From the Guidelines
Venlafaxine is used to treat anxiety disorders, including social anxiety disorder and generalized anxiety disorder.
Uses of Venlafaxine
- Venlafaxine, a Serotonin-Norepinephrine Reuptake Inhibitor (SNRI), is suggested for the treatment of social anxiety disorder in adults 1.
- It is also used to treat generalized anxiety disorder, particularly in children and adolescents 7 years old, although duloxetine is the only SNRI with an FDA indication for this condition 1.
- The choice of medication for anxiety within the SNRI class may be governed by considerations such as pharmacokinetics, pharmacodynamics, tolerability, cost, and insurance formularies 1.
Important Considerations
- Venlafaxine extended release has a sufficiently long elimination half-life to permit single daily dosing, while venlafaxine immediate release may require twice- or thrice-daily dosing due to its short elimination half-life 1.
- Adverse effects of venlafaxine can include diaphoresis, dry mouth, abdominal discomfort, nausea, vomiting, diarrhea, dizziness, headache, tremor, insomnia, somnolence, decreased appetite, and weight loss 1.
- Uncommon but potentially serious adverse effects of venlafaxine include suicidal thinking and behavior, behavioral activation/agitation, hypomania, mania, sexual dysfunction, seizures, abnormal bleeding, and serotonin syndrome 1.
From the FDA Drug Label
INDICATIONS AND USAGE Venlafaxine tablets, USP are indicated for the treatment of major depressive disorder The efficacy of Venlafaxine Hydrochloride Tablets in the treatment of major depressive disorder was established in 6-week controlled trials of adult outpatients whose diagnoses corresponded most closely to the DSM-III or DSM-III-R category of major depression
- Major Depressive Disorder: Venlafaxine is used for the treatment of major depressive disorder.
- Key Symptoms: A major depressive episode implies a prominent and relatively persistent depressed or dysphoric mood that usually interferes with daily functioning, including symptoms such as change in appetite, change in sleep, psychomotor agitation or retardation, loss of interest in usual activities or decrease in sexual drive, increased fatigue, feelings of guilt or worthlessness, slowed thinking or impaired concentration, and a suicide attempt or suicidal ideation. Venlafaxine is also used for maintaining an antidepressant response for up to 26 weeks following 8 weeks of acute treatment 2.
From the Research
Uses of Venlafaxine
- Venlafaxine is used as an effective antidepressant and has been approved for the treatment of generalized anxiety disorder 3.
- It is a serotonin-norepinephrine reuptake inhibitor (SNRI) that binds and blocks both the SERT and NET transporters, making it a mixed serotonin-norepinephrine reuptake inhibitor 4.
- Venlafaxine is used to treat major depressive disorder (MDD) with or without comorbid anxiety, and its pharmacodynamic properties can be harnessed to guide clinical practice 5.
- It is also used to manage fatigue/low energy, a frequent residual symptom in MDD, as evidenced by pooled data from clinical trials of venlafaxine XR 5.
Therapeutic Profile
- Venlafaxine has a high efficacy on depressive-like symptoms in relevant animal models, but to the same extent as common antidepressants 4.
- It appears to be one of the most effective treatments for major depression, but direct comparative studies are warranted to provide definitive conclusions about its superiority 4.
- Venlafaxine has been compared to selective serotonin reuptake inhibitors (SSRIs) in terms of efficacy, and some studies suggest that it has superior efficacy to SSRIs in the treatment of major depression 6.
- However, other studies have found that venlafaxine and SSRIs have similar and limited efficacy, and that venlafaxine is best avoided due to its higher risk of cardiovascular adverse effects and fatal overdoses 7.
Clinical Implications
- Venlafaxine should be considered as a first-line treatment for MDD with or without comorbid anxiety, and its pharmacodynamic properties can be used to guide clinical practice 5.
- The dose of venlafaxine can be adjusted to achieve optimal therapeutic effects, with lower doses selectively inhibiting 5HT uptake and higher doses inhibiting both 5HT and NE uptake 3.
- Clinicians should be aware of the potential risks and benefits of venlafaxine, including its higher risk of cardiovascular adverse effects and fatal overdoses, and monitor patients closely for these adverse effects 7.