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What is Venlafaxine HCL ER?

Common mental illnesses like major depressive disorder, generalized anxiety disorder, and panic disorder affect millions of Americans every year. While many different treatment options are available, some patients prefer extended release capsules or extended release tablets like venlafaxine HCL ER for the treatment of their symptoms.  These medications can offer substantial relief from symptoms, but what is venlafaxine HCL ER?

Venlafaxine HCL ER, also known under the brand name Effexor ER, was first approved by the U.S. Food and Drug Administration (FDA) in 1997.  The prescription drug belongs to a class of drugs called selective serotonin norepinephrine reuptake inhibitor antidepressants (SNRIs), which are commonly used to treat mental health conditions that include depression and anxiety. 

What is Venlafaxine HCL ER Used to Treat?

Venlafaxine HCL ER is approved to treat several mental health conditions, including clinical depression, generalized anxiety disorder, and panic disorder. It is converted from venlafaxine hydrochloride to desvenlafaxine when metabolized. It is also occasionally prescribed for social anxiety disorder and bipolar disorder. A brief explanation of each of these conditions and their associated symptoms is provided below.

Clinical Depression/Major Depressive Disorder

Major depressive disorder, or clinical depression, is a mental illness that is defined by feelings of sadness that are persistent, intense, and last for at least two weeks or more. In addition to emotional changes that contribute to changes in moods and behaviors, clinical depression also contributes to physical changes to sleep and appetite. People with clinical depression commonly lose interest in hobbies or activities that they previously enjoyed, have trouble performing daily tasks, and experience suicidal thoughts or behaviors.  Each year, about seven percent of American adults experience an episode of major depressive disorder; the condition is one of the most common mental health issues. The following symptoms are commonly associated with major depressive disorder:

  • Feeling sad, empty, or tearful
  • Mood swings
  • Feelings of worthlessness, guilt, hopelessness, or helplessness
  • Lost of interest in activities you used to enjoy
  • Nervous energy
  • Feelings of moving or thinking in slow motion
  • Difficult concentrating and low energy
  • Sleeping and eating more or less than usual
  • Suicidal thoughts or behaviors

Generalized Anxiety Disorder

The body’s natural response to stress is anxiety, which we define as fear or apprehension about what is to come. Everyone experiences anxiety at various points throughout their lifetimes, but if the feelings last longer than six months, become extreme, or begin to interfere with your life, anxiety is considered a mental health issue. Generalized anxiety disorder, or GAD, is a common form of anxiety disorder that does not have an obvious cause or source, and most people with the condition recognize that their feelings are irrational but find that they are unable to control them. Symptoms of generalized anxiety disorder include rapid breathing, restlessness, an increased heart rate, trouble concentrating, and difficulty falling asleep. 

Panic disorder

Panic disorder, which is a condition that involves repeated panic attacks, involves sudden periods of intense fear and anxiety that cause physical symptoms without an obvious cause for fear. Panic attacks sometimes feel like heart attacks, so the two are commonly mistaken. It is common for people to experience one or two panic attacks throughout the course of their lives, particularly in an extremely stressful situation, such as the death of a loved one, but people that experience panic attacks on a recurring basis are diagnosed with panic disorder. Symptoms of panic attacks include:

  • Chills
  • Nausea
  • Sense of impending doom or danger
  • Rapid, pounding heart rate
  • Trembling or shaking
  • Feeling detached from reality
  • Fear of loss of control 
  • Chest pain
  • Dizziness, lightheadedness or faintness
  • Headache
  • Numbness or tingling sensation
  • Sweating
  • Shortness of breath or tightness in your throat
  • Hot flashes
  • Abdominal cramping

What is the Cost of Venlafaxine HCL ER?

Venlafaxine HCL ER is available in both generic and brand name forms; the medication is sold under the brand name Effexor XR. As is the case with many prescription medications, the brand name drug is significantly more expensive than the generic version of the medication; in this case, a 30-day supply of Effexor XR is approximately 40 times as expensive as the same form and strength of venlafaxine HCL ER, as indicated in the table below. Furthermore, venlafaxine is generally covered by most commercial insurance companies, Medicare, and Medicaid, while Effexor XR may not be covered. Regardless of your insured status or the coverage level you receive, however, you can save on both the generic and brand name forms of the drug by using a pharmacy discount card. Pharmacy discount cards are free, have no eligibility requirements, and provide discounts on all brand name and generic drugs that are approved by the FDA.

Costs of a 30-Day Supply of Effexor XR and Venlafaxine HCL ER

Effexor XR

Venlafaxine HCL ER

37.5 mg oral capsules

$364.30

$8.50

150 mg oral capsules

$405.70

$10.30

How Do I Know What Dose of Venlafaxine to Take?

The right dose of venlafaxine varies from person to person and will be determined by your healthcare provider based on your age, the form of the medication you take,  and the purpose of treatment. It is common for SSNRIs like venlafaxine to need to be adjusted several times before you find the right dose, so don’t be discouraged if it doesn’t feel perfect right away. Adults with major depressive disorder typically begin treatment with venlafaxine HCL ER at a dose of 75 mg taken orally once per day, while a maintenance dose is typically between 75 mg to 225 mg taken orally once per day. Patients with moderate depression take a maximum dose of 225 mg per day, while severely depressed patients can take a maximum dose of 375 mg per day. When taken for generalized anxiety disorder, the initial dosage is 75 mg taken orally once a day, with the maintenance dosage somewhere between 75 mg and 225 mg taken orally once a day. The maximum dose for adults with generalized anxiety disorder is 225 mg per day.

Panic disorder in adults is treated with a lower initial dosage of 37.5 mg taken orally once a day for 7 days. After the initial seven day treatment period, 75 mg is taken orally once per day. The maintenance dose for adults with panic disorder is 75 mg to 225 mg of venlafaxine HCL ER taken once a day, while the maximum dosage is 225 mg per day.

It is possible to experience withdrawal symptoms when use of venlafaxine HCL ER is stopped abruptly or during a change in dosage,  particularly when patients have been taking the medication for six weeks or longer. In order to avoid withdrawal symptoms, patients should consult with their doctor before stopping their medication or changing their dose. Withdrawing from venlafaxine HCL ER under a doctor’s supervision can help to reduce the likelihood of experiencing withdrawal symptoms and allows your doctor to manage your symptoms appropriately. You should seek medical advice if you experience symptoms of venlafaxine withdrawal, which include:

  • Irritability
  • Nausea
  • Dizziness
  • Vomiting
  • Headache
  • Paresthesias (prickling or tingling sensation on the skin)
  • Nightmares

Are There Any Side Effects Associated With Venlafaxine?

Possible side effects of venlafaxine generally fall into two categories: common and less common. Common side effects associated with venlafaxine that do not require medical attention unless they are severe or do not go away include:

  • Drowsiness
  • Dizziness
  • Nightmares
  • Vomiting
  • Constipation
  • Gas
  • Burping
  • Change in ability to taste food
  • Weight loss
  • Pain, burning, numbness or tingling in part of the body
  • Twitching
  • Sweating
  • High blood pressure
  • Frequent urination
  • Sore throat, chills, or other signs of infection
  • Changes in sexual desire or ability
  • Weakness or tiredness
  • Headache
  • Nausea
  • Stomach pain
  • Diarrhea
  • Heartburn
  • Dry mouth
  • Loss of appetite
  • Uncontrollable shaking of a part of the body
  • Muscle tightness
  • Yawning
  • Hot flashes or flushing
  • Difficulty urinating
  • Ringing in the ears
  • Enlarged pupils 

Less common, but potentially serious side effects of venlafaxine can also occur. If you experience any of the following side effects, seek medical attention from a healthcare professional immediately:  

  • Rash
  • Itching
  • Chest pain
  • Seizures
  • Small purple spots on the skin
  • Fever, confusion, severe muscle stiffness, sweating, or fast or irregular heartbeat
  • Problems with coordination
  • Coma
  • Hives
  • Trouble breathing or swallowing (may be the result of an allergic reaction)
  • Serotonin syndrome
  • Fast, pounding, or irregular heartbeat
  • Unusual bruising or bleeding
  • Eye pain or redness
  • Interstitial lung disease (very rare)
  • Angle closure glaucoma
  • ?Vision changes
  • Fever
  • Hallucinations

Are there any drug interactions associated with venlafaxine HCL ER?

It’s important to give your doctor a complete record of all prescription and over the counter medications that you are taking, in addition to any vitamins, nutritional supplements, or herbs that you might be using in order to avoid potential drug interactions. Potential drug interactions associated with venlafaxine HCL ER include:

  • MAO inhibitors such as isocarboxazid, phenelzine, selegiline, and tranylcypromine
  • Anticoagulants, such as warfarin
  • Amiodarone
  • Amphetamines
  • Antidepressants
  • Buspirone 
  • Cimetidine
  • Clozapine
  • Diuretics
  • Duloxetine
  • Haloperidol
  • Imipramine
  • Indinavir
  • Ketoconazole
  • Linezolid
  • Lithium
  • Medications for anxiety
  • Medications for mental illness
  • Medications for pain
  • Medications for seizure
  • Medications for weight loss
  • Medications for migraines, including almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan, zolmitriptan
  • Methadone
  • Methylene blue
  • Monoamine oxidase inhibitors (MAOIs)
  • NSAIDs such as naproxen and ibuprofen 
  • Phentermine
  • Ritonavir
  • Sedatives
  • Selective serotonin reuptake inhibitors (SSRIs) such as citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, and sertraline
  • Sibutramine
  • Sleeping pills
  • Tramadol
  • Tranquilizers
  • St. John’s wort
  • Tryptophan

You should also refrain from using Velafaxine if:

  • You are pregnant or breastfeeding as it may transfer to the baby or to breast milk. 
  • You have liver disease or kidney disease

Keep this drug out of the reach of children and stored at room temperature. 

References:

https://www.webmd.com/drugs/2/drug-4870-5047/venlafaxine-oral/venlafaxine-oral/details 

https://www.drugs.com/venlafaxine.html 

https://medlineplus.gov/druginfo/meds/a694020.html 

https://www.mayoclinic.org/drugs-supplements/venlafaxine-oral-route/description/drg-20067379 

https://www.healthline.com/health/venlafaxine-oral-tablet 

https://www.nami.org/About-Mental-Illness/Treatments/Mental-Health-Medications/Types-of-Medication/Venlafaxine-(Effexor) 

Published October 1st, 2020 by Bridget Reed
Fact Checked by Chris Riley

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