 4
- A dose-response relationship exists in the 75-225 mg/day range 3, 5
Higher Doses for Severe or Resistant Depression
- For severe depression or inpatients, doses up to 375 mg/day may be used 1, 3, 6
- A mean dose of approximately 350 mg/day was effective in inpatient studies 3
- Higher doses (375 mg/day) may provide superior efficacy and faster onset compared to standard doses 6, 7
- However, there was no consistent evidence of increased response with doses greater than 225 mg/day in outpatient populations 3
Maximum Dose
- The maximum daily dose is 375 mg/day 3, 6, 7
- Doses above 225 mg/day should be reserved for severe or treatment-resistant cases 6
Duration of Adequate Trial
- Allow 4-6 weeks at the target dose to assess response 1
- Significant antidepressant effects may be noted as early as 1-2 weeks with higher doses (150-200 mg/day) 5
Special Populations
Hepatic Impairment
- Reduce the total daily dose by 50% in patients with mild to moderate hepatic impairment 3
- Venlafaxine clearance is reduced by approximately 50% in cirrhotic patients, and elimination half-life is prolonged by 30% 3
Renal Impairment
- Reduce the total daily dose by 25-50% in patients with renal impairment (GFR 10-70 mL/min) 3
- In dialysis patients, reduce the dose by approximately 50% due to 57% reduction in clearance 3
Depression with Anxiety
- Use the same dosing strategy (75-225 mg/day) for depression with comorbid anxiety 5
- Venlafaxine shows dose-related improvements in anxiety symptoms associated with depression 5
- One study showed venlafaxine may be superior to fluoxetine for treating anxiety in depressed patients 1
Important Safety Considerations
- Monitor blood pressure, particularly at higher doses, as increases can occur 1
- Cardiac conduction abnormalities have been reported in a small number of patients; use with caution in cardiac disease 1
- Taper when discontinuing to avoid withdrawal syndrome 1
- Nausea is the most common adverse effect, highest during the first 2 weeks 4, 2