Venlafaxine (Effexor) | NAMI: National Alliance on Mental Illness

Brand names:

• Effexor®
  • Tablets (immediate release): 25 mg, 37.5 mg, 50 mg, 75 mg, 100 mg
• Effexor XR®
  • Capsules (extended release): 37.5 mg, 75 mg, 150 mg
• Venlafaxine
  • Tablets (extended release): 37.5, 75 mg, 150 mg, 225 mg
  • Tablets (immediate release): 25 mg, 37.5 mg, 50 mg 75, mg 100 mg

Generic name: venlafaxine (ven la FAX een)

All FDA black box warnings are at the end of this fact sheet. Please review before taking this medication.

What Is Venlafaxine And What Does It Treat?

Venlafaxine is an antidepressant medication that works in the brain. It is approved for the treatment of major depressive disorder (MDD), generalized anxiety disorder (GAD), panic disorder, and social anxiety disorder (social phobia).

Symptoms of depression include:

• Depressed mood – feeling sad, empty, or tearful
• Feeling worthless, guilty, hopeless, and helpless
• Loss of interest or pleasure in your usual activities
• Sleep and eat more or less than usual (for most people it is less)
• Low energy, trouble concentrating, or thoughts of death (suicidal thinking)
• Psychomotor agitation (‘nervous energy’)
• Psychomotor retardation (feeling like you are moving and thinking in slow motion)
• Suicidal thoughts or behaviors

Generalized Anxiety Disorder (GAD) occurs when a person experiences excessive anxiety or worry for at least six months. Other symptoms include:

• Restlessness
• Fatigue (low energy, feeling tired all the time)
• Difficulty concentrating
• Irritability
• Muscle tension
• Sleep disturbance (difficulty falling asleep or waking up in the middle of the night)

Panic Disorder occurs when a person experiences unexpected and repeated episodes of intense fear. These episodes have physical symptoms including chest pain, shortness of breath, heart palpitations, sweating, dizziness, and nausea. Fear of future episodes is also part of panic disorder.

Social phobia/social anxiety disorder is a fear of situations where one may feel as if they are being judged by others. Symptoms include:

• Blushing
• Difficulty talking
• Nausea
• Sweating
• Shaking

Venlafaxine may also be helpful when prescribed “off-label” for attention-deficit/hyperactivity disorder (ADHD) in adults and children/adolescents, diabetic neuropathy, migraine prevention, hot flashes, obsessive compulsive disorder (OCD), posttraumatic stress disorder (PTSD), and premenstrual dysphoric disorder (PMDD) . “Off-label” means that it hasn’t been approved by the Food and Drug Administration for this condition. Your mental health provider should justify his or her thinking in recommending any “off-label” treatment. They should be clear about the limits of the research around that medication and if there are any other options.

What Is The Most Important Information I Should Know About Venlafaxine?

Do not stop taking venlafaxine, even when you feel better. With input from you, your health care provider will assess how long you will need to take the medicine.

Missing doses of venlafaxine may increase your risk for relapse in your symptoms.

Stopping venlafaxine abruptly may result in one or more of the following withdrawal symptoms: irritability, nausea, feeling dizzy, vomiting, nightmares, headache, and/or paresthesias (prickling, tingling sensation on the skin).

Depression is also a part of bipolar illness. People with bipolar disorder who take antidepressants may be at risk for “switching” from depression into mania. Symptoms of mania include “high” or irritable mood, very high self-esteem, decreased need for sleep, pressure to keep talking, racing thoughts, being easily distracted, frequently involved in activities with a large risk for bad consequences (for example, excessive buying sprees).

Medical attention should be sought if serotonin syndrome is suspected. Please refer to serious side effects for signs/symptoms.

Are There Specific Concerns About Venlafaxine And Pregnancy?

If you are planning on becoming pregnant, notify your health care provider to best manage your medications. People living with MDD who wish to become pregnant face important decisions. Untreated MDD has risks to the fetus, as well as the mother. It is important to discuss the risks and benefits of treatment with your doctor and caregivers. For women who take antidepressant medications during weeks 13 through the end of their pregnancy (second and third trimesters), there is a risk that the baby can be born before it is fully developed (before 37 weeks).

Caution is advised with breastfeeding since venlafaxine does pass into breast milk.

What Should I Discuss With My Health Care Provider Before Taking Venlafaxine?

• Symptoms of your condition that bother you the most
• If you have thoughts of suicide or harming yourself
• Medications you have taken in the past for your condition, whether they were effective or caused any adverse effects
• If you experience side effects from your medications, discuss them with your provider. Some side effects may pass with time, but others may require changes in the medication.
• Any other psychiatric or medical problems you have, including a history of bipolar disorder
• All other medications you are currently taking (including over the counter products, herbal and nutritional supplements) and any medication allergies you have
• Other non-medication treatment you are receiving, such as talk therapy or substance abuse treatment. Your provider can explain how these different treatments work with the medication.
• If you are pregnant, plan to become pregnant, or are breastfeeding
• If you drink alcohol or use drugs

How Should I Take Venlafaxine?

Venlafaxine immediate release tablets are usually taken two or three times per day with or without food. The extended release tablets and capsules are taken one time per day with or without food.

Typically patients begin at a low dose of medicine and the dose is increased slowly over several weeks.

The dose usually ranges from 37.5 mg to 300 mg. Only your health care provider can determine the correct dose for you.

Extended release tablets: swallow whole; do not chew, crush, or break

Extended release capsules: swallow whole or sprinkle onto food, such as applesauce or pudding and eat immediately.

Consider using a calendar, pillbox, alarm clock, or cell phone alert to help you remember to take your medication. You may also ask a family member or friend to remind you or check in with you to be sure you are taking your medication.

What Happens If I Miss A Dose Of Venlafaxine?

If you miss a dose of venlafaxine, take it as soon as you remember, unless it is closer to the time of your next dose. Discuss this with your health care provider. Do not double your next dose or take more than what is prescribed.

What Should I Avoid While Taking Venlafaxine?

Avoid drinking alcohol or using illegal drugs while you are taking antidepressant medications. They may decrease the benefits (e.g., worsen your condition) and increase adverse effects (e.g., sedation) of the medication.

What Happens If I Overdose With Venlafaxine?

If an overdose occurs, call your doctor or 911. You may need urgent medical care. You may also contact the poison control center at 1-800-222-1222.

A specific treatment to reverse the effects of venlafaxine does not exist.

What Are The Possible Side Effects Of Venlafaxine?

Common side effects

• Headache, nausea, diarrhea, dry mouth, increased sweating
• Feeling nervous, restless, fatigued, sleepy or having trouble sleeping (insomnia)

These will often improve over the first week or two as you continue to take the medication.

• Sexual side effects, such as problems with orgasm or ejaculatory delay
• Increased blood pressure

These often do not improve over time.

Rare/serious side effects

Increased heart rate, low blood pressure, increased salivation, irregular menstrual cycle, increased frequency of urination, changes in taste, low sodium (symptoms of low sodium levels may include headache, weakness, difficulty concentrating and remembering), teeth grinding, difficulty urinating, angle closure glaucoma (symptoms of angle closure glaucoma may include eye pain, changes in vision, swelling or redness in or around eye).

Serotonin syndrome (symptoms may include shivering, diarrhea, confusion, severe muscle tightness, fever, seizures, and death)

SNRI antidepressants including venlafaxine may increase the risk of bleeding events. Combined use of aspirin, nonsteroidal anti-inflammatory drugs (e.g., ibuprofen, naproxen), warfarin, and other anti-coagulants may increase this risk. This may include gums that bleed more easily, nose bleed, or gastrointestinal bleeding. Some cases have been life threatening.

Are There Any Risks For Taking Venlafaxine For Long Periods Of Time?

To date, there are no known problems associated with long term use of venlafaxine. It is a safe and effective medication when used as directed.

What Other Medications May Interact With Venlafaxine?

Venlafaxine should not be taken with or within 2 weeks of taking monoamine oxidase inhibitors (MAOIs). These include phenelzine (Nardil®), tranylcypromine (Parnate®), isocarboxazid (Marplan®), rasagiline (Azilect®), and selegiline (Emsam®).

Although rare, there is an increased risk of serotonin syndrome when venlafaxine is used with other medications that increase serotonin, such as other antidepressants, migraine medications called “triptans” (e.g., Imitrex®), some pain medications (e.g., tramadol (Ultram®), and the antibiotic linezolid (Zyvox®).

Venlafaxine may increase the effects of other medications that can cause bleeding (e. g., ibuprofen (Advil®, Motrin®), warfarin (Coumadin®) and aspirin).

How Long Does It Take For Venlafaxine To Work?

Sleep, energy, or appetite may show some improvement within the first 1-2 weeks. Improvement in these physical symptoms can be an important early signal that the medication is working. Depressed mood and lack of interest in activities may need up to 6-8 weeks to fully improve.

Summary of FDA Black Box Warnings

Suicidal thoughts or actions in children and adults

Depression and certain other psychiatric disorders are themselves associated with increases in the risk of suicide. Patients with major depressive disorder (MDD), both adult and pediatric, may experience worsening of their depression and/or the emergence of suicidal ideation and behavior (suicidality) or unusual changes in behavior, whether or not they are taking antidepressant medications. This risk may persist until significant remission occurs.

In short-term studies, antidepressants increased the risk of suicidality in children, adolescents, and young adults when compared to placebo. Short-term studies did not show an increase in the risk of suicidality with antidepressants compared to placebo in adults beyond age 24. Adults age 65 and older taking antidepressants have a decreased risk of suicidality. Patients, their families, and caregivers should be alert to the emergence of anxiety, restlessness, irritability, aggressiveness and insomnia. If these symptoms emerge, they should be reported to the patient’s prescriber or health care professional. All patients being treated with antidepressants for any indication should watch for and notify their health care provider for worsening symptoms, suicidality and unusual changes in behavior, especially during the first few months of treatment.

Provided by

(December 2020)

©2020 The College of Psychiatric and Neurologic Pharmacists (CPNP) and the National Alliance on Mental Illness (NAMI). CPNP and NAMI make this document available under the Creative Commons Attribution-No Derivatives 4. 0 International License. Last Updated: January 2016.

This information is being provided as a community outreach effort of the College of Psychiatric and Neurologic Pharmacists. This information is for educational and informational purposes only and is not medical advice. This information contains a summary of important points and is not an exhaustive review of information about the medication. Always seek the advice of a physician or other qualified medical professional with any questions you may have regarding medications or medical conditions. Never delay seeking professional medical advice or disregard medical professional advice as a result of any information provided herein. The College of Psychiatric and Neurologic Pharmacists disclaims any and all liability alleged as a result of the information provided herein.

Effexor XR Oral: Uses, Side Effects, Interactions, Pictures, Warnings & Dosing

See also Warning section.

Nausea, drowsiness, dizziness, dry mouth, constipation, loss of appetite, blurred vision, nervousness, trouble sleeping, unusual sweating, or yawning may occur. If any of these effects persist or worsen, tell your doctor promptly.

Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

This medication may raise your blood pressure. Check your blood pressure regularly and tell your doctor if the results are high.

Tell your doctor right away if any of these unlikely but serious side effects occur: easy bruising/bleeding, decreased interest in sex, changes in sexual ability, muscle cramps/weakness, shaking (tremor).

Get medical help right away if any of these rare but serious side effects occur: cough that doesn’t go away, shortness of breath, chest pain, severe/pounding headache, black/bloody stools, vomit that looks like coffee grounds, eye pain/swelling/redness, widened pupils, vision changes (such as seeing rainbows around lights at night), seizure.

This medication may increase serotonin and rarely cause a very serious condition called serotonin syndrome/toxicity. The risk increases if you are also taking other drugs that increase serotonin, so tell your doctor or pharmacist of all the drugs you take (see Drug Interactions section). Get medical help right away if you develop some of the following symptoms: fast heartbeat, hallucinations, loss of coordination, severe dizziness, severe nausea/vomiting/diarrhea, twitching muscles, unexplained fever, unusual agitation/restlessness.

A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

In the US –

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.

In Canada – Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

Facts, Side Effects, Cost, Dosing

What is Effexor?

Effexor is an antidepressant medication known as a serotonin-norepinephrine reuptake inhibitor. Effexor is used to treat depression, and the extended-release version of the medication is used to treat generalized anxiety disorder, social anxiety disorder, and panic disorder.

When did the U.S. Food and Drug Administration (FDA) approve the medication?

Effexor was first approved by the FDA in 1993.

Is there a generic version of Effexor?

Yes, the generic version of Effexor is known as venlafaxine and is sold in the U.S.

Are there any major differences between Effexor and other mental health medications?

Effexor is a serotonin-norepinephrine reuptake inhibitor (SNRI). SNRIs work by increasing levels of serotonin and norepinephrine in the brain. The extended-release version of the medication is also prescribed to treat anxiety disorders. If you have bipolar disorder and take an SNRI, you may be at risk for triggering a manic episode if you are not also taking a mood stabilizer. Talk to your doctor about your specific symptoms, other health concerns, and other medications you take so they can make the best recommendation for your condition and symptoms.

Can children take Effexor?

The safety and efficacy of Effexor has not been established for children.

Are there potential interaction issues for people taking Effexor and any other drugs?

Talk to your doctor if you take MAO inhibitors. There are hundreds of drugs which are known to interact with Effexor in major, moderate, or mild ways, so let your doctor know what other medications you are taking before you begin taking the medication. Some of these include anticoagulants, other antidepressants, anxiety medications, weight loss medications, pain medications, seizure medications, migraine medications, cimetidine, clozapine, diuretics, duloxetine, haloperidol, imipramine, indinavir, ketoconazole, linezolid, lithium, methadone, methylene blue, phentermine, ritonavir, sedatives, sibutramine, sleeping medications, tramadol, and tranquilizers.

Are there any other medical conditions that would make someone ineligible for Effexor therapy?

Talk to your doctor about other medical conditions before you take Effexor, such as heart attack, heart disease, high blood pressure, high cholesterol, seizures, liver disease, heart disease, kidney disease, or thyroid disease. Also tell your doctor if you are allergic to any medications, have a history of abusing medication, or a history of suicidal thoughts or behavior.

What is the typical dose that would be prescribed to someone taking Effexor?

Dosage will vary depending on the condition being treated and whether you are taking Effexor tablets or extended-release capsules.

What do I do if I miss a dose?

Take the dose of Effexor when you remember, but skip the missed dose if it is almost time for your next dose. You should never take extra doses of the medication to make up for missed doses, and you should not take more than one dose per day if you take extended-release capsules.

How long does it take for Effexor to reach full efficacy?

It may take several weeks or longer for the medication to be fully effective and for initial side effects to decrease.

What side effects can Effexor cause?

Common side effects can include:

• nausea
• headaches
• diarrhea
• dry mouth
• restlessness
• fatigue
• sleepiness
• feeling nervous
• insomnia
• increased sweating
• increased blood pressure
• sexual side effects

It also is recommended that you wait to drive or operate machinery until you know how the medication affects you. It is also recommended that people avoid alcohol and illegal drugs while on the medication, as they can worsen adverse effects. Report side effects to your doctor immediately. Serious side effects can include rash, hives, seizures, chest pain, difficulty breathing or swallowing, irregular heartbeat, eye pain, fever, confusion, bleeding or bruising, coordination problems, muscle stiffness, hallucinations, and coma. You can also report side effects to the FDA at 1-800-FDA-1088 or online.

What are the potential psychological side effects of taking Effexor?

A small percentage of teens and young adults who take antidepressants experience an increase in suicidal thoughts and behavior. Seek medical help if you experience these thoughts or other changes in behavior or mood.

What are the potential long-term effects of taking Effexor?

Effexor may cause angle-closure glaucoma, so talk to your doctor about the risks and about setting up an eye examination.

Is it safe for a woman who is pregnant, about to become pregnant, or nursing to take Effexor?

Birth defects and fetal harm are possible when Effexor is taken during pregnancy, but the risk is very low. The drug may be transferred via breast milk. Therefore, talk to your doctor about the risks and benefits if you are pregnant, planning to become pregnant, or are nursing before you take Effexor.

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Can symptoms occur if Effexor is discontinued?

It’s important not to discontinue use of the drug before talking with your doctor. Withdrawal symptoms of Effexor can include anxiety, agitation, vertigo, nausea, diarrhea, vomiting, sleep problems, nightmares, headache, fatigue, and dry mouth.

What should I do if I overdose on Effexor?

An overdose of Effexor could be fatal, so seek immediate help or call the Poison Help Line at 1-800-222-1222 if you overdose. Overdose symptoms can include dizziness, vomiting, nausea, muscle pain, sleepiness, hot and cold spells, tingling or numbness in hands and feet, increased pupil size, seizures, changes in heartbeat, and coma.

Is Effexor habit-forming?

Effexor is not habit-forming, but it is not recommended that you discontinue use of the drug before talking with your doctor, as withdrawal symptoms can occur.

How much does Effexor cost?

According to goodrx.com, 30 capsules of 75 mg generic venlafaxine ER cost approximately $130. 30 capsules of 75 mg Effexor XR cost approximately $400.

Are there any disadvantages to Effexor?

The biggest disadvantages of Effexor are the potential side effects. Talk to your doctor about what medication is best for you.

DISCLAIMER: The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other healthcare provider.  This article mentions drugs that were FDA-approved and available at the time of publication and may not include all possible drug interactions or all FDA warnings or alerts. The author of this page explicitly does not endorse this drug or any specific treatment method. If you have health questions or concerns about interactions, please check with your physician or go to the FDA site for a comprehensive list of warnings.

Article Sources

FDA – Effexor
NIH – Venlafaxine

Last Updated: Jan 8, 2021

Warnings of Effexor (Venlafaxine) for Depression

Venlafaxine is an antidepressant drug in a class called serotonin-norepinephrine reuptake inhibitors (SNRIs). It is an oral tablet that comes in both an immediate-release (Effexor) and extended-release (Effexor XR) formula. Both are used to treat depression in addition to a variety of other mental health conditions.

SNRIs work by blocking the reabsorption (or reuptake) of serotonin and norepinephrine back into the nerve cells that released them. Blocking their reuptake increases the levels of these neurotransmitters in the brain. This improves your focus and alertness and boosts your mood.

Effexor has been discontinued in the U.S., but Effexor XR is still available by prescription. Unlike Effexor, Effexor XR only needs to be taken once a day.

Common Side Effects

Like any medication, side effects may occur while taking Effexor. Be sure to contact your doctor if they don’t go away or become bothersome. Common side effects include:

• Constipation
• Diarrhea
• Drowsiness
• Feeling tired
• Headache
• Heartburn
• Loss of appetite
• Nausea
• Sexual side effects
• Vomiting

These side effects often improve over the first week or two as you continue taking the medication. Call your doctor if your symptoms become severe or don’t go away.

Before Taking

Effexor should not be taken with or within two weeks of taking monoamine oxidase inhibitors (MAOIs). Examples of MAOIs include:

• Emsam (selegiline)
• Marplan (isocarboxazid)
• Nardil (phenelzine)
• Parnate (tranylcypromine)

Serious and even fatal complications may result from such a combination.

Precautions

Make sure your doctor knows your complete medical history. Effexor should be used with caution if you have:

• Brain disease or damage, or a history of seizures: The risk of seizures may be increased when taking Effexor.
• Heart disease or high or low blood pressure: Effexor may occasionally make these conditions worse.
• History of mania: The risk of developing mania may be increased while taking Effexor. Obviously, this is very important for bipolar patients to watch for.
• Kidney disease or liver disease: Higher blood levels of Effexor may occur, increasing the chance of side effects. Your doctor may need to adjust your dose.

Warnings and Interactions

Warnings are established to both ensure the safe use and discontinuation of Effexor. Your doctor should monitor you for the following complications while you’re taking Effexor.

Serotonin Syndrome

Be careful when mixing Effexor with other medicines that also affect serotonin levels, such as other antidepressants, lithium, and St. John’s wort. Doing so can lead to an excessive serotonin buildup in the brain. This can cause a condition called serotonin syndrome.

Symptoms of serotonin syndrome include:

• Confusion
• Diarrhea
• Dilated pupils
• Fever
• Loss of muscle coordination
• Muscle stiffness
• Sudden spikes in blood pressure or heart rate
• Sweating or shivering
• Twitching muscles
• Unusual agitation or restlessness

Some cases of serotonin syndrome can be life-threatening. If you’re taking Effexor and experience any of these symptoms, contact your doctor as soon as possible.

Risk of Overdose

You should always avoid drinking or using other drugs while you’re taking Effexor. These substances may decrease the benefits of the medication, or they can result in a toxic overdose. The most common Effexor overdose effects include:

• Changes in consciousness (ranging from sleepiness to coma)
• Dilated pupils
• Fast heart rate
• Seizures
• Vomiting

To reduce your risk of overdose, your doctor will only prescribe you the lowest possible dose in the smallest quantity.

Suicidal Thoughts and Actions

Children and adolescents (up to age 25) may experience increased suicidal thoughts and behaviors when taking antidepressant medications. The danger is greatest the first few months of treatment or when changing the dose.

Though this warning is true for all antidepressants, taking Effexor may increase your risk even more. A major study found that Effexor was associated with a higher risk of both completed and attempted suicide compared with other antidepressants, including Celexa (citalopram), Prozac (fluoxetine), and Prothiaden (dothiepin).

Discontinuation Syndrome

Stopping Effexor abruptly may result in one of more of the following withdrawal symptoms:

• Anxiety or worsening of depression
• Dizziness
• Gastrointestinal upset
• Headaches
• Irritability
• Nausea
• Nightmares
• Paresthesias (prickling, tingling sensation on the skin)
• Vomiting

It’s important to not stop taking Effexor on your own. If you and your doctor decide it’s best for you to stop Effexor, they can provide you with a tapering strategy to minimize any withdrawal symptoms

A Word From Verywell

Before prescribing Effexor, your doctor will take a thorough medical history. Even so, it’s important for you to play an active role in your care. Be sure to share every detail of your health history, regardless of whether or not you think it’s important. 

Overall, Effexor is a well-tolerated medication that has helped many people cope with a variety of mental health conditions. You deserve to get well. The good news is that if Effexor doesn’t help, there are lots of other options to try.

Venlafaxine: MedlinePlus Drug Information

A small number of children, teenagers, and young adults (up to 24 years of age) who took antidepressants (‘mood elevators’) such as venlafaxine during clinical studies became suicidal (thinking about harming or killing oneself or planning or trying to do so). Children, teenagers, and young adults who take antidepressants to treat depression or other mental illnesses may be more likely to become suicidal than children, teenagers, and young adults who do not take antidepressants to treat these conditions. However, experts are not sure about how great this risk is and how much it should be considered in deciding whether a child or teenager should take an antidepressant. Children younger than 18 years of age should not normally take venlafaxine, but in some cases, a doctor may decide that venlafaxine is the best medication to treat a child’s condition.

You should know that your mental health may change in unexpected ways when you take venlafaxine or other antidepressants even if you are an adult over 24 years of age. You may become suicidal, especially at the beginning of your treatment and any time that your dose is increased or decreased. You, your family, or your caregiver should call your doctor right away if you experience any of the following symptoms: new or worsening depression; thinking about harming or killing yourself, or planning or trying to do so; extreme worry; agitation; panic attacks; difficulty falling asleep or staying asleep; aggressive behavior; irritability; acting without thinking; severe restlessness; and frenzied abnormal excitement. Be sure that your family or caregiver knows which symptoms may be serious so they can call the doctor if you are unable to seek treatment on your own.

Your healthcare provider will want to see you often while you are taking venlafaxine, especially at the beginning of your treatment. Be sure to keep all appointments for office visits with your doctor.

The doctor or pharmacist will give you the manufacturer’s patient information sheet (Medication Guide) when you begin treatment with venlafaxine. Read the information carefully and ask your doctor or pharmacist if you have any questions. You also can obtain the Medication Guide from the FDA website: http://www.fda.gov/Drugs/DrugSafety/ucm085729.htm.

No matter your age, before you take an antidepressant, you, your parent, or your caregiver should talk to your doctor about the risks and benefits of treating your condition with an antidepressant or with other treatments. You should also talk about the risks and benefits of not treating your condition. You should know that having depression or another mental illness greatly increases the risk that you will become suicidal. This risk is higher if you or anyone in your family has or has ever had bipolar disorder (mood that changes from depressed to abnormally excited) or mania (frenzied, abnormally excited mood) or has thought about or attempted suicide. Talk to your doctor about your condition, symptoms, and personal and family medical history. You and your doctor will decide what type of treatment is right for you.

Safety Info | EFFEXOR XR® (venlafaxine HCl)

Suicidality and Antidepressant Drugs

Antidepressants increased the risk of suicidal thinking and behavior (suicidality) in children, teens, and young adults compared to placebo. Depression and certain other psychiatric disorders are themselves associated with increases in the risk of suicide. Patients of all ages who are started on antidepressant therapy should be monitored appropriately and observed closely for clinical worsening, suicidality, or unusual changes in behavior. Effexor XR is not approved for use in children and teens.

Do not take EFFEXOR XR if you:

• Are allergic to Effexor XR or any of the ingredients in Effexor XR
• Have uncontrolled angle-closure glaucoma
• Currently take, or have taken within the last 14 days, any medicine known as an MAOI such as linezolid or methylene blue. Do not take an MAOI within 7 days of stopping Effexor XR. Ask your doctor or pharmacist if you are not sure if your medicine is an MAOI

All patients taking antidepressants should be watched closely for signs that their condition is getting worse or that they are becoming suicidal, especially when they first start therapy, or when their dose is increased or decreased. Patients should also be watched for becoming agitated, irritable, hostile, aggressive, impulsive, or restless. Such symptoms should be reported to the patient’s doctor right away.

Before taking Effexor XR, tell your doctor and pharmacist about all prescription and over-the-counter medications and supplements you take or plan to take, including those to treat migraines or psychiatric disorders (including other antidepressants or amphetamines) to avoid a potentially life-threatening condition called serotonin syndrome.

Effexor XR may raise blood pressure in some patients. Your blood pressure should be controlled before starting treatment and should be monitored regularly.

Taking Effexor XR with aspirin, nonsteroidal anti-inflammatory drugs, warfarin, or other blood thinners may increase the risk of bleeding events.

Some people are at risk for visual problems such as eye pain, changes in vision, or swelling or redness around the eye. You may want to undergo an eye examination to see if you are at risk and get preventative treatment if you are.

When people suddenly stop using or quickly lower their daily dose of Effexor XR, serious discontinuation symptoms may occur. Talk to your doctor before discontinuing or reducing your dose of Effexor XR.

Pregnant or nursing women shouldn’t take any antidepressant without consulting their doctor.

Until you see how Effexor XR affects you, be careful doing such activities as driving a car or operating machinery. Avoid drinking alcohol while taking Effexor XR.

In clinical studies, the most common side effects with Effexor XR (reported in at least 5% of patients and at least twice as often as with placebo) were constipation, dizziness, dry mouth, insomnia, loss of appetite, nausea, nervousness, sexual side effects, sleepiness, sweating, and weakness.

INDICATIONS

Effexor XR extended-release capsules are a prescription medicine indicated for the treatment, in adults, of Major Depressive Disorder (MDD), Generalized Anxiety Disorder (GAD), Social Anxiety Disorder (SAD), and Panic Disorder (PD) with or without agoraphobia.

Please see Full Prescribing Information, including BOXED WARNING and Medication Guide.

Effexor XR – Uses, Side Effects, Interactions

How does this medication work? What will it do for me?

Venlafaxine belongs to the class of antidepressant and anxiolytic medications known as serotonin and norepinephrine reuptake inhibitors (SNRIs). It is used to treat depression. It works on the central nervous system (CNS) to elevate mood in people with depression.

Venlafaxine is also used to treat the symptoms of anxiety causing distress in generalized anxiety disorder (GAD), social anxiety disorder (social phobia), and panic disorder (panic attacks). SNRIs work by increasing the amount of two chemicals called serotonin and norepinephrine, which are available in certain parts of the brain.

Symptoms may begin to improve within 2 weeks of starting venlafaxine, but it may take several weeks before the full beneficial effects of this medication are felt.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

What form(s) does this medication come in?

37.5 mg
Each extended release, hard gelatin capsule, with gray cap and peach-coloured body, with “W” and “Effexor XR” on the cap and “37. 5″ on the body, in red ink, contains venlafaxine HCl equivalent to 37.5 mg of venlafaxine base. Nonmedicinal ingredients: ethylcellulose, gelatin, hydroxypropyl methylcellulose, iron oxide, microcrystalline cellulose, talc, titanium dioxide, and Opacode Red S-1-15034 ink. Gluten-free.

75 mg
Each extended release, hard gelatin capsule, with peach-coloured cap and body, with “W” and “Effexor XR” on the cap and “75” on the body, in red ink, contains venlafaxine HCl equivalent to 75 mg of venlafaxine base. Nonmedicinal ingredients: ethylcellulose, gelatin, hydroxypropyl methylcellulose, iron oxide, microcrystalline cellulose, talc, titanium dioxide, and Opacode Red S-1-15034 ink. Gluten-free.

150 mg
Each extended release, hard gelatin capsule, with dark orange cap and body, with “W” and “Effexor XR” on the cap and “150” on the body, in white ink, contains venlafaxine HCl equivalent to 150 mg of venlafaxine base. Nonmedicinal ingredients: ethylcellulose, gelatin, hydroxypropyl methylcellulose, iron oxide, microcrystalline cellulose, talc, titanium dioxide, and White Tek SB-0007 ink. Gluten-free.

How should I use this medication?

Venlafaxine should be taken once daily with food, either in the morning or in the evening. Swallow the capsules whole. Do not crush, chew, or split the capsules.

Depression: The recommended dose of venlafaxine for people with depression is 75 mg once daily. For some people, the doctor may recommend starting with a lower dose of 37.5 mg daily for the first 4 to 7 days of treatment so they can get used to the medication. The dose can then be increased to 75 mg daily. If the expected benefit does not occur after a few weeks, your doctor may gradually increase the dose to a maximum of 225 mg daily, until improvement is seen.

Generalized anxiety disorder (GAD): For people with GAD, the recommended starting dose of venlafaxine is 37.5 mg once daily for 4 to 7 days. Your doctor may gradually increase the dose to a maximum of 225 mg daily, based on your response to the medication.

Social anxiety disorder (social phobia): The usual recommended starting dose of venlafaxine is 75 mg once daily. For some people, the doctor may recommend starting with a lower dose of 37.5 mg daily for the first 4 to 7 days of treatment so they can get used to the medication. The dose can then be increased to 75 mg daily. Your doctor may gradually increase the dose based on your response to the medication, to a maximum of 225 mg daily.

Panic disorder (panic attacks): For people with panic attacks, the recommended starting dose of venlafaxine extended release is 37.5 mg once daily for 7 days. The dose can then be increased to 75 mg daily. Your doctor may gradually increase the dose based on your response to the medication to a maximum of 225 mg daily.

Many things can affect the dose of a medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is important that this medication be taken exactly as prescribed by your doctor. If you miss a dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication at room temperature, protect it from moisture, and keep it out of the reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Who should NOT take this medication?

Do not take venlafaxine if you:

• are allergic to venlafaxine or any ingredients of the medication
• are currently taking an MAO inhibitor (e.g., phenelzine, tranylcypromine), have taken one in the last 14 days, or will start treatment with one in the next 14 days

What side effects are possible with this medication?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

• abnormal dreams
• constipation
• dizziness
• drowsiness
• dry mouth
• headache
• increased sweating
• loss of appetite
• nausea
• nervousness
• sweating
• sexual difficulties
• trouble sleeping
• unusual tiredness or weakness
• vomiting
• weakness

Although most of the side effects listed below don’t happen very often, they could lead to serious problems if you do not check with your doctor or seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

• agitation
• difficulty urinating
• fast heartbeat
• hallucinations (hearing or seeing things that aren’t there)
• increased blood pressure
• mood or mental changes
• restlessness or inability to sit still
• severe abdominal pain
• signs of bleeding (e.g., unusual nosebleeds, bruising, blood in urine, coughing blood, bleeding gums, cuts that don’t stop bleeding)
• signs of liver damage (e.g., yellowing of the skin and eyes, abdominal pain, dark urine, clay-coloured stools, loss of appetite, or nausea and vomiting)
• symptoms of glaucoma (increased pressure in the eyes) (e.g., decreased or blurred vision, eye pain, red eye, swelling of the eye)
• signs of low sodium (e.g., tiredness, weakness, confusion, achy, stiff, uncoordinated muscles)
• symptoms of mania (e. g., irritability, elevated mood, decreased need for sleep, racing thoughts)
• unusual or sudden body or facial movements or postures

Stop taking the medication and seek immediate medical attention if any of the following occur:

• attempts at suicide or thoughts of suicide or self-harm
• convulsions (seizures)
• serotonin syndrome (symptoms include confusion, diarrhea, fever, poor coordination, restlessness, shivering, sweating, trembling or shaking, or twitching)
• signs of an allergic reaction (e.g., difficulty breathing, hives, swelling of the face or throat)
• signs of bleeding in the stomach (e.g., bloody, black, or tarry stools; spitting up of blood; vomiting blood or material that looks like coffee grounds)
• signs of extremely high blood pressure (e.g., severe headache upon wakening that is concentrated in the back of the head and neck, fast or irregular heartbeat, dizziness, chest pain)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Are there any other precautions or warnings for this medication?

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Allergic reactions: In rare cases, some people may develop an allergic reaction to this medication. Signs of an allergic reaction include a severe rash, swollen face, or difficulty breathing. If these occur, get immediate medical attention.

Behaviour changes or suicidal behaviour: Some people taking this medication experience erratic or aggressive behaviour, agitation, depressed mood, or they may have thoughts of harming themselves or others. If you experience any mood or behaviour changes, or if your friends or family observe any of these changes while you are taking this medication, stop taking this medication and contact your doctor immediately.

Bleeding disorders: Venlafaxine may increase bruising and bleeding from cuts may take longer to stop. If you have a bleeding disorder or a history of bleeding problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Blood pressure: Treatment with venlafaxine has been associated with increases in blood pressure. Your doctor may monitor your blood pressure while you are taking venlafaxine. Rarely, some people may experience a large increase in blood pressure. This extremely high blood pressure can cause rapid or irregular heartbeat, chest pain, dizziness, feeling overly tired, blurred vision, and symptoms of severe headache upon awakening that is mainly in the back of the head and neck region. If any of these symptoms occur, contact your doctor immediately.

Bone health and osteoporosis: Recent studies have shown that there may be an increased risk of bone fractures (breaks) with the use of venlafaxine and other antidepressants. People with osteoporosis or those with risk factors for developing osteoporosis, may be more likely to experience a fracture. If you have osteoporosis or are at risk for developing osteoporosis, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Cholesterol: Venlafaxine can cause higher blood cholesterol levels. If you are at risk of developing high cholesterol or you have high cholesterol levels before starting venlafaxine, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Drowsiness/reduced alertness: Venlafaxine may cause drowsiness or dizziness, affecting your ability to drive or operate machinery. Avoid these and other hazardous tasks until you have determined how this medication affects you.

Glaucoma: This medication may cause the symptoms of glaucoma (increased pressure in the eye) to become worse. If you have glaucoma, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. Report any changes in vision to your doctor as soon as possible while you are taking this medication.

Heart disease: If you have heart disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. Venlafaxine may cause increased blood pressure or increased cholesterol levels.

Kidney function:  Kidney disease or reduced kidney function may cause this medication to build up in the body, causing side effects. If you have kidney disease or reduced kidney function, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Liver function: Liver disease or reduced liver function may cause this medication to build up in the body, causing side effects. If you have liver problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. Your doctor may want to test your liver function regularly with blood tests while you are taking this medication.

If you experience symptoms of liver problems such as fatigue, feeling unwell, loss of appetite, nausea, yellowing of the skin or whites of the eyes, dark urine, pale stools, abdominal pain or swelling, and itchy skin, contact your doctor immediately.

Mania/hypomania: Venlafaxine may cause activation of mania or hypomania. People with a history of bipolar disorder should be closely monitored by their doctor while taking this medication.

Neuroleptic malignant syndrome (NMS): Venlafaxine can rarely cause a potentially fatal syndrome known as neuroleptic malignant syndrome (NMS). If you notice the symptoms of NMS such as high fever, muscle stiffness, confusion or loss of consciousness, sweating, racing or irregular heartbeat, or fainting, get immediate medical attention.

Seizures: If you have a history of seizures, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Serotonin syndrome: This medication may cause a potentially life-threatening condition called serotonin syndrome, especially when used with other medications that increase serotonin levels (e.g., sumatriptan, rizatriptan). If you experience symptoms of serotonin syndrome such as agitation, hallucinations, fast heart rate, fever, lack of coordination, nausea, vomiting, and diarrhea, get immediate medical attention.

Stopping the medication: Stopping this medication suddenly may lead to side effects. If you are thinking of stopping this medication, check with your doctor first. When stopping venlafaxine treatment after more than one week, it is recommended that the dose of the medication be reduced gradually to prevent symptoms such as anxiety, agitation, confusion, diarrhea, dizziness, dry mouth, fatigue, headache, nausea, loss of appetite, nervousness, sleep disturbances, sweating, and vomiting.

Pregnancy: Newborns whose mothers take medications such as venlafaxine during the third trimester of pregnancy may experience complications that require prolonged hospitalization. These complications normally resolve over time.

This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: This medication passes into breast milk. If you are a breast-feeding mother and are taking venlafaxine, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of this medication have not been established for children under 18 years old. There have been reports that using this and similar medications for children below the age of 18 may cause behavioural and emotional changes, such as suicidal thoughts and behaviour.

Seniors: Seniors may be more sensitive to the side effects of this medication.

What other drugs could interact with this medication?

There may be an interaction between venlafaxine and any of the following:

• acalabrutinib
• alcohol
• alpha-agonists (e.g., clonidine, methyldopa)
• alpha/beta-agonists (e.g., epinephrine, norepinephrine)
• amphetamines (e.g., dextroamphetamine, lisdexamfetamine)
• anticoagulants (e.g., apixaban, edoxaban, dabigatran, rivaroxaban, warfarin)
• antihistamines (e.g., cetirizine, doxylamine, diphenhydramine, hydroxyzine, loratadine)
• antiplatelet medications (e.g., acetylsalicylic acid [ASA], clopidogrel)
• antipsychotics (e.g., chlorpromazine, clozapine, haloperidol, olanzapine, quetiapine, risperidone)
• “azole” antifungals (e.g., itraconazole, ketoconazole, voriconazole)
• barbiturates (e.g., butalbital, phenobarbital)
• bromocriptine
• bupropion
• buspirone
• carbamazepine
• celecoxib
• crizotinib
• cyclobenzaprine
• dasatinib
• dexmethylphenidate
• dextromethorphan
• ergot alkaloids (e.g., ergotamine, dihydroergotamine)
• glucosamine
• grapefruit juice
• heparin
• linezolid
• lithium
• low molecular weight heparins (e.g., dalteparin, enoxaparin, tinzaparin)
• methadone
• methylene blue
• methylphenidate
• metoclopramide
• mirtazapine
• monoamine oxidase inhibitors (MAOIs; e.g., moclobemide, phenelzine, rasagiline, selegiline, tranylcypromine)
• multivitamins with minerals
• narcotic pain relievers (e.g., codeine, fentanyl, morphine, oxycodone)
• nonsteroidal anti-inflammatory drugs (NSAIDs; e.g., ibuprofen, indomethacin, naproxen)
• obinutuzumab
• pentoxifylline
• phenytoin
• primidone
• propafenone
• pseudoephedrine
• rivaroxaban
• safinamide
• St. John’s wort
• selective serotonin reuptake inhibitors (SSRIs; e.g., citalopram, fluoxetine, sertraline)
• other serotonin / norepinephrine reuptake inhibitors (SNRIs; e.g., desvenlafaxine, duloxetine)
• serotonin antagonists (anti-emetic medications; e.g., granisetron, ondansetron)
• tramadol
• trazodone
• tricyclic antidepressants (e.g., amitriptyline, desipramine, imipramine)
• “triptan” migraine medications (e.g., sumatriptan, rizatriptan, zolmitriptan)
• tryptophan supplements
• vitamin E

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

All material copyright MediResource Inc. 1996 – 2021. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/drug/getdrug/Effexor-XR

Venlafaxine: Pediatric Medication | Memorial Sloan Kettering Cancer Center

This document, provided by Lexicomp ^® , contains all the information you need to know about the drug, including the indications, route of administration, side effects and when you should contact your healthcare provider.

Trade names: USA

Effexor XR

Trade names: Canada

ACT Venlafaxine XR; APO-Venlafaxine XR; Auro-Venlafaxine XR; DOM-Venlafaxine XR; Effexor XR; GD-Venlafaxine XR [DSC]; M-Venlafaxine XR; MYLAN-Venlafaxine XR [DSC]; PMS-Venlafaxine XR; RIVA-Venlafaxine XR [DSC]; SANDOZ Venlafaxine XR; TARO-Venlafaxine XR; TEVA-Venlafaxine XR; Venlafaxine XR

Warning

• Drugs like this have increased the likelihood of suicidal thoughts or actions in children and young people.This risk may be higher in people who have attempted suicide or have had suicidal thoughts in the past. All people taking this drug must be closely monitored. Call your doctor right away if you have signs such as depressed mood (depression), nervousness, anxiety, grumpiness, or anxiety attacks, or if other mood or behavior changes occur or worsen. Call your doctor immediately if you have suicidal thoughts or attempted suicides.
• This drug is not approved for use in children. Consult your doctor.

What is this drug used for?

• The drug is used to treat depression.
• Used to treat anxiety.
• Used to treat panic attacks.
• This drug can be given to children for other indications. Consult your doctor.

What should I tell my doctor BEFORE my child takes this drug?

• If your child is allergic to this drug, any of its ingredients, other drugs, foods, or substances.Tell your doctor about the allergy and how your child has it.
• If your child has high blood pressure.
• If your child is taking weight loss medications.
• If your child has been taking drugs for depression or some other medical condition in the past 14 days. These include isocarboxazid, phenelzine, and tranylcypromine. An episode of very high blood pressure may occur.
• If your child is receiving any of the following: linezolid or methylene blue.

This list of drugs and diseases that may be adversely associated with this drug is not exhaustive.

Talk to your doctor or pharmacist about all medications your child is taking (prescription and over-the-counter, natural products, and vitamins) and any health concerns. You need to make sure that this drug is safe for your child’s illness and in combination with other drugs that he or she is already taking.You should not start, stop, or change the dosage of any drug your child is taking without talking to your doctor.

What do I need to know or do while my child is taking this drug?

All forms of issue:

• Tell all health care providers for your child that your child is taking this drug. These are your child’s doctors, nurses, pharmacists and dentists.
• Consult with your child’s doctor before using marijuana, other forms of cannabis, prescription or over-the-counter drugs that may slow down your child’s actions.
• Have your child avoid tasks or activities that require attention until you see how this drug is working for your child. This includes cycling, playing sports, or using items such as scissors, lawn mowers, electric scooters, toy cars, or motorized vehicles.
• Do not suddenly stop giving this drug to your child without talking to your doctor. This can increase your child’s risk of side effects. If your child needs this drug, stop taking this drug gradually, as directed by the doctor.
• High blood pressure has happened with this drug. Monitor your child’s blood pressure as directed by your doctor.
• Alcohol may interact with this drug. Make sure your child does not drink alcohol.
• This drug may increase the risk of bleeding. Sometimes bleeding can be life-threatening. Consult your doctor.
• The risk of eye problems may be increased in some patients with this drug. Your child’s doctor may order your child to be examined by an ophthalmologist to see if they are at increased risk of developing these eye problems.Call your doctor right away if your child has eye pain, change in vision, swelling, or redness around the eye.
• Low blood sodium levels may happen with this drug. In very severe cases, this can be fatal. Consult your doctor.
• Increases in cholesterol have happened with this drug. If you have any questions, please consult your doctor.
• This drug may interfere with some laboratory tests.Tell all healthcare professionals and laboratory staff providing your child’s healthcare that your child is taking this drug.
• In some cases, the drug may affect the growth rate in children and adolescents. They may need to check their growth rate regularly. Consult your doctor.

If your daughter is pregnant or breastfeeding:

• Consult a doctor if your daughter is pregnant, pregnant, or breastfeeding.The benefits and risks for your daughter and her child will need to be discussed.
• Taking this drug during the third trimester of pregnancy may cause some health problems in the newborn. Consult your doctor.

Sustained-release capsules:

• Particles of this drug can be seen in your child’s stool. This is normal and not a cause for concern.

Extended release tablets:

• The tablet shell can sometimes be seen in the stool of a child.This is normal and not a cause for concern.

What side effects should I report to my child’s healthcare provider right away?

WARNING / CAUTION: Although rare, this drug can cause very serious and sometimes deadly side effects in some people. Call your child’s doctor right away or get medical attention if your child has any of the following signs or symptoms that could be associated with a very bad side effect:

• Signs of an allergic reaction such as rash, hives, itching, reddened and swollen skin with blistering or scaling, possibly associated with fever, wheezing or wheezing, tightness in the chest or throat, difficulty breathing, swallowing or speaking, unusual hoarseness, swelling in the mouth, face, lips, tongue, or throat.
• Signs of low sodium levels such as headache, trouble concentrating, memory impairment, confused thinking, weakness, seizures, and balance problems.
• Signs of bleeding such as vomiting or coughing up blood; vomiting like coffee grounds; blood in the urine; black, red, or tarry stools; bleeding from the gums; non-cyclic vaginal bleeding; bruising that occurs or increases for no reason; bleeding that you cannot stop.
• Signs of high blood pressure, such as very severe headache, or dizziness, or loss of consciousness, or blurred vision.
• Pain or pressure in the chest.
• Convulsions.
• Shortness of breath.
• Cough.
• Bone pain.
• A serious and sometimes fatal complication called serotonin syndrome can occur. This risk may be increased if the child is also taking certain other drugs.Call your child’s healthcare provider right away if the child develops anxiety, balance disorders, confusion, hallucinations, fever, tachycardia or irregular heartbeat, flushing, muscle twitching or stiffness, seizures, tremors or tremors, excessive sweating, severe diarrhea, nausea or vomiting, very bad headache.

If your child is or may be sexually active:

• Sexual problems such as decreased sex drive or ejaculation problems.

What are some other side effects of this drug?

Any drug can have side effects. However, many people have little or no side effects. Call your child’s doctor or get medical help if any of these or other side effects bothers your child or does not go away:

• Anxiety.
• Weight loss.
• Feeling dizzy, sleepy, tired, or weak.
• Shiver.
• Headache.
• Nervous tension and agitation.
• Constipation, diarrhea, nausea, vomiting, or decreased appetite.
• Dry mouth.
• Gas.
• Sleep disorders.
• Excessive sweating.
• Strange or unusual dreams.
• Yawning.

This list of potential side effects is not exhaustive. If you have any questions about side effects, talk to your child’s doctor.Talk to your child’s doctor about side effects.

You can report side effects to the National Health Office.

What is the best way to give this drug?

Give this drug to your child as directed by the doctor. Read all the information provided to you. Follow all instructions strictly.

All forms of issue:

• Give this drug with food.
• Give this drug at the same time of the day.
• Continue giving this drug as directed by your child’s doctor or other healthcare professional, even if your child is well.

Sustained-release capsules:

• The child must swallow the drug whole. Do not let your child crush, chew, or dissolve the capsules or their contents.
• You can pour the contents of the capsules into the applesauce. Do not allow your child to chew the drug. Have your child swallow the drug right away and drink it with cool water.

Extended release tablets:

• Have your child swallow whole. Tell your child not to chew, crush, or crush the tablet.
• Give this drug with a full glass of water.

What if my child misses a dose of a drug?

• Give the missed dose as soon as possible.
• If it is time for your child to take the next dose, do not take the missed dose and then return to your child’s normal schedule.
• Do not give a double dose at the same time or additional doses.

How do I store and / or discard this drug?

• Store at room temperature in a dry place. Do not store in the bathroom.
• Store all medicines in a safe place. Keep all medicines out of the reach of children and pets.
• Dispose of unused or expired drugs. Do not empty into toilet or drain unless directed to do so. If you have any questions about the disposal of your medicinal products, consult your pharmacist. Your area may have drug recycling programs.

General information on medicinal products

• If your child’s symptoms or health problems do not improve, or if they get worse, see your child’s doctor.
• Do not share your child’s medicine with others or give anyone’s medicine to your child.
• Some medicines may have different patient information sheets. If you have questions about this drug, talk with your child’s doctor, nurse, pharmacist, or other healthcare professional.
• If you think there has been an overdose of a drug, call a Poison Control Center immediately or seek medical attention.Be prepared to tell or show which drug you took, how much and when it happened.

Use of information by consumer and limitation of liability

This information should not be used to make decisions about taking this or any other drug. Only the attending physician has the necessary knowledge and experience to make decisions about which drugs are suitable for a particular patient. This information does not guarantee that the drug is safe, effective, or approved for the treatment of any disease or specific patient.Here are only brief general information about this drug. It does NOT contain all available information on the possible use of the drug with instructions for use, warnings, precautions, information about interactions, side effects and risks that may be associated with this drug. This information should not be construed as a treatment guide and does not replace information provided to you by your healthcare professional. Check with your doctor for complete information on the possible risks and benefits of taking this drug.Use of this information is governed by the Lexicomp End User License Agreement available at https://www.wolterskluwer.com/en/solutions/lexicomp/about/eula.

Copyright

© UpToDate, Inc. and its affiliates and / or licensors, 2021. All rights reserved.

Effexor Xr Capsule / Capsule in English – Item

Effexor XR

Venlafaxine hydrochloride is an antidepressant of the group of selective serotonin and norepinephrine reuptake inhibitors (SNRIs). It is used to treat a wide range of mental disorders, including depression, generalized anxiety disorder, panic disorder with and without agoraphobia, social anxiety disorder, and others.

The active metabolite of venlafaxine is sold as a stand-alone drug under the trade name Pristiq:

Other SNRIs:

Other preparations containing venlafaxine:

Manufacturer:

Pfizer

Approximate scope (Used in…):

Psychiatry / Psychiatry

Route of Administration:

Oral / Oral

Dosage Form:

Capsules / Capsules

Color of the inscription (Color):

Black / Black

Extended-Release:

Yes

Discontinued (Withdrawn / Discontinued Drug):

No

Major Depressive Disorder Clinical Study: venlafaxine XR, buprenorphine, Placebo – Clinical Trials Registry

Polyneuropathy – treatment, symptoms, causes, diagnosis

Polyneuropathy, or peripheral neuropathy, results from damage to peripheral nerves and often results in symptoms such as weakness, numbness, and pain, usually in the arms and legs. But polyneuropathy can also affect other parts of the body.Peripheral neuropathy can develop in one nerve (mononeuropathy), two or more nerves in different areas, or many nerves can be involved (polyneuropathy).

The peripheral nervous system transmits information from the brain and spinal cord (central nervous system) to the rest of the body. Peripheral neuropathy can result from traumatic injury, infection, metabolic disorders, hereditary causes, and exposure to toxins. Diabetes mellitus is one of the most common causes of polyneuropathy.

Patients with peripheral neuropathy usually describe pain as a tingling or burning sensation. In many cases, symptoms are reduced if compensation for the underlying disease occurs.

Each nerve in the peripheral nervous system has a specific function, so the symptoms depend on the type of nerves that are damaged. Nerves are classified into:

• Sensory nerves that receive sensations from the skin, such as temperature, pain, vibration or pressure
• Motor (motor) nerves that control muscle movements
• Autonomic nerves, which control functions such as blood pressure, heart rate, digestion and bladder function

Symptoms

Symptoms of polyneuropathy, may include:

• Gradual onset of numbness and tingling in the legs or arms, which can spread up the arms and legs
• Acute stabbing or burning pain
• Increased touch sensitivity
• Lack of coordination and falling
• Muscle weakness or paralysis if motor nerves are damaged

If autonomic nerves are involved, symptoms may include:

• Heat intolerance and changes in sweating
• Problems with digestion, bladder or intestines
• Changes in blood pressure resulting in dizziness

Reasons

A number of factors can lead to the development of neuropathy, including:

• Alcoholism.A poor diet can lead to vitamin deficiencies.
• Autoimmune diseases. These include diseases such as Sjogren’s syndrome, systemic lupus erythematosus, rheumatoid arthritis, Guillain-Barré syndrome, chronic inflammatory demyelinating polyneuropathy, and necrotizing vasculitis.
• Diabetes. More than half of people with diabetes develop some type of neuropathy.
• Exposure to poisons. Toxic substances include heavy metals or chemicals.
• Medicines. Certain medications, especially those used to treat cancer (chemotherapy), can cause peripheral neuropathy.
• Infection. These include some viral or bacterial infections, including Lyme disease, shingles, Epstein-Barr virus, hepatitis C, leprosy, diphtheria, and HIV.
• Hereditary diseases. For example, a disease such as Charcot-Marie’s disease is a hereditary type of neuropathy.
• Injury or compression to the nerve. Injuries such as road accidents, falls, or sports injuries can damage or even rupture peripheral nerves. Nerve compression can occur with constant exposure to peripheral nerves.
• Tumors. Malignant and benign tumors can damage or put pressure on nerves.
• Vitamin deficiency. B vitamins, including B-1, B-6 and B-12, vitamin E and niacin are important for nerves.
• Diseases of the bone marrow. These include the presence of abnormal protein in the blood (monoclonal gammopathies), multiple myeloma, lymphoma, and amyloidosis.
• Other diseases. These include kidney disease, liver disease, connective tissue disease, and thyroid disease (hypothyroidism).

Complications of polyneuropathy may include

• Burns and skin injuries. If there is numbness in parts of the body, the patient may not feel temperature changes or pain.
• Infection. Feet and other areas of the body with reduced sensitivity can be invisibly damaged. It is necessary to monitor the integrity of the skin, especially if there is diabetes mellitus, since even minor skin lesions can lead to tissue infection.

Diagnostics

When diagnosing polyneuropathy, doctors may be primarily interested in the answers to the following questions

• Does the patient have a medical condition such as diabetes or kidney disease?
• When did the symptoms start?
• Were the symptoms persistent or episodic?
• How severe are the symptoms?
• What causes an increase or decrease in symptoms?
• Did anyone in the patient’s family have similar symptoms?
• The doctor needs a complete medical history.The doctor will review the medical history, including symptoms, the patient’s lifestyle, exposure to toxins, bad habits, and a family history of neurological disease.
• During a neurological examination, the physician may check tendon reflexes, muscle strength and tone, ability to sense certain sensations, and coordination.

The doctor can order an examination

• Imaging CT or MRI can detect a variety of diseases (including tumors).
• Neurophysiology. Electromyography records electrical activity in muscles, which can help determine if symptoms, including weakness, are caused by muscle damage or nerve damage. ENMG checks the conduction of the impulse along the nerves and allows you to determine the degree of damage to the nerve fibers. Neurophysiological studies of the autonomic nervous system – sensory tests that record how the patient feels touch, vibration, cold and warmth – can also be done.
• Nerve biopsy. The doctor may recommend removing a small part of the nerve, usually the sensory nerve, to examine the morphological changes in the nerve in order to determine the cause of the nerve damage.
• Skin biopsy. In this test, a small portion of the skin is removed to examine the number of nerve endings. A decrease in the number of nerve endings indicates neuropathy.
• Laboratory research methods are required to rule out various diseases such as diabetes mellitus, autoimmune kidney disease, etc.D.

Treatment

The goal of polyneuropathy treatment is to treat the underlying disease and minimize symptoms. If laboratory tests and other methods of examination indicate the absence of the underlying disease, the doctor may recommend expectant tactics in order to see if there is an independent reduction in the symptoms of neuropathy. If there is exposure to toxins or alcohol, your doctor will recommend avoiding these substances.

Drug treatment

Medicines used to relieve pain in polyneuropathy include:

• Pain relievers such as paracetamol or NSAIDs reduce pain
• Medicines containing opioids, such as tramadol (Conzip, Ultram ER, and others) or oxycodone (Oxycontin, Roxicodone, and others), can lead to dependence and addiction, so these drugs are usually only prescribed when other methods treatments have no effect.
• Anticonvulsants. Medicines such as gabapentin (Gralise, Neurontin) and pregabalin (Lyrica), synthesized to treat epilepsy, can significantly reduce pain in neuropathy. Side effects of these drugs may include drowsiness and dizziness.
• Capsaicin. A cream containing this substance (found naturally in hot peppers) can be used to provide some relief from neuropathy symptoms. But given the irritating effect of capsaicin on the skin, not all patients can tolerate the effects of capsaicin creams.
• Antidepressants. Certain tricyclic antidepressants, such as amitriptyline, doxepin, and nortriptyline (Pamelor), can be used to reduce pain in neuropathy by acting on the central nervous system.
• The serotonin and norepinephrine reuptake inhibitor duloxetine (Cymbalta) and the antidepressant venlafaxine (Effexor XR) may also relieve pain in peripheral neuropathy associated with diabetes. Side effects may include dry mouth, nausea, drowsiness, dizziness, decreased appetite, and constipation.
• Intravenous immunoglobulin is the mainstay of treatment for chronic inflammatory demyelinating polyneuropathy and other inflammatory neuropathies.
• Alpha Lipoic Acid. It has been used for the treatment of peripheral neuropathy in Europe for many years. This antioxidant helps reduce symptoms. Talking to your doctor about alpha lipoic acid intake may affect blood sugar levels. Other side effects can include stomach upset and skin rashes.
• Herbs. Certain herbs, such as evening primrose oils, can help reduce neuropathic pain in diabetic patients.
• Amino Acids. Amino acids such as acetyl-L-carnitine may help improve symptoms of peripheral neuropathy in chemotherapy and diabetes patients. Side effects may include nausea and vomiting.

In addition to drug treatment, other methods of treatment may be used.

• Myostimulation allows, to a certain extent, to restore the conduction of a nerve impulse through the muscles.
• Plasmapheresis and intravenous immunoglobulin.
• exercise therapy. In the presence of muscle weakness, exercise can improve muscle strength and tone. Regular exercise, such as walking three times a week, can reduce neuropathy pain, improve muscle strength, and help control blood sugar levels. Exercises such as yoga and tai chi can also be quite effective.
• Acupuncture. The impact on biologically active points can improve the sensitivity of nerve receptors and reduce pain.

Advice for patients with polyneuropathy

• Feet needs to be taken care of, especially if you have diabetes. Check your feet daily for blisters, cuts, or calluses. Wear soft, loose cotton socks and soft boots.
• It is necessary to quit smoking. Smoking can affect blood circulation in the extremities, increasing the risk of foot problems and other complications of neuropathy.
• Eat healthy food.A healthy diet is especially important to ensure that the patient gets the vitamins and minerals they need.
• Drinking alcohol should be avoided. Alcohol can worsen the symptoms of polyneuropathy.
• Monitoring blood glucose levels in the presence of diabetes mellitus will keep blood glucose levels under control and may help improve the course of neuropathy.

Effexor XR and Celexa for the treatment of depression and panic disorder: differences and side effects

Are

Celexa and Effexor XR the same thing?

Effexor XR (extended release venlafaxine hydrochloride) and Celexa (citalopram hydrobromide) are antidepressants used to treat depression.

Effexor XR is also used to treat anxiety and social disorders.

side effects of humalog and lantus

Effexor XR and Celexa are different types of antidepressants. Effexor XR is a Selective Serotonin and Norepinephrine Reuptake Inhibitor (SSNRI) and Celexa is a Selective Serotonin Reuptake Inhibitor (SSRI).

What are the possible side effects of Effexor XR?

Common Effexor XR side effects include:

• nausea,
• constipation,
• insomnia,
• dizziness,
• asthenia,
• drowsiness,
• dry mouth,
• nervousness,
• strange dreams.
• blurred vision,
• changes in appetite or weight,
• decreased libido,
• impotence
• difficulty with orgasm, and
• increased sweating.

Tell your doctor if you have the unlikely but serious side effects of Effexor XR, including:

• mild bruising or bleeding,
• decreased interest in sex,
• changes in sexual ability,
• muscle cramps or weakness, or
• shaking (tremor).

Serious side effects of Effexor XR include clinical worsening of symptoms and risk of suicide, especially in younger patients. Tell your doctor if you experience worsening depression or suicidal thoughts while taking Effexor XR.

What are the possible side effects of Celexa?

Common Celexa side effects include:

oxycodone apap 5 mg 325 mg side effects

• constipation,
• nausea,
• diarrhea,
• upset stomach,
• decreased sex drive,
• impotence
• difficulty with orgasm,
• dizziness,
• drowsiness,
• fatigue,
• sleep problems (insomnia),
• dry mouth,
• increased sweating or urination,
• weight changes and cold symptoms such as stuffy nose,
• sneezing, sore throat, or
• cough.

What is Effexor XR?

Effexor XR (long-acting venlafaxine hydrochloride) is an antidepressant used to treat patients with serious depressive disorders such as panic and social disorders. Effexor XR is available as a versatile product.

What is Celexa?

Celexa is a prescription drug used to treat depression. It is important to talk with your health care provider about the risks of treating depression, as well as the risks of not being treated.You should discuss all treatment options with your doctor. Celexa is also used to treat major depressive disorder (MDD).

Talk to your doctor if you do not think your condition is improving with Celexa treatment.

What medicines interact with Effexor XR?

Effexor XR may interact with other drugs that cause drowsiness (such as cold or allergy medicines, sedatives, narcotics, sleeping pills, muscle relaxants, and medicines for seizures or anxiety), non-steroidal anti-inflammatory drugs (NSAIDs), cimetidine, ketoconazole, linezolinazole , lithium, haloperidol, tramadol, L-tryptophan, warfarin, almotriptan, frovatriptan, sumatriptan, naratriptan, risatriptan, zolmitriptan, other antidepressants, or other drugs.

What medications interact with Celexa?

Do not take Zimbalta if you:

• take a monoamine oxidase inhibitor (MAOI) . If you are unsure whether you are taking an MAOI, including the antibiotic linezolid, or IV, ask your doctor or pharmacist. methylene blue.
• Do not take MAOIs within 5 days after you stop taking. Cymbalta unless directed by your healthcare professional.
• Do not start Cymbalta if you have stopped taking an MAOI within the past 14 days, unless advised by your healthcare professional.

Tell your doctor about all medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Cymbalta and some medicines can interact with each other, may not work, or cause serious side effects.

amoxicillin other drugs of the same class

Especially tell your doctor if you are taking:

• triptans used to treat migraines
• medicines used to treat mood, anxiety, psychotic or thought disorders, including tricyclic drugs, lithium, buspirone, SSRIs, SNRIs, or MAOIs
• tramadol and fentanyl
• amphetamines
• cimetidine
• antibiotics ciprofloxacin, enoxacin
• medication for the treatment of irregular heart rhythms (e.g. propafenone, flecainide, quinidine)
• theophylline
• non-blood thinner varietal warmer

anti-inflammatory drugs (NSAIDs) (such as ibuprofen, naproxen, or aspirin)

• OTC supplements such as tryptophan or St. John’s wort
• Thioridazine (Mellaril). Mellaril, together with Cymbalta, can cause serious heart rhythm problems or sudden death.

If you are unsure, ask your doctor for a list of these drugs.

Do not take Cymbalta with other medicines containing duloxetine.

How should I take Effexor XR?

The recommended dose of Effexor XR for most patients is 5 mg orally twice a day.

How should I take Celexa?

Take Celexa exactly as directed. Your doctor may need to change your Celexa dose until it is right for you.

Celexa can be taken with or without food.

If you miss a dose of Celexa, take the missed dose as soon as you remember. If it’s time for your next dose, skip the missed dose and take your next dose at the usual time. Do not take two doses of Celexa at the same time.

If you have taken too much Celexa, call your doctor or poison control center right away, or seek emergency help.

Disclaimer

All drug information presented on RxList.com is obtained directly from drug monographs published by the US Food and Drug Administration (FDA).

Any drug information published on RxList.com regarding general drug information, drug side effects, use, dosage, etc.From the original drug documentation contained in his FDA drug monograph.

The drug information contained in drug comparisons published on RxList.com is primarily derived from FDA drug information. The drug comparison information contained in this article does not include data from human or animal clinical trials conducted by any drug comparison drug manufacturer.

The medication comparison information provided does not cover all potential uses, warnings, drug interactions, side effects, side effects, or allergic reactions.RxList.com is not responsible for the medical care provided to a person based on the information posted on this site.

Because drug information can and will change at any time, RxList.com makes every effort to update its drug information. Due to the fact that information on medicines is time-dependent, RxList.com makes no guarantees that the information provided is the most up-to-date.

long-term side effects of prilosec

The absence of drug warnings or information does not in any way guarantee the safety, efficacy, or side effects of any medication.The medication information provided is for reference only and cannot be used as a substitute for medical advice.

If you have specific questions about drug safety, side effects, uses, warnings, etc., you should ask your doctor or pharmacist or consult the FDA websites for specific drug details. gov or RxList.com for more information. …

You can also report negative side effects of prescription drugs to the FDA by visiting the FDA MedWatch website or by calling 1-800-FDA-1088.

References
Pfizer. Effexor XR product information.

https://www.effexorxr.com/

FDA. Celexa Medication Information.

https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/020822s047lbl.pdf

How to treat depression? – Medical center for xenon therapy XeMed

Treatments for depression are medication, talk therapy (where a person talks to an experienced professional about their thoughts and feelings; sometimes referred to as “psychotherapy”), or a combination of the two.

In this essay, only the drug therapy used to treat depression, the so-called antidepressants, will be considered. Your doctor may prescribe psychotherapy in addition to your medications. Always ask your doctor about the benefits and risks of adding psychotherapy to your treatment regimen.

What do the letters CP, CR, XR, and XL stand for after the brand name of an antidepressant?

Labels on antidepressant packages indicate the duration of action in the human body.This means that the drug stays in the body for a longer period of time and you may need to take the drug less frequently.

Wellbatrin SR® is a sustained release drug. You can take this medication twice a day.
Paxil CR® is a controlled release drug. You use this medicine once a day.
Effexor XR®, Wellbatrin XL®, and Prozac Weekly® are extended release formulations. You can take Wellbutrin XL® and Effexor XR® once a day.As for Prozac Weekly®, it can be taken once a week.

How do antidepressants work?

Antidepressants help improve your brain’s ability to use certain chemicals that control mood or stress.

What does research say about how these drugs help people with depression?

All antidepressants are aimed at reducing the symptoms of depression and improving the quality of life of people with depression.
All antidepressants prevent the recurrence of symptoms of depression.

What is the effectiveness of antidepressants?

Although all antidepressants work in much the same way, it is important to remember that some people will not feel better the first time they take the drug. They may need to try several medications before finding one that works for them. Others may find that the symptoms have returned, although the drug helped at first. It is important to carefully follow your doctor’s instructions to find a medication that will work.

Only three out of five report improvement after the first dose of an antidepressant.

What did the study find about specific antidepressants?

Studies have shown specific benefits of several medicines:

People who took Mirtazapine (Remeron®) felt better earlier than if they were taking other antidepressants. Remeron® is effective in one to two weeks. All other antidepressants after 4 weeks at the earliest.
Prozac Weekly® and Paxil CR® worked as efficiently as conventional Prozac® and Paxil®.
Fewer people are taking Venlafaxine (Effexor®, Effexor XR®) because it is less effective than other antidepressants. Side effects such as nausea and vomiting were also the reason for the rejection of Venlafaxine.

Can an antidepressant fight other problems that accompany depression?

Anxiety.
People with depression report a decrease in anxiety symptoms with any of the antidepressants.
Pain.
Paroxetine (Paxil®) and Duloxetine (Cymbalta®) have been noted to help people with depression and chronic pain.
Insomnia.
Fluoxetine (Prozac®), Mirtazapine (Remeron®), Paroxetine (Paxil®) and Sertraline (Zoloft®) have been effective for insomnia, but unfortunately there are not enough studies to be sure.

What are the side effects of antidepressants?

The proportion of people who have some kind of side effect from taking an antidepressant is about the same for all antidepressants.However, the side effects of each medicine may be different, and some medicines may cause side effects more often than others.

The most common side effects for antidepressants highlighted in this analysis are:

Nausea and vomiting
Weight gain
Diarrhea
Drowsiness
Sexual dysfunction

Other, more serious, but much less common antidepressant side effects discussed in this article may include: seizures, heart problems, blood salt imbalances, toxicity, suicidal ideation, or serotonin syndrome (a life-threatening condition where your body produces too much serotonin).Serotonin syndrome can lead to tremors, diarrhea, fever, and seizures.

If you have suicidal thoughts or other serious side effects such as seizures or heart problems while taking an antidepressant, see your doctor right away.

Although all antidepressants cause different side effects, some of them cause certain complications more often than others.

What happens if I stop taking antidepressants?

Some patients experience withdrawal symptoms after stopping the antidepressant.These are called “withdrawal symptoms”
Withdrawal symptoms: headache, dizziness, delirium, nausea and anxiety. You should never stop taking antidepressants without consulting your doctor.
These symptoms most often occurred after discontinuation of Paroxetine (Paxil Paxil®, CR®) and Venlafaxine (Effexor®, Effexor XR®).
Fluoxetine (Prozac® Weekly®) was least likely to develop withdrawal symptoms after discontinuation.

Source: U.S. Department of Health & Human Services

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