Venlafaxine (oral)

What is the most important information I should know about venlafaxine?

Do not take this medication if you are allergic to venlafaxine, or if you are also using a monoamine oxidase inhibitor (MAOI) such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate).

You may have thoughts about suicide when you first start taking an antidepressant, especially if you are younger than 24 years old. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment.

Call your doctor at once if you have any new or worsening symptoms such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

Avoid drinking alcohol, which can increase some of the side effects of venlafaxine. Using too much of this medicine in addition to drinking alcohol can cause death.

It may take 4 weeks or more for your symptoms to improve. For best results, keep using the medication as directed. Do not stop using venlafaxine without first talking to your doctor. You may have unpleasant side effects if you stop taking this medication suddenly.

What is venlafaxine?

Venlafaxine is an antidepressant in a group of drugs called selective serotonin and norepinephrine reuptake inhibitors (SSNRIs). Venlafaxine affects chemicals in the brain that may become unbalanced and cause depression.

Venlafaxine is used to treat major depressive disorder, anxiety, and panic disorder.

Venlafaxine may also be used for purposes other than those listed in this medication guide.

What should I discuss with my healthcare provider before taking venlafaxine?

Do not take this medication if you are allergic to venlafaxine, or if you are also using a monoamine oxidase inhibitor (MAOI) such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate). You must wait at least 14 days after stopping an MAOI before you can take venlafaxine. After you stop taking venlafaxine, you must wait at least 7 days before you start taking an MAOI.

Before taking venlafaxine, tell your doctor if you are allergic to any medications, or if you have:

• bipolar disorder (manic depression);
• cirrhosis or other liver disease;
• kidney disease;
• high blood pressure;
• glaucoma;
• seizures or epilepsy;
• a bleeding or blood clotting disorder; or
• high cholesterol.

If you have any of the conditions listed above, you may not be able to take venlafaxine, or you may need a dosage adjustment or special monitoring during treatment.

You may have thoughts about suicide when you first start taking an antidepressant, especially if you are younger than 24 years old. Tell your doctor if you have worsening symptoms of depression or suicidal thoughts during the first several weeks of treatment, or whenever your dose is changed.

Your family or other caregivers should also be alert to changes in your mood or symptoms. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment.

FDA pregnancy category C. Venlafaxine may be harmful to an unborn baby, and may cause problems in a newborn baby if the mother takes the medication late in pregnancy (during the third trimester). Tell your doctor if you are pregnant or plan to become pregnant during treatment.

Venlafaxine can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

Do not give this medication to anyone under 18 years old without the advice of a doctor.

How should I take venlafaxine?

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Your doctor may occasionally change your dose to make sure you get the best results from the medication. Follow the directions on your prescription label.

Take this medication with a full glass of water.

Venlafaxine should be taken with food.

Swallow the controlled-release capsule (Effexor XR) whole, without crushing or chewing. To make the medication easier to swallow, you may open the capsule and sprinkle the medicine into a small amount of applesauce. Swallow all of the mixture without chewing, and do not save any for later use.

Try to take venlafaxine at the same time each day.

It may take 4 weeks or more for your symptoms to improve. For best results, keep using the medication as directed. Do not stop using venlafaxine without first talking to your doctor. You may have unpleasant side effects if you stop taking this medication suddenly.

Store venlafaxine at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember. However, if it is almost time for the next regularly scheduled dose, skip the missed dose and take the next one as directed. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have taken too much of this medication. An overdose of venlafaxine can be fatal, especially if taken together with alcohol.

Symptoms of a venlafaxine overdose may include dizziness, sleepiness, nausea, and numbness or tingling in your hands or feet.

What should I avoid while taking venlafaxine?

Avoid drinking alcohol, which can increase some of the side effects of venlafaxine. Using too much of this medicine in addition to drinking alcohol can cause death.

Avoid using other medicines that make you sleepy (such as cold medicine, pain medication, muscle relaxers, medicine for seizures, other medication for depression or anxiety). They can add to sleepiness caused by venlafaxine.

Venlafaxine can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

What are the possible side effects of venlafaxine?

Get emergency medical help if you have any of these signs of an allergic reaction: skin rash or hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Contact your doctor promptly if you have any of the following side effects, especially if they are new symptoms or if they get worse: mood changes, anxiety, panic attacks, trouble sleeping, irritability, agitation, aggressiveness, severe restlessness, mania (mental and/or physical hyperactivity), thoughts of suicide or hurting yourself.

Call your doctor at once if you have any of these serious side effects:

• increased blood pressure (severe headache, blurred vision);
• nausea, vomiting, diarrhea, fever, fast heartbeat; hallucinations, loss of coordination, fainting, coma;
• seizure (convulsions);
• extreme thirst with headache, nausea, vomiting, and weakness; or
• easy bruising or bleeding.

Other less serious side effects are more likely to occur, such as:

• drowsiness, dizziness, nervousness, or anxiety;
• dry mouth, increased sweating;
• nausea, vomiting, diarrhea, constipation;
• decreased sex drive, impotence, or difficulty having an orgasm;
• headache, blurred vision;
• tremor or chills; or
• changes in appetite or weight.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

What other drugs will affect venlafaxine?

Before taking venlafaxine, tell your doctor if you are using any of the following medicines:

• cimetidine (Tagamet, Tagamet HB);
• warfarin (Coumadin);
• ketoconazole (Nizoral);
• tryptophan (sometimes called L-tryptophan);
• haloperidol (Haldol) or risperidone (Risperdal);
• almotriptan (Axert), frovatriptan (Frova), sumatriptan (Imitrex), naratriptan (Amerge), rizatriptan (Maxalt), or zolmitriptan (Zomig); or
• any other antidepressants such as amitriptyline (Elavil), amoxapine (Ascendin), citalopram (Celexa), clomipramine (Anafranil), desipramine (Norpramin), escitalopram (Lexapro), fluoxetine (Prozac), fluvoxamine (Luvox), imipramine (Tofranil), nortriptyline (Pamelor), paroxetine (Paxil), protriptyline (Vivactil), sertraline (Zoloft), or trimipramine (Surmontil).

If you are using any of these drugs, you may not be able to use venlafaxine, or you may need dosage adjustments or special tests during treatment.

There may be other drugs not listed that can affect venlafaxine. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Where can I get more information?

Your pharmacist has information about venlafaxine written for health professionals that you may read.

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2003 Cerner Multum, Inc. Version: 8.04. Revision date: 10/02/2007.