Venlafaxine 75 mg: Dosing Recommendations
For a patient currently taking venlafaxine 75 mg daily, this represents the standard starting therapeutic dose, which can be maintained if effective, or increased by 75 mg increments at intervals of no less than 4 days up to 225 mg/day (or higher for severe depression), with the target therapeutic range being 150-225 mg/day. 1
Current Dose Assessment
- 75 mg/day is the FDA-approved starting dose for venlafaxine immediate-release (administered in 2-3 divided doses with food) 1
- For venlafaxine extended-release formulations, 75 mg once daily is within the therapeutic range, though many patients require higher doses for optimal response 2, 3
- This dose has demonstrated efficacy: in breast cancer patients with hot flashes, 75 mg/day produced a 61% reduction in hot flash scores 4
Dose Titration Strategy
If clinical response is inadequate after 4-6 weeks:
- Increase by 75 mg increments at intervals of no less than 4 days 1
- Target the therapeutic range of 150-225 mg/day, which typically requires 2-4 weeks to reach 2
- For moderately depressed outpatients, doses above 225 mg/day showed no additional benefit, but severely depressed inpatients responded to mean doses of 350 mg/day 1
- Maximum dose is 375 mg/day in divided doses for severe or treatment-resistant depression 1, 5
Monitoring Requirements
Blood pressure monitoring is essential:
- Cardiac conduction abnormalities and blood pressure increases occur particularly at higher doses 2
- Approximately 10% of patients on average doses of 342 mg/day showed mildly raised blood pressure 6
- Use with caution in patients with cardiac disease 2
Discontinuation Protocol
Never stop venlafaxine abruptly:
- Venlafaxine must be tapered gradually to prevent discontinuation syndrome 4, 2, 1
- This is particularly important with short-acting formulations like immediate-release venlafaxine 4
- If intolerable symptoms occur during taper, resume the previous dose and decrease more gradually 1
- Allow at least 7 days after stopping venlafaxine before starting an MAOI 1
Special Populations
Dose adjustments required for:
- Hepatic impairment (mild-moderate): Reduce total daily dose by 50% 1
- Renal impairment (GFR 10-70 mL/min): Reduce total daily dose by 25% 1
- Hemodialysis patients: Reduce total daily dose by 50% 1
- Elderly patients: No automatic dose adjustment needed, but exercise caution when increasing doses 1
Common Pitfalls
- Inadequate trial duration: Allow 4-6 weeks at therapeutic doses before declaring treatment failure 2
- Too-rapid titration: Increases should occur no more frequently than every 4 days to assess tolerability 1
- Ignoring drug interactions: Venlafaxine has weak CYP2D6 inhibition, making it safer than paroxetine or fluoxetine when combined with tamoxifen 4
- Abrupt discontinuation: This consistently causes withdrawal symptoms; always taper 4, 1