What is the starting dose of Effexor (venlafaxine) for an adult patient?

Starting Dose of Effexor (Venlafaxine)

The recommended starting dose of venlafaxine immediate-release is 75 mg/day divided into two or three doses taken with food, which can be increased to 150 mg/day and up to 225 mg/day based on tolerability and clinical response. 1

Standard Dosing for Depression

• Begin with 75 mg/day in divided doses (two or three times daily) with food 1
• Increase the dose in increments of up to 75 mg/day at intervals of no less than 4 days 1
• Target therapeutic range is typically 150-225 mg/day for most outpatients with moderate depression 1
• Maximum dose is 375 mg/day (generally in three divided doses) for more severely depressed patients, particularly inpatients 1

Extended-Release Formulation

• For venlafaxine XR, the starting approach allows for once-daily dosing, which may improve tolerability 2
• When used for neuropathic pain, start at 37.5 mg once or twice daily, titrating by 75 mg each week to reach the therapeutic target of 150-225 mg/day 2
• Allow 2-4 weeks to reach efficacious dosing of 150-225 mg/day 3, 2

Dose Adjustments for Special Populations

Hepatic Impairment

• Reduce total daily dose by 50% in patients with mild to moderate hepatic impairment or cirrhosis 1
• Individual variability is high; some patients may require greater than 50% reduction 1

Renal Impairment

• Reduce total daily dose by 25% in patients with mild to moderate renal impairment (GFR 10-70 mL/min) 1
• Reduce total daily dose by 50% in patients undergoing hemodialysis 1

Elderly Patients

• No dose adjustment required based on age alone 1
• However, use slower titration and extra caution when increasing doses in elderly patients 2, 1

Critical Monitoring Requirements

• Monitor blood pressure, especially at doses >200 mg/day, as dose-dependent increases can occur 3, 2
• Watch for cardiac conduction abnormalities, particularly in patients with pre-existing cardiac disease 3, 2
• Always taper when discontinuing to prevent withdrawal syndrome; never stop abruptly 3, 2

Common Pitfalls to Avoid

• Do not increase doses faster than every 4 days to allow adequate assessment of tolerability 1
• Do not skip blood pressure monitoring at higher doses (>200 mg/day), as hypertension is a recognized dose-dependent adverse effect 3, 4, 5
• Do not use standard doses in hepatic or renal impairment without appropriate reduction 1
• The most common side effects include nausea, increased fatigue, concentration difficulties, and sleepiness, which are more severe at higher doses 6