Venlafaxine Dose Escalation from 150 mg Daily
For a patient currently taking venlafaxine 150 mg daily, the next dose is 225 mg/day, which represents the upper end of the standard therapeutic range for most patients with depression. 1, 2
Dose Titration Guidelines
Standard Escalation Protocol:
- Increase by increments of up to 75 mg/day at intervals of no less than 4 days 3
- From your current 150 mg/day, add 75 mg to reach 225 mg/day 3
- The therapeutic target range is 150-225 mg/day for most patients 1, 2
Extended-Release Formulation Preferred:
- Use once-daily dosing with the XL formulation for improved adherence and tolerability 2
- The XL formulation reduces peak-related side effects like nausea compared to immediate-release 2
Maximum Dosing Considerations
If 225 mg/day proves insufficient:
- More severely depressed patients may require higher doses up to 375 mg/day maximum 3
- Doses above 225 mg/day are typically reserved for severe or treatment-resistant depression, particularly in inpatient settings 3, 4
- Divide doses of 300-375 mg/day into three daily administrations 3
Timeline for Clinical Response
Allow adequate trial duration:
- Requires 4-6 weeks total, including titration time, to assess full therapeutic response 1, 5
- After reaching 225 mg/day, wait at least 2 weeks at this dose before considering further escalation 1
Critical Safety Monitoring
Blood Pressure Surveillance:
- Monitor blood pressure at each dose increase, as venlafaxine causes dose-dependent blood pressure elevations 1, 2, 5
- This effect becomes more pronounced at higher doses (>225 mg/day) 1
Cardiac Precautions:
- Exercise heightened caution in patients with cardiac disease due to potential cardiac conduction abnormalities 1, 5
- Consider baseline ECG if cardiac history present 1
Important Discontinuation Warning
Never abruptly stop venlafaxine: