Venlafaxine Dosing: Next Step After 75 mg
The next dose of venlafaxine after 75 mg is 150 mg daily. 1
Standard Dose Escalation
Venlafaxine should be increased from 75 mg to 150 mg daily when additional clinical effect is needed and the current dose is well tolerated. 1
Dose increases should be made in increments of up to 75 mg/day at intervals of no less than 4 days. 1 This means you must wait at least 4 days between dose adjustments to properly assess tolerability and response.
The FDA-approved dosing sequence for immediate-release venlafaxine is: 75 mg/day → 150 mg/day → 225 mg/day, with a maximum of 375 mg/day for severely depressed patients. 1
Formulation-Specific Considerations
For extended-release (XR) formulations, the same dosing progression applies (75 mg → 150 mg → 225 mg), but XR is administered once daily with food. 2
For immediate-release (IR) formulations, doses should be divided into 2-3 times daily with food. 1
Timing of Dose Adjustment
Wait 4-8 weeks at each dose level before concluding inadequate response. 2 This ensures sufficient time to evaluate clinical effect before escalating further.
Some patients may show dose-related improvements as early as 1-2 weeks, particularly at the 150 mg dose level. 3
Therapeutic Range
The effective dosage range is typically 150-225 mg/day, which represents the standard therapeutic window for most patients with major depression. 2
Doses above 225 mg/day (up to 375 mg maximum) are reserved for more severely depressed patients, particularly inpatients who may require higher doses for adequate response. 1, 4
Monitoring Requirements
Monitor blood pressure regularly as venlafaxine can cause dose-dependent increases, particularly at higher doses. 2
Watch for common side effects including nausea (most common in first 2 weeks), dizziness, somnolence, insomnia, dry mouth, and sweating. 3, 5
Special Population Adjustments
If your patient has hepatic or renal impairment, the standard progression does not apply: