Side Effects, Dosage, Uses, and More

Highlights for venlafaxine

1. Venlafaxine oral tablet is only available as a generic drug. It comes in both an immediate-release and an extended-release form.
2. Venlafaxine also comes as an extended-release oral capsule.
3. Venlafaxine oral tablet is used to treat depression (immediate-release tablet and extended-release tablet). It’s also used to treat social anxiety disorder (extended-release tablet only).

FDA warning: Suicidal behavior warning

This drug has a boxed warning. This is the most serious warning from the Food and Drug Administration (FDA). A boxed warning alerts doctors and patients about drug effects that may be dangerous.

• Venlafaxine may increase suicidal thoughts or actions in some children and young adults. This usually happens within the first few months of treatment or during dosage changes. Call your doctor right away if you notice any new or sudden changes in your or your child’s mood, behavior, thoughts, or feelings, especially if they are severe.
• Venlafaxine should not be used in people younger than 18 years of age.

Other warnings

• Serotonin syndrome warning: This drug may cause a possibly life threatening condition called serotonin syndrome. Symptoms of serotonin syndrome include:
  • hallucinations and delusions
  • agitation
  • coma
  • fast heart rate
  • changes in blood pressure
  • dizziness
  • loss of consciousness
  • seizures
  • shakiness
  • muscle tremor or stiff muscles
  • sweating
  • nausea
  • vomiting
• High blood pressure warning: Venlafaxine may increase your blood pressure. Your doctor will likely make sure your blood pressure is normal before you start taking venlafaxine. They will check your blood pressure regularly during your treatment.
• Increased bleeding warning: This drug may increase your risk for bleeding or bruising if used with aspirin, nonsteroidal anti-inflammatory drugs such as ibuprofen or naproxen, or the blood thinner warfarin. Talk with your doctor if you’re taking or planning to take any prescription or over-the-counter medications that increase the risk of bleeding.

Venlafaxine is a prescription drug. It comes as an oral tablet and an oral capsule.

Venlafaxine oral tablet comes in immediate-release and extended-release forms. Both forms are only available as generic drugs. Generic drugs usually cost less than brand-name drugs.

Why it’s used

Venlafaxine oral tablet is used to treat depression (immediate-release tablet and extended-release tablet). It’s also used to treat social anxiety disorder (extended-release tablet only).

Venlafaxine may be used as part of a combination therapy. This means you may need to take it with other medications to treat your condition.

How it works

Venlafaxine belongs to a class of antidepressant drugs called serotonin norepinephrine reuptake inhibitors (SNRIs). A class of drugs is a group of medications that work in a similar way. These drugs are often used to treat similar conditions.

SNRIs work by increasing the levels of substances called serotonin and norepinephrine in your brain. Having more serotonin and norepinephrine in your brain can improve your symptoms of depression and anxiety.

Venlafaxine oral tablet may cause drowsiness. It may also affect your ability to make decisions, think clearly, or react quickly. You should not drive, use heavy machinery, or do things that require you to be alert until you know you can function normally. Venlafaxine may also cause other side effects.

More common side effects

The more common side effects of venlafaxine can include:

• unusual dreams
• sexual problems, such as:
  • decreased interest in sex
  • impotence (not being able to get or keep an erection)
  • trouble having an orgasm
• loss of appetite
• constipation
• nausea or vomiting
• dry mouth
• tiredness
• trouble sleeping or change in sleep habits
• yawning
• tremor or shaking
• dizziness
• blurry vision
• sweating
• feeling anxious, nervous, or jittery
• headache
• increased heart rate

If these effects are mild, they may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk to your doctor or pharmacist.

Serious side effects

Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:

• Attempting suicide
• Acting on dangerous impulses
• Aggressive or violent behavior
• Thoughts about suicide or dying
• New or worsened depression
• New or worsened anxiety or panic attacks
• Agitation, restlessness, anger, or irritability
• Trouble sleeping
• Serotonin syndrome. Symptoms can include:
  • agitation
  • hallucinations (seeing or hearing something that isn’t there)
  • coma
  • changes in your mental status
  • coordination problems
  • muscle twitching or overactive reflexes
  • fast heart rate
  • high or low blood pressure
  • sweating
  • fever
  • nausea
  • vomiting
  • diarrhea
  • muscle stiffness
• High blood pressure. Symptoms can include:
  • headache
  • chest pain
• Mania. Symptoms can include:
  • greatly increased energy
  • severe trouble sleeping
  • racing thoughts
  • reckless behavior
  • unusually grand ideas
  • excessive happiness or irritability
  • talking more or faster than usual
• Seizures
• Eye problems. Symptoms can include:
  • eye pain
  • vision changes
  • enlarged pupils
  • swelling or redness in or around your eyes
• Low sodium levels. Symptoms can include:
  • headache
  • weakness
  • feeling unsteady
  • confusion
  • problems concentrating
  • thinking or memory problems
• Bruising easily
• Frequent nosebleeds
• Frequent bleeding from your gums while brushing your teeth or flossing
• Dark, tar-like stool
• Bleeding from wounds that’s hard to stop
• Lung disease or pneumonia. Symptoms can include:
  • shortness of breath that gets worse
  • cough
  • chest discomfort

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare provider who knows your medical history.

Venlafaxine oral tablet can interact with other medications, vitamins, or herbs you may be taking. An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well.

To help avoid interactions, your doctor should manage all of your medications carefully. Be sure to tell your doctor about all medications, vitamins, or herbs you’re taking. To find out how this drug might interact with something else you’re taking, talk to your doctor or pharmacist.

Examples of drugs that can cause interactions with venlafaxine are listed below.

Drugs you should not use with venlafaxine

Do not take these drugs with venlafaxine. When used with venlafaxine, these drugs can cause dangerous effects in your body. Examples of these drugs include:

• Monoamine oxidase inhibitors (MAOIs), including linezolid and methylene blue. Unless directed by your doctor, do not start venlafaxine within 2 weeks of stopping an MAOI and do not take an MAOI within 7 days of stopping venlafaxine. Taking venlafaxine and an MAOI too close together in time may cause serious or life threatening side effects. These side effects can include high fever, uncontrolled muscle spasms, and stiff muscles. Other side effects can include sudden changes in your heart rate or blood pressure, confusion, and passing out.
• Drugs for weight loss, such as phentermine. Using venlafaxine with drugs such as phentermine may lead to excessive weight loss, serotonin syndrome, and heart problems such as rapid heart rate and high blood pressure.

Interactions that increase your risk of side effects

Taking venlafaxine with certain medications raises your risk of side effects. Examples of these drugs include:

• Cimetidine. Taking this drug with venlafaxine raises your risk of high blood pressure or liver disease. These risks are greater if you are a senior.
• Haloperidol. Taking this drug with venlafaxine raises your risk of QT prolongation. This is a heart condition with symptoms such as dizziness and an irregular heart rhythm.
• Warfarin. Taking this drug with venlafaxine raises your risk of bleeding. Your doctor will monitor you closely, especially when starting or stopping your venlafaxine therapy. Tell your doctor right away if you notice any abnormal bleeding or bruising.
• Anti-inflammatory drugs such as aspirin, ibuprofen, naproxen, and ketoprofen. Taking any of these drugs with venlafaxine raises your risk of bleeding. Your doctor will monitor you closely, especially when starting or stopping your venlafaxine therapy. Tell your doctor right away if you notice any abnormal bleeding or bruising.
• Drugs such as ritonavir, clarithromycin, or ketoconazole. Drugs such as ritonavir, clarithromycin, or ketoconazole can slow the breakdown of drugs in your body. If you take any of these drugs with venlafaxine, the amount of venlafaxine may build up in your body. This would increase your risk of side effects.
• Drugs that cause drowsiness, such as zolpidem, lorazepam, and diphenhydramine. Taking any of these drugs with venlafaxine may make the sleepiness from venlafaxine even worse.
• Other drugs that can increase serotonin levels, such as fluoxetine, paroxetine, citalopram, duloxetine, lithium, and tramadol. Venlafaxine increases your levels of serotonin. Taking it with any of these drugs may increase your serotonin levels even more. If your serotonin levels are too high, a life threatening condition called serotonin syndrome can occur. Your doctor will monitor you closely when starting or increasing your dosage of either drug.
• Certain drugs for migraine, called triptans, such as sumatriptan, rizatriptan, and zolmitriptan. Venlafaxine increases your levels of serotonin. Taking it with any of these drugs may increase your serotonin levels even more. If your serotonin levels are too high, a life threatening condition called serotonin syndrome can occur. Your doctor will monitor you closely when starting or increasing your dosage of either drug.

Interactions that can make your drugs less effective

When certain drugs are used with venlafaxine, they may not work as well. This is because the amount of these drugs in your body may be decreased. Examples of these drugs include:

• Metoprolol. Metoprolol may be less effective when you take it with venlafaxine. This may cause your blood pressure to rise. Talk to your doctor before taking these drugs together.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking.

Venlafaxine oral tablet comes with several warnings.

Allergy warning

Venlafaxine can cause a severe allergic reaction. Symptoms can include:

• trouble breathing
• swelling of your face, tongue, eyes, or mouth
• rash, hives, or blisters, alone or with joint paint or fever

If you have an allergic reaction, call your doctor or local poison control center right away. If your symptoms are severe, call 911 or go to the nearest emergency room.

Don’t take this drug again if you’ve ever had an allergic reaction to it. Taking it again could be fatal (cause death).

Alcohol interaction warning

Do not drink alcohol with venlafaxine. Drinking alcohol raises your risk of sleepiness from venlafaxine. This may affect your ability to make decisions, think clearly, and react quickly. If you drink alcohol, talk to your doctor.

Warnings for people with certain health conditions

For people with liver disease: If you have a history of liver disease, your liver may not process this drug as quickly as it should. This could lead to a buildup of this drug in your body. Your doctor may start you on a reduced dosage. If they increase your dosage later, they will monitor you closely.

For people with kidney disease: If you have kidney disease or a history of kidney disease, you may not be able to clear this drug from your body well. This may increase the levels of venlafaxine in your body. This can cause more side effects. Your doctor may start you on a low dosage and monitor you closely if they increase your dosage.

For people with heart problems: Venlafaxine can increase your heart rate, especially if you’re taking doses greater than 200 mg per day. If you have heart failure or if you’ve recently had a heart attack, your heart may not be able to tolerate this side effect.

For people with hyperthyroidism: Hyperthyroidism can increase your heart rate. Venlafaxine can also increase your heart rate. If you have hyperthyroidism and take venlafaxine, your heart rate may increase to a dangerous level. You are especially at risk if you take venlafaxine doses greater than 200 mg per day.

For people with a history of seizures: Venlafaxine raises your risk of seizures. If you have a seizure, stop taking venlafaxine and call your doctor right away.

For people with increased eye pressure (glaucoma): Venlafaxine can widen your pupils and block the flow of fluid in your eye. These effects can increase the pressure in your eyes. People with a history of increased eye pressure or glaucoma should have their eye pressure checked regularly while taking venlafaxine. Do not take venlafaxine if you have uncontrolled angle-closure glaucoma.

Warnings for other groups

For pregnant women: Venlafaxine is a category C pregnancy drug. That means two things:

1. Research in animals has shown adverse effects to the fetus when the mother takes the drug.
2. There haven’t been enough studies done in humans to be certain how the drug might affect the fetus.

Talk to your doctor if you’re pregnant or plan to become pregnant. This drug should only be used if the potential benefit justifies the potential risk to the fetus. Call your doctor right away if you become pregnant while taking this drug.

For women who are breastfeeding: Venlafaxine may pass into breast milk and cause side effects in a child who is breastfed. Talk to your doctor about breastfeeding your child. You may need to decide whether to stop breastfeeding or stop taking this medication.

For seniors: The kidneys of older adults may not work as well as they used to. This can cause your body to process drugs more slowly. As a result, more of a drug stays in your body for a longer time. This raises your risk of side effects. Older adults may be at higher risk than younger people for low sodium levels in their blood when taking venlafaxine.

For children: This drug should not be used in people younger than 18 years of age.

All possible dosages and drug forms may not be included here. Your dosage, drug form, and how often you take the drug will depend on:

• your age
• the condition being treated
• how severe your condition is
• other medical conditions you have
• how you react to the first dose

Forms and strengths

Generic: Venlafaxine

• Form: immediate-release oral tablet
• Strengths: 25 mg, 37. 5 mg, 50 mg, 75 mg, 100 mg
• Form: extended-release oral tablet
• Strengths: 37.5 mg, 75 mg, 150 mg, 225 mg

Dosage for depression

Adult dosage (ages 18 years and older)

• Immediate-release oral tablets:
  • Typical starting dosage: 75 mg total per day, taken in two or three divided doses
  • Dosage increases: If needed, your doctor may increase your dosage to 150 mg per day.
  • Typical maximum dosage: 225 mg per day. If you have more severe depression, your doctor may prescribe a dosage as high as 375 mg per day, taken in three divided doses.
• Extended-release oral tablets:
  • Typical starting dosage: 75 mg per day, taken in a single dose in the morning or evening. Some patients should start at a lower dosage of 37.5 mg per day for 4–7 days.
  • Dosage increases: If needed, your doctor may increase your dosage. They may increase it every 4 days by 75 mg until you reach 225 mg per day.
  • Typical maximum dosage: 225 mg per day.

Child dosage (ages 0–17 years)

This medication should not be used in people younger than 18 years of age.

Dosage for social anxiety disorder

Adult dosage (ages 18 years and older)

• Extended-release oral tablets:
  • Typical dosage: 75 mg per day, given in a single dose in the morning or evening.
  • Maximum dosage: 75 mg per day.

Child dosage (ages 0–17 years)

This medication should not be used in people younger than 18 years of age.

Special dosage considerations

People with liver problems: People with mild to moderate liver problems should take about half of the typical dose. People with severe liver disease or cirrhosis may need an even lower dosage. Your doctor can tell you more.

People with kidney problems: People with mild to moderate kidney problems should take 75% of the typical dosage. People who are on dialysis should take half of the typical dosage. Your doctor can tell you more.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always to speak with your doctor or pharmacist about dosages that are right for you.

Venlafaxine oral tablet is used for long-term treatment. It comes with serious risks if you don’t take it as prescribed.

If you stop taking the drug suddenly or don’t take it at all: Your depression or anxiety may not get better and may get worse. Do not stop venlafaxine without talking to your doctor. Stopping venlafaxine too quickly can cause serious symptoms such as:

• anxiety
• irritability
• tiredness
• restlessness
• trouble sleeping
• headache
• sweating
• dizziness
• tingling or “pins and needles” feeling
• shaking
• confusion
• nightmares
• nausea
• vomiting
• diarrhea

If this happens, your doctor may have you start taking venlafaxine again and decrease your dosage slowly.

If you miss doses or don’t take the drug on schedule: Your medication may not work as well or may stop working completely. For this drug to work well, a certain amount needs to be in your body at all times.

If you take too much: You could have dangerous levels of the drug in your body. This can lead to death. Symptoms of an overdose of this drug can include:

• fast heart rate
• unusual sleepiness
• enlarged pupils
• seizure
• vomiting
• heart rhythm changes
• low blood pressure
• muscle aches or pains
• dizziness

If you think you’ve taken too much of this drug, call your doctor or seek guidance from the American Association of Poison Control Centers at 800-222-1222 or through their online tool. But if your symptoms are severe, call 911 or go to the nearest emergency room right away.

What to do if you miss a dose: Take your dose as soon as you remember. If you remember just a few hours before your next scheduled dose, take only one dose. Never try to catch up by taking two doses at once. This could result in dangerous side effects.

How to tell if the drug is working: The symptoms of your depression or anxiety should be less severe or happen less often.

Keep these considerations in mind if your doctor prescribes venlafaxine oral tablet for you.

General

• Take venlafaxine with food.
• You can cut or crush the immediate-release tablet, but do not cut or crush the extended-release tablet.

Storage

• Store the immediate-release oral tablet at room temperature between 68°F and 77°F (20°C and 25°C).
• Store the extended-release oral tablet at temperatures between 59°F and 86°F (15°C and 30°C).
• Keep this drug away from light.
• Don’t store this medication in moist or damp areas, such as bathrooms.

Refills

A prescription for this medication is refillable. You should not need a new prescription for this medication to be refilled. Your doctor will write the number of refills authorized on your prescription.

Travel

When traveling with your medication:

• Always carry your medication with you. When flying, never put it into a checked bag. Keep it in your carry-on bag.
• Don’t worry about airport X-ray machines. They can’t hurt your medication.
• You may need to show airport staff the pharmacy label for your medication. Always carry the original prescription-labeled container with you.
• Don’t put this medication in your car’s glove compartment or leave it in the car. Be sure to avoid doing this when the weather is very hot or very cold.

Availability

Not every pharmacy stocks this drug. When filling your prescription, be sure to call ahead to make sure your pharmacy carries it.

Insurance

Many insurance companies require a prior authorization for this drug. This means your doctor may need to get approval from your insurance company before your insurance company will pay for the prescription.

There are other drugs available to treat your condition. Some may be better suited for you than others. Talk to your doctor about other drug options that may work for you.

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

Venlafaxine – StatPearls – NCBI Bookshelf

Continuing Education Activity

Venlafaxine is FDA approved to treat and manage symptoms of depression, social anxiety disorder, and cataplexy. Off-label, venlafaxine can be used for attention deficit disorder, fibromyalgia, diabetic neuropathy, complex pain syndromes, hot flashes, migraine prevention, post-traumatic stress disorder, obsessive-compulsive disorder, and premenstrual dysphoric disorder. Venlafaxine may be used independently or as part of combination therapy with other drugs. This activity outlines the indications, mechanism of action, administration methods, significant adverse effects, contraindications, toxicity, and monitoring, of venlafaxine so providers can direct patient therapy where it is indicated as part of the interprofessional team.

Objectives:

• Identify the approved and off-label indications for venlafaxine.

• Describe the adverse effects associated with venlafaxine, including the FDA black-box warning.

• Summarize the relevant drug-drug interactions of venlafaxine.

• Explain the importance of collaboration and coordination among the interprofessional team and how it can enhance patient care with venlafaxine therapy to improve patient outcomes for patients who have depression and related conditions for which it is indicated.

Access free multiple choice questions on this topic.

Indications

The prevalence of mental disorders in the United States is approximately 30 percent. The global burden of disease statistics shows that four of the ten most important causes of disease worldwide are psychiatric in origin. The pathophysiology behind psychiatric disorders is the imbalance of the complex neurotransmitter system in the brain.  The mainstay of treatment for depression and anxiety has been therapies to modulate these neuron transmitters, including selective serotonin reuptake inhibitors (SSRI), mixed norepinephrine/serotonin reuptake inhibitors (SNRI), tricyclic antidepressants (TCA), and monoamine oxidase inhibitors (MAOI). This article will focus on venlafaxine, which belongs to the class of antidepressants called serotonin-norepinephrine reuptake inhibitors (SNRIs).[1]

Venlafaxine is FDA approved to treat and manage symptoms of depression, social anxiety disorder,  and cataplexy.  Off-label, venlafaxine can be used for attention deficit disorder, fibromyalgia, diabetic neuropathy, complex pain syndromes, hot flashes, migraine prevention, post-traumatic stress disorder, obsessive-compulsive disorder, and premenstrual dysphoric disorder.  Venlafaxine may be used independently or as part of combination therapy with other drugs.[2]

Mechanism of Action

Venlafaxine works by increasing serotonin levels, norepinephrine, and dopamine in the brain by blocking transport proteins and stopping their reuptake at the presynaptic terminal. This action leads to more transmitters available at the synapse and ultimately increases the stimulation of postsynaptic receptors. SNRIs act primarily upon serotonergic and noradrenergic neurons but have little or no effect upon cholinergic or histaminergic receptors. Venlafaxine is a bicyclic phenylethylamine compound.[3] Venlafaxine is a more potent inhibitor of serotonin reuptake than norepinephrine reuptake. Venlafaxine is essentially a selective serotonin reuptake inhibitor at 75 mg, and with higher doses such as 225 mg/day, it has significant effects on the norepinephrine transporter in addition to serotonin.

Administration

Venlafaxine is prescribed only for those 18 years and older and should not be used in children under 18. Venlafaxine should be taken with food, and patients should not take it with alcohol as combining alcohol and venlafaxine can lead to increased sedation. 

Venlafaxine comes in an oral tablet and an oral capsule. The oral tablets come in immediate-release (25 mg, 37.5 mg, 50 mg, 75 mg and 100 mg) and extended-release forms (37.5 mg, 75 mg, 150 mg, and 225 mg.) The immediate-release tablet can be cut or crushed, but the extended-release tablet may not be. Treatment for depression for the immediate release oral table typically starts at 75 mg total per day, given in two or three divided doses.[4] Dosage can increase to 150 mg per day, with a maximum dose of 375 mg per day. The typical starting dose of the extended-release oral tablet is 75 mg per day, taken as a single dose in the morning or evening. This dose can be increased by 75 mg every four days until reaching the maximum dose of 225 mg per day.

Adverse Effects

Venlafaxine causes a lower frequency of anticholinergic, sedating, and cardiovascular side effects but a higher incidence of gastrointestinal complaints, sleep impairment, and sexual dysfunction than TCAs. Additionally, venlafaxine may impair sexual function, resulting in diminished libido, impotence, or difficulty achieving orgasm. Sexual dysfunction frequently results in noncompliance and should be asked about specifically. Sexual dysfunction can sometimes be ameliorated by lowering the dose or instituting drug-free weekends and holidays in appropriate patients. Some patients find withdrawal symptoms uncomfortable.[5]  

Common side effects include: 

• Headache

• Nausea

• Insomnia, dizziness, hypotension, anorexia, somnolence

• Xerostomia

• Asthenia

• HTN

• Impotence, decreased libido, and/or anorgasmia

• Constipation

• Weight loss

• Abnormal dreams

• Diarrhea, abdominal pain

• Blurred vision

• Anxiety, tremor

• Hypercholesterolemia

• Hyponatremia

• Serotonin syndrome[6]

• Seizures

There is an FDA black box warning against venlafaxine as it can increase suicidality, cause depression exacerbation, hypomania/mania, and serotonin syndrome. Venlafaxine can also cause abnormal bleeding, altered platelet function, and anaphylaxis/anaphylactoid reaction. Venlafaxine can cause fatal skin conditions such as Stevens-Johnson syndrome, toxic epidermal necrolysis, and erythema multiforme. Venlafaxine can also cause deterioration of glaucoma angle closure and seizures.[7] Venlafaxine has implications linking it to SIADH, HTN, arrhythmia, interstitial lung disease, eosinophilic pneumonia, pancreatitis, and hepatotoxicity. One main concern with SSRIs and SNRIs is the risk of serotonin syndrome, thought to result from hyperstimulation of brainstem 5HT-1A receptors.[8]

Contraindications

Contraindications to venlafaxine include concurrent use of monoamine oxidase inhibitors. Clinicians should not use venlafaxine if there is a history of anaphylaxis, and caution is necessary when combining venlafaxine with other serotonin modulators. Venlafaxine should be used cautiously with other sedating medications such as CNS depressants and alcohol use. Venlafaxine is contraindicated if it causes worsening suicidal ideation, depression, anxiety, and psychosis. Caution is advisable in heart failure patients, hyperthyroidism, and those with recent myocardial infarctions as it can raise blood pressure and increase heart rate. Venlafaxine raises the risk of seizures, and prescribers should avoid the drug in patients with a seizure disorder.[9] Venlafaxine can cause pupillary dilation and block the flow of fluid in the eye, leading to increased ocular pressure. Patients with glaucoma should have their eye pressures regularly monitored while taking venlafaxine. Venlafaxine is contraindicated in patients with uncontrolled angle-closure glaucoma.  Venlafaxine is a category C pregnancy drug. Venlafaxine can potentially pass into breast milk and cause side effects in breastfed children and should not be used in pregnancy and breastfeeding.

Monitoring

Venlafaxine can interact with many other medications, vitamins, or herbs.[10] Concurrent use of these agents can cause dangerous effects and are contraindicated with venlafaxine. The following is a brief list of drug interactions with venlafaxine:

• Patients should not take venlafaxine with monoamine oxidase inhibitors (MAOIs), linezolid, and methylene blue.  

• Caution is necessary when using venlafaxine with other drugs that can increase serotonin levels, including SSRIs, SNRIs, and tramadol, as they can lead to life-threatening serotonin syndrome. Other drugs that can raise serotonin include triptans, such as sumatriptan, rizatriptan, and zolmitriptan.

• Venlafaxine should not be combined with drugs for weight loss, such as phentermine. Using venlafaxine with drugs like phentermine may result in excessive weight loss, serotonin syndrome, and heart problems such as tachycardia and hypertension. 

• Venlafaxine with cimetidine raises the risk of high blood pressure or liver disease.

• Venlafaxine with haloperidol raises the risk of QT prolongation.[11]

• Venlafaxine taken with warfarin and anti-inflammatory drugs such as aspirin, ibuprofen, naproxen (NSAIDs) increase the risk of bleeding.

• Ritonavir, clarithromycin, or ketoconazole can inhibit the breakdown of venlafaxine leading to venlafaxine accumulation in the body.  

• Venlafaxine, taken with zolpidem, lorazepam, and diphenhydramine, can lead to increased sedation. 

• Metoprolol may be less effective when taken with venlafaxine.

• Venlafaxine can cause false positives when testing the patient’s urine for phencyclidine (PCP) and amphetamine. This effect may remain for several days after stopping venlafaxine.

Toxicity

Venlafaxine oral tablet is prescribed for long-term treatment, and it comes with serious risks if not taken as prescribed or stop it abruptly. Abrupt cessation of venlafaxine can lead to serious adverse effects such as irritability, tiredness, restlessness, anxiety,  insomnia, trouble sleeping, nightmares, headache, sweating, dizziness, tingling, or “pins and needles” feeling, shaking, confusion, nausea, vomiting, or diarrhea.  Symptoms of an overdose of venlafaxine can include: tachycardia, unusual sleepiness, dilated pupils, seizures, vomiting, cardiac arrhythmias, hypotension, muscle aches or pains, or dizziness.

Severe toxicity of venlafaxine, especially when combined with other antidepressants such as SSRI, SNRI, or MAOI, can lead to serotonin syndrome. Serotonin syndrome is a possibly life-threatening condition associated with increased serotonergic activity in the central nervous system. Serotonin syndrome may present with a spectrum of clinical findings, including autonomic hyperactivity, mental status changes, and neuromuscular abnormalities. Serotonin syndrome characteristically presents with myoclonus, agitation, abdominal cramping, hyperpyrexia, hypertension, and potentially death. No laboratory tests exist to confirm the diagnosis as serotonin concentrations do not correlate clinically with symptoms. Hunter Toxicity Criteria Decision Rules can be used to form the diagnosis.[12] To meet the criteria, the patient must be taking a serotonergic agent and fulfill one of the following conditions patients must exhibit spontaneous clonus

• An inducible clonus must be present, plus agitation or diaphoresis

• The presence of ocular clonus plus agitation or diaphoresis

• Tremor with hyperreflexia

• Hypertonia with a temperature above 38 degrees C plus ocular clonus or inducible clonus

Management of serotonin syndrome involves prompt discontinuation of all serotonergic agents with supportive care aimed at normalizing hemodynamics. Patient sedation with benzodiazepines and serotonin antagonists may also be an option.[8] Cyproheptadine can be an option in the event of a failure with benzodiazepines and supportive care. Cyproheptadine is a histamine-1 receptor antagonist with nonspecific 5-HT1A and 5-HT2A antagonistic properties, with an initial dose of 8 mg. treatment with propranolol, bromocriptine, or dantrolene is not recommended. Serotonin syndrome symptoms usually resolve within 24 hours of discontinuation of the offending agent.

Enhancing Healthcare Team Outcomes

Interprofessional healthcare team members should check the patient’s blood pressure before starting the medication and, additionally, continue to monitor blood pressure while on venlafaxine. Patients on venlafaxine should also have their renal function, and lipid profiles monitored. Close monitoring of psychiatric disorders, including symptoms of suicidality, depression, mania, anxiety, or unusual behavior changes, is a necessary precaution. Exercise care when transitioning from or to monoamine oxidase inhibitors. Do not start venlafaxine within two weeks of stopping an MAOI, and MAOI therapy should not commence within seven days of stopping venlafaxine. Only through close monitoring of the patient can the adverse effects be avoided. This monitoring should have contributions from all clinicians (MDs, DOs, NPs, PAs), nursing staff, and pharmacists, who need to coordinate their activities and openly share patient information to drive therapeutic decisions, minimize adverse events, drug-drug interactions, and optimizing patient outcomes. [Level 5]

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References

1.

Strawn JR, Geracioti L, Rajdev N, Clemenza K, Levine A. Pharmacotherapy for generalized anxiety disorder in adult and pediatric patients: an evidence-based treatment review. Expert Opin Pharmacother. 2018 Jul;19(10):1057-1070. [PMC free article: PMC6340395] [PubMed: 30056792]

2.

Safarova TP, Yakovleva OB, Sheshenin VS, Gavrilova SI. [Methods of augmentation of antidepressant therapy (on the model of complex therapy with the inclusion of actovegin) in gerontopsychiatric hospital]. Zh Nevrol Psikhiatr Im S S Korsakova. 2018;118(6. Vyp. 2):55-63. [PubMed: 30346435]

3.

Saad MA, El-Sahar AE, Sayed RH, Elbaz EM, Helmy HS, Senousy MA. Venlafaxine Mitigates Depressive-Like Behavior in Ovariectomized Rats by Activating the EPO/EPOR/JAK2 Signaling Pathway and Increasing the Serum Estradiol Level. Neurotherapeutics. 2019 Apr;16(2):404-415. [PMC free article: PMC6554373] [PubMed: 30361931]

4.

Fava GA, Benasi G, Lucente M, Offidani E, Cosci F, Guidi J. Withdrawal Symptoms after Serotonin-Noradrenaline Reuptake Inhibitor Discontinuation: Systematic Review. Psychother Psychosom. 2018;87(4):195-203. [PubMed: 30016772]

5.

Ning J, Luo J, Meng Z, Luo C, Wan G, Liu J, Wang S, Lian X, Melgiri ND, Sun Y, Huang R. The efficacy and safety of first-line therapies for preventing chronic post-surgical pain: a network meta-analysis. Oncotarget. 2018 Aug 10;9(62):32081-32095. [PMC free article: PMC6112831] [PubMed: 30174798]

6.

Zhan Z, Cao CS, Huang L. Serotonin Syndrome Induced by a Single Dose of Venlafaxine and Magnesium Valproate. Psychiatr Danub. 2021 Summer;33(2):193-195. [PubMed: 34185746]

7.

Dubovicky M, Belovicova K, Csatlosova K, Bogi E. Risks of using SSRI / SNRI antidepressants during pregnancy and lactation. Interdiscip Toxicol. 2017 Sep;10(1):30-34. [PMC free article: PMC6096863] [PubMed: 30123033]

8.

Schoretsanitis G, Augustin M, Saßmannshausen H, Franz C, Gründer G, Paulzen M. Antidepressants in breast milk; comparative analysis of excretion ratios. Arch Womens Ment Health. 2019 Jun;22(3):383-390. [PubMed: 30116895]

9.

Gallagher HC, Gallagher RM, Butler M, Buggy DJ, Henman MC. Venlafaxine for neuropathic pain in adults. Cochrane Database Syst Rev. 2015 Aug 23;2015(8):CD011091. [PMC free article: PMC6481532] [PubMed: 26298465]

10.

Woroń J, Siwek M, Gorostowicz A. Adverse effects of interactions between antidepressants and medications used in treatment of cardiovascular disorders. Psychiatr Pol. 2019 Oct 30;53(5):977-995. [PubMed: 31955180]

11.

Sertraline and venlafaxine: new indication. Prevention of recurrent depression: no advance. Prescrire Int. 2005 Feb;14(75):19-20. [PubMed: 15751171]

12.

Drugs and Lactation Database (LactMed®) [Internet]. National Institute of Child Health and Human Development; Bethesda (MD): Mar 15, 2023. Venlafaxine. [PubMed: 30000251]

Disclosure: Dharminder Singh declares no relevant financial relationships with ineligible companies.

Disclosure: Abdolreza Saadabadi declares no relevant financial relationships with ineligible companies.

Velaxin – instruction for zastosuvannya, buy capsules Velaksin in Ukraine | Price from 659.50 UAH

Dosage

• Venlafaxine: 37.5 mg/capsule (1)
• Venlafaxine: 75 mg/capsule (1) capsule (1)

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Creation date: 04/27/2021
Update date: 07/24/2023

Velaxin

Velaxin is an antidepressant drug.

Form of release and warehouse

The medicinal product is issued in hard gelatin capsules of prolonged release, which can be used at 37.5 mg, 75 mg or 150 mg of soft speech – venlafaxine (in the hydrochloride form).

The next hour for the production of tablets, additional components are also extracted. The capsular shell vibrates with gelatin and titanium dioxide with the addition of barnacles to the oxide of red and yellow.

The maximum price for Velaxin is in MIS Pharmacy 9-1-1. On the site, for an affordable option, you can buy medical preparations, vitamins, goods for watching over the body.

You can buy Velaxin capsules in a pharmacy with a doctor’s prescription.

Pharmacological activity

Venlafaxine is a medicinal language that cannot be compared to other groups of antidepressants, such as tetracyclic and tricyclic drugs. We have two active racemic forms.

Antidepressant effect of Velaksin was used to improve neurotransmitter activity in the central nervous system. Venlafaxine and yoga’s main metabolite are strong inhibitors of serum ingestion of two neurotransmitters, serotonin and norepinephrine (C33CiN). In addition, the stench of the building is despised by neurons that dopamine is intoxicated with.

Pharmacokinetics.

Absorption. Taking 92% of a single oral dose of venlafaxine is absorbed. After taking venlafaxine prolonged viability capsules, the maximum plasma concentrations of venlafaxine and EFA are reached between 6. 0 ± 1.5 and 8.8 ± 2.2 years. Absorption rate of venlafaxine from venlafaxine prolonged viability capsules more, lower rate of elimination. Thus, the right period of drinking after taking venlafaxine prolonged viability capsules (15±6 years) is in fact the period of drinking and absorption, instead of the right period of taking the tablets negai vivilnennya. After the intake of equal daily doses of venlafaxine in tablets of non-gainous vilification or in capsules of prolonged vigilance after injection like venlafaxine, the EFA was similar for the two drug forms, and the coagulation of the concentration in blood plasma was troch lower. for treatment with venlafaxine prolongation capsules. In this way, capsules with prolongation of venlafaxine will provide more rapid absorption, and the same volume of absorption, like tablets of non-gain vilnennia.

Metabolism. Venlafaxine and its metabolites are excreted in the body by the head rank of drugs. Approximately 87% of venlafaxine is excreted over a period of 48 years with apparently unchanged venlafaxine, unconjugated EFA, conjugated EFA, or other other metabolites. Periodic administration of venlafaxine and its active metabolite

Indications before congestion

Velaxin in capsules is prescribed for the treatment of depressive episodes of various genesis and prevention of recurrent roses coil.

The drug is effective in social and general anxiety disorders.

Contraindications

The antidepressant is contraindicated in case of hypersensitivity to any component.

Do not administer Velaxin to patients with suboctal glaucoma and significant arterial hypertension, as at the time of treatment, blood pressure ≥ 180/115 mm Hg. Art.

Medication of contraindications in case of important nirk and hepatic insufficiency, as well as in case of damaged secoviduct, for example, due to pathology of the anterior lesion.

Do not vicorate Velaxin in combination with irreversible MAO inhibitors, similar combinations can lead to a risk of development of serotonin syndrome – an unsafe reaction to the body, which can cause death.

Velaxin intake for children up to 18 years of age, during pregnancy and lactation hours.

Preservative remedy for vicorist in such conditions:

• aggression;
• episodes of mania in history;
• cirrhosis of the liver;
• pomirnі that important zahvoryuvannya nirok

90,006 history of ship attacks;

• succumbing to bleeding;
• one-hour injection of anticoagulants;
• sickness of the heart of that vessel;
• myocardial infarction, transfer to the past.

Ingestion specifics

Velaxin tablets (capsules) indicated for oral ingestion. It’s necessary to take it for an hour and a half, forging it with water. It is not possible to open, open and open the capsules. The additional dose is taken at 2 doses (skin 12 years old). But in some cases, the doctor recommends taking the entire dose at a time.

At the cob stage, prescribe 375 mg of biscuit per extract. The effectiveness of the licks is assessed after 2 days. As the therapeutic effect is not sufficient, the additional dose should be increased to 150 mg in 2 divided doses. Then, at intervals of at least 3-4 days at a time, increase the dose by 37.5 or 75 mg until a clear effect is reached, and up to a maximum of 375 mg per dose.

In important cases, therapy should be started immediately with a dose of 150 mg per dose.

For the prevention of relapses, it is recommended to continue treatment for at least 6 months.

If the therapy lasted for over 6 days, the drug was not taken sharply. In order to eliminate the development of non-negligible symptoms, the dose is reduced step by step, the optimal hour for the end of treatment is 2 days. In case of indulgence in likuvannya, the symptoms are blamed, especially in case of a sharp intoxication of likuvannya.

One-hour administration of the antibiotic linezolid (weak non-selective reverse MAO inhibitor) with venlafaxine is contraindicated.

No clinically significant interactions of venlafaxine with antihypertensive drugs (including β-blockers, angiotensin-converting enzyme (ACE) inhibitors, and diuretics) and hypoglycemic drugs were found.

Arterial pressure. Venlafaxine, fallow in doses, may increase arterial pressure. It is necessary to carefully monitor the parameters of the arterial pressure in all patients and normalize the arterial pressure with venlafaxine to the cob, which is recommended to be controlled periodically – on the cob and after increasing the dose. It is recommended to take care of a hundred of patients, in which the main ailment could be caused by increased arterial pressure, for example, in patients with impaired cardiac function. A possible development of postural hypertension, therefore, in patients, especially those of a summer age, it is necessary to avoid possible confusion, impaired motor coordination.

Haloperidol. During the follow-up pharmacokinetics of haloperidol, there was a 42% decrease in nirk clearance, an 88% increase in maximum plasma concentration, and a 70% increase in haloperidol AUC without changing the dosing period. This fact should be taken to account in case of total congestion of haloperidol and venlafaxine.

Overdose

Signs of venlafaxine overdose (when used alone or in combination with alcohol and/or other drugs): changes in electrocardiogram (lower Q interval) T, blockade of the lower bundle of His, lowering the QRS complex), sinus and tympanic tachycardia, bradycardia, arterial hypotension, change in the level of vidomosty (from drowsiness to comi), sudomi, mydriasis, vomit, vertigo. Qi symptoms and recovery sounded completed independently.

Overdosing treatment includes keeping the air passages clear, adequate acid protection and proper ventilation. It is recommended to conduct a trial monitoring of the frequency of heart rate and signs of important life functions, general supportive and symptomatic therapy. Possibly zastosuvannya activated vugillya. It is not recommended to vomit through the risk of aspiration.

Side effects

Tablets may cause side effects from the side of various body systems:

• sleep disturbance and mood orientation, hallucinations, phobias, apathy, mania, delirium, anxiety, maniacal reactions, suicidal thoughts and feelings;
• loss of appetite, nausea, abdominal pain, change in body fat;
• thrombocytopenia, bleeding in the intestinal tract;
• headache, sudomi, myoclonus, tremor, extrapyramidal reactions;
• destruction of the zor and lowering of the yoga of hospitality;
• increase in blood cholesterol levels;
• damage to cardiac conduction, accelerated heartbeat, decreased arterial pressure.

Perevagi Velaksin

Venlafaxine is the first representative of CIZZCiN, the third generation of antidepressants. Vіn zastosovuєtsya since 1993 year and for the same hour vyvchavsya in different controlled dolіdzhennyah. Authoritative experts in the field of psychopharmacotherapy call yoga one of the most effective antidepressant drugs. Virazhenіst yogo dії suttєvo do not lie in the virazhennostі depresії, scho testify about the possibility of yogo zastosuvannya in depressive episodes of different levels of importance.

Velaxin is a prolonged dosage form of venlafaxine, which allows taking the drug once a day. Compared with other representatives of the SIZZSIN group, this medication helps to achieve more 3-fold remission of illness.

List of vicarious literature

1. Compendium – medicinal preparations;
2. Sovereign register of medical supplies;
3. JAMA.

Velaxin 9 nutrition extension0130

Why Velaxin?

Faces are recognized for the glimpse of depressive states.

Who should prescribe Velaxin?

The drug is prescribed to patients for 18 years.

How to take Velaxin capsules?

Start healing at a dose of 75 mg/dose. In times of consumption, gradually increase, but not more lower to 375 mg. Take the next dose for 2 doses at intervals of 12 years. Capsules need to be taken every hour.

How to replace Velaxin?

Analogues (replacement) Velaksin – Alventa, Venlaxor, Velafax, Newwelong.

Velaxin instructions

VELAXIN®
(UA/3580/02/01)

Release form:

prolonged-dose capsules, 37. 5 mg; 10 capsules in a blister; 3 blisters in a cardboard box; 14 capsules in a blister; 2 blisters in a cardboard box

Stock:

1 capsule contains 37.5 mg venlafaxine (which is equivalent to 42.42 mg venlafaxine hydrochloride)

Manufacturer:

Ugorshchina

VELAXIN®
(UA/3580/02/02)

Release form:

prolonged-dose capsules, 75 mg; 10 capsules in a blister; 3 blisters in a cardboard box; 14 capsules in a blister; 2 blisters in a cardboard box

Stock:

1 capsule contains 75 mg venlafaxine (which is equivalent to 84. 84 mg venlafaxine hydrochloride)

Manufacturer:

Ugorshchina

VELAXIN®
(UA/3580/02/03)

Release form:

prolonged-dose capsules, 150 mg; 10 capsules in a blister; 3 blisters in a cardboard box; 14 capsules in a blister; 2 blisters in a cardboard box

Stock:

1 capsule contains 150 mg venlafaxine (which is equivalent to 169. 68 mg venlafaxine hydrochloride)

Manufacturer:

Ugorshchina

Velaksin price in Pharmacy 911

Venlafaxine (Venlafaxinum) – PsyAndNeuro.ru

150 mg capsule

75 mg capsule

37. 5 mg capsule

Trade names in Russia fix, venlafaxine hydrochloride

Formulation

Tablets 37.5 mg, 75 mg, 150 mg, 225 mg; capsules 37.5 mg, 75 mg, 150 mg. Pack of 28, 30 pcs.

Content

Antidepressant

Serotonin and norepinephrine reuptake inhibitor

Depressive episode

F33. Recurrent Depressive Disorder

◊ FDA Guidelines

• Depression
• GTR
• Social phobia
• Panic disorder

◊ UK Medicines and Healthcare Products Regulatory Agency recommendations

Major depressive episode

◊ Using off-label

• Hot flashes during chemotherapy
• PTSD
• ADHD
• Neuropathic pain

• Depressive mood
• Decreased energy and motivation
• Sleep disorder
• Anxiety

Venlafaxine is a “bicyclic antidepressant, structurally unrelated to SSRIs, tricyclic antidepressants and MAO inhibitors [3]. The exact mechanism of action is unknown, but appears to be related to the potentiation of neurotransmitter activity in the CNS. Thus, venlafaxine and its active metabolite, O-desmethylvenlafaxine (ODV), inhibit the reuptake of both serotonin and norepinephrine, and to a greater extent the first mediator than the second. Venlafaxine and EFA also have weak inhibitory effects on dopamine reuptake, but, unlike tricyclic antidepressants and some SSRI antidepressants, they are not active at histaminergic, muscarinic, or α-1-adrenergic receptors [2].

• Bioavailability: 45%
• Half-life 3-7 hours.
• The half-life of metabolites is 9-13 hours.
• Metabolized in the liver by CYP2D6.
• Eating does not affect absorption.

◊ Dosage and dose adjustment

• Depression: 75-225 mg/day
• Generalized anxiety disorder: 150-225 mg/day
• Increase dose no faster than 75 mg every 4 days. Maximum dose: 375 mg/day
• For PTSD it is possible to use in the range of 37.5-300 mg/day
• Pris ADHD – 18.75-75 mg/day, after 4 weeks can be increased to 150 mg, and then to 225 mg/day
• Neuropathic pain – 75-225 mg/day
• For hot flashes during chemotherapy, it is possible to use in the range of 37.5-150 mg / day for 4-12 weeks.
• At all doses, it affects the transmission of serotonin. However, there are some features: 75-225 mg – mainly for serotonin; 225-375 mg – the dual effect on serotonin and norepinephrine in some patients begins only at such doses.
• Therefore, if there is no response at low doses, increase should be tried.
• Patients with anxiety are advised to titrate the dose slowly [1].

◊ How fast it works

• Begins to work in 2-4 weeks.
• If not effective after 6-8 weeks, increase or stop dose.
• With GAD, the action begins to unfold after 8 weeks.
• The course may last for years to prevent the return of symptoms of depression.

◊ Expected result

Complete remission. After the disappearance of the symptoms of depression, you should continue taking 1 year if it was the treatment of the first episode. If this is a re-episode treatment, treatment can be extended indefinitely [1].

◊ If not working

• Change dose, switch to another drug, or add an auxiliary drug.
• Connect psychotherapy.
• Revise diagnosis for comorbid conditions.
• In patients with undiagnosed bipolar affective disorder, the effectiveness of treatment may be low, in which case a Mood Stabilizer should be switched [1].

◊ How to stop taking

• Some patients may have a withdrawal syndrome. They may be advised to decrease the dose very slowly according to the following scheme: reduce by 1% every 3 days, crush the tablet, dissolve in fruit juice (100 ml) and then pour 1 ml, thus reducing the amount of venlafaxine consumed by 1%. After 3-7 days – pour 2 ml, etc.
• The second regimen is to add fluoxetine during venlafaxine taper.
• It is important to distinguish withdrawal from relapse of symptoms.

◊ Therapeutic combinations

• Combination with mirtazapine (California rocket fuel – see other serotonin cocktails)
• For insomnia and anxiety: benzodiazepines
• For insomnia: trazodone
• Fatigue, drowsiness: modafinil
• For bipolar depression, psychotic depression, resistant depression: mood stabilizers, atypical antipsychotics [1].

• Use with caution if patients have experienced seizures
• Use with caution if the patient has a heart condition
• Use with caution if patients diagnosed with bipolar affective disorder
• May increase ALT and AST levels
• Closely monitor patients with suicidal ideation
• Not allowed:

– angle-closure glaucoma

– together with MAO inhibitors

– allergy to venlafaxine [1].

◊ Patients with diseased kidneys

Reduce dose by 25-50% [1].

◊ Patients with diseased liver

Reduce dose by 50%.

◊ Heart patients

Use with caution

◊ Elderly patients

Some patients tolerate low doses better. Over the age of 65 reduces the risk of suicide [1].

◊ Children and adolescents

• Patients should be checked regularly and personally, especially during the first weeks of treatment.
• Use with caution, considering the risk of undiagnosed bipolar affective disorder and suicidal tendencies.
• Inform adults of the risks [1].

◊ Pregnant

• Risk Category C – Animal studies have shown risks of adverse effects on the fetus, there have been no adequate studies in pregnant women.
• Not recommended for pregnant women, especially during the first trimester
• However, continuation of treatment after pregnancy may be necessary and the risks should be weighed [1].

◊ Breastfeeding

• The drug passes into breast milk.
• However, postpartum treatment may be necessary and the risks should be weighed [1].

• Interaction with: selegiline, safinamide, procarbazine, phenelzine is contraindicated (!)
• Tramodol increases the risk of seizures
• Together with MAO inhibitors may cause life-threatening serotonin syndrome. Therefore, you can start taking venlafaxine only 14 days after the end of taking MAO inhibitors.
• MAO inhibitors can be started no earlier than 5-7 days after the end of venlafaxine
• Together with anticoagulants increases the risk of bleeding [1].

Check blood pressure before starting treatment and check it regularly during treatment.

◊ Side effects mechanism Most side effects come on quickly and go away over time.

◊ Side effects

• Headache, nervousness, insomnia
• Nausea, diarrhea, loss of appetite
• Sweating
• Urinary disorders
• Increase in blood pressure with increasing dose, increase in heart rate
• Dangerous side effects: mania, suicidal ideation, convulsions
• Weight set: no
• Sedation: yes, but infrequently
• Sexual dysfunction: yes (ejaculation/orgasm disorder, impotence) [1].

◊ What to do about side effects

1. Wait
2. Reduce dose
3. Switch to another drug [1].

◊ Long-term use

Regular visits to the doctor and blood pressure measurements above 225 mg/day

9 0417 ◊ Addictive

No.