What is the appropriate next dose of venlafaxine (Effexor) for a patient currently taking 37.5 mg daily?

Next Dose of Venlafaxine After 37.5 mg

The next dose is 75 mg daily, which should be initiated after at least 4 days at the current 37.5 mg dose. 1

Standard Titration Protocol

For patients currently on 37.5 mg daily, increase to 75 mg daily as the next step. 1 The FDA-approved dosing schedule specifies:

• Starting dose: 75 mg/day (divided into 2-3 doses for immediate-release) 1
• Dose increments: Up to 75 mg/day increases 1
• Minimum interval between increases: At least 4 days 1

Since your patient is on 37.5 mg (half the standard starting dose), the logical next step is to reach the recommended initial therapeutic dose of 75 mg daily. 1

Target Therapeutic Dose

The therapeutic target is 150 mg/day, which typically requires 2-4 weeks to achieve. 2, 3 The recommended titration schedule to reach this target:

• Week 1: 75 mg/day 2
• Week 2: Increase to 150 mg/day (target achieved) 2
• Weeks 3-6: Maintain 150 mg/day for a complete therapeutic trial of 4-6 weeks 2

Using 75 mg weekly increments allows you to reach therapeutic dosing in 1-2 weeks, compared to 3-4 weeks with smaller 37.5 mg increments. 2

Formulation Considerations

Extended-release (XR) formulation is preferred for once-daily dosing and improved tolerability. 2, 3 The XR formulation:

• Reduces peak-related side effects like nausea 2
• Improves adherence with once-daily dosing 2
• Has lower risk of discontinuation syndrome with missed doses 2

Safety Monitoring

Measure blood pressure before each dose increase, particularly as you approach doses >200 mg/day. 2, 3 Venlafaxine causes dose-dependent blood pressure elevations. 2, 3

Exercise caution in patients with cardiac disease due to rare reports of conduction abnormalities. 2, 3

Common Pitfall to Avoid

The most common adverse event is nausea, which peaks during the first 2 weeks of treatment. 4 Reassure patients that nausea typically resolves and has low likelihood of developing after the initial 2-week period. 4

Maximum Dosing

If 150 mg/day proves insufficient after a 4-6 week trial, doses can be increased:

• Outpatient maximum: 225 mg/day for most patients 1
• Severely depressed inpatients: Up to 375 mg/day may be considered 1
• Dose increases: Continue using 75 mg increments at minimum 4-day intervals 1