Effexor XR (Venlafaxine) - Oral

Warning:

Effexor XR (venlafaxine) comes with a black box warning, which is the Food and Drug Administration’s (FDA’s) highest level of warning. Children, adolescents, and young adults starting or changing their dose of antidepressants such as venlafaxine are at an increased risk of suicidal thinking and behavior. Effexor XR is not approved for use in children.

What Is Effexor XR?

Effexor XR ((venlafaxine) is a prescription medication used for treating certain mood disorders. It comes as an extended-release capsule or tablet that is taken by mouth. It is approved only for adult use, not for children or adolescents.

This medication is a serotonin and norepinephrine reuptake inhibitor (SNRI). Serotonin and norepinephrine have a strong impact on mood, as well as on many other functions of the body. Venlafaxine prolongs the action of these neurotransmitters by preventing their removal from nerve endings in the brain.

Drug Facts

Generic Name: Venlafaxine

Brand Name(s): Effexor, Effexor XR

Administration Route(s): Oral

Drug Availability: Prescription

Therapeutic Classification: Antidepressant

Available Generically: Yes

Controlled Substance: N/A

Active Ingredient: Venlafaxine

Dosage Form(s): Tablet, capsule

What Is Effexor XR Used For?

The FDA approved Effexor XR to treat:

This medication is used on a daily basis to control symptoms. It does not cure any of these conditions and does not stop symptoms while they are happening.

Effexor

Verywell / Dennis Madamba

How to Take Effexor XR

You should take this medication once a day with food at the same time each day.

The capsules have to be swallowed whole. You should not divide, crush, chew, or dissolve them. 

Continue to use this medication as prescribed, and do not stop taking it without consulting your healthcare provider. To stop Effexor XR, they may need to reduce your dose gradually.

Storage

Keep this medication in its original container and away from the reach of children or pets.

Store at a temperature of 68 F to 77 F.

Off-Label Uses

Healthcare providers can prescribe Effexor XR off-label for patients who may benefit from treatment.

Off-label uses include:

Additionally, healthcare providers sometimes prescribe this medication for off-label use in children.

When used off-label, the dose may be different from the prescribed dose for the indicated conditions.

How Long Does Effexor XR Take to Work?

This medication can begin to have effects within a few days. It takes a few weeks to achieve the intended therapeutic effects.

What Are the Side Effects of Effexor XR?

This is not a complete list of side effects, and others may occur. A medical professional can advise you on side effects. If you experience other effects, contact your pharmacist or a medical professional. You may report side effects to the FDA at www.fda.gov/medwatch or 1-800-FDA-1088.

Effexor XR can cause many side effects, which can be mild or short-lasting. Some people may experience severe and dangerous side effects. Before you start taking this medication, familiarize yourself with the potential signs and symptoms of its side effects.

Let your healthcare provider know if you have any side effects, and seek prompt medical attention if you develop any serious reactions.

Common Side Effects

The most common side effects that can occur with Effexor XR are:

  • Nausea
  • Extreme fatigue 
  • Dry mouth
  • Sweating
  • Decreased appetite 
  • Constipation
  • Decreased libido and sexual dysfunction
  • Dyspepsia

Tell your healthcare provider if you begin to experience any of these problems, even if they are mild. Sometimes side effects can be treated. For example, lifestyle modifications can help relieve certain side effects, such as constipation or dry mouth.

Sometimes common side effects can affect your quality of life to a severe degree, necessitating a change in your Effexor XR treatment.

Severe Side Effects

Effexor XR can cause serious side effects. These may be dangerous and potentially life-threatening. Venlafaxine comes with a black box warning, which is the FDA's highest level of warning. Children, adolescents, and young adults starting or changing their dose of antidepressants such as venlafaxine are at an increased risk of suicidal thinking and behavior.

Severe potential side effects of Effexor XR can include:

  • Hypersensitivity, which can include sudden swelling, trouble breathing, and skin changes 
  • Suicidal thoughts and actions, which can be sudden or gradual
  • Serotonin syndrome, which can cause agitation, confusion, stiff muscles, and changes in blood pressure and heart rate
  • Elevated blood pressure, which usually doesn’t have symptoms, but can cause headaches
  • Abnormal bleeding, which can present as bruises or prolonged bleeding after a cut
  • Angle closure glaucoma, which causes changes in vision
  • Activation of mania or hypomania, which presents as changes in behavior, such as decreased sleep, rapid speech, and sometimes recklessness
  • Kidney damage, which might not cause any symptoms at the early stages, but can cause a change in the amount or color of urine
  • Liver damage, which can cause yellowing of the skin and eyes and a general sick feeling
  • Seizures, which can result in involuntary movements and changes in consciousness
  • Low sodium, which can cause dizziness, confusion, or loss of consciousness
  • Interstitial lung disease and eosinophilic pneumonia, which can cause shortness of breath, coughing, and fever

When used off-label for children, this medication can cause weight changes, significant appetite changes, and can affect a child’s growth and height.

Stopping this medication can cause discontinuation syndrome, with symptoms of headaches, mood changes, and sleeping problems. This can also occur with missed doses, even if it is just one day.

Long-Term Side Effects

This medication should not cause long-term side effects. However, the side effects can continue to last for several weeks after you stop taking it.

Harmful effects that occur while using the medication can lead to long-term health issues, such as vision loss due to glaucoma.

Report Side Effects

Effexor Xr may cause other side effects. Call your healthcare provider if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your provider may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting Program or by phone (800-332-1088).

Dosage: How Much of Effexor XR Should I Take?

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The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For oral dosage forms (extended-release capsules, extended-release tablets):
    • For depression:
      • Adults—At first, 75 milligrams (mg) per day, taken as one dose in the morning or evening. Some patients may need a starting dose of 37.5 mg per day, taken for 4 to 7 days. Your doctor may adjust your dose as needed and tolerated. However, the dose is usually not more than 225 mg per day.
      • Children—Use and dose must be determined by your doctor.
    • For generalized anxiety disorder:
      • Adults—At first, 75 milligrams (mg) per day, taken as one dose in the morning or evening. Some patients may need a starting dose of 37.5 mg per day, taken for 4 to 7 days. Your doctor may adjust your dose as needed and tolerated. However, the dose is usually not more than 225 mg per day.
      • Children—Use and dose must be determined by your doctor.
    • For panic disorder:
      • Adults—At first, 37.5 milligrams (mg) per day, taken for 7 days, taken as one dose in the morning or evening. Your doctor may adjust your dose as needed and tolerated. However, the dose is usually not more than 225 mg per day.
      • Children—Use and dose must be determined by your doctor.
    • For social anxiety disorder:
      • Adults—75 milligrams (mg) per day, taken as one dose in the morning or evening.
      • Children—Use and dose must be determined by your doctor.
  • For oral dosage form (tablets):
    • For depression:
      • Adults—At first, a total of 75 milligrams (mg) per day, divided and taken 2 or 3 times during the day. Your doctor may adjust your dose as needed. However, the dose is usually not more than 225 mg per day.
      • Children—Use and dose must be determined by your doctor.

Modifications

Your healthcare provider might modify your dose of Effexor XR if you have kidney or liver disease:

  • Mild or moderate kidney disease: The total daily dose is 25% to 50% less than the standard recommended dose. 
  • Severe kidney disease or dialysis: The total daily dose is half the standard recommended dose.
  • Liver disease: The total daily dose is half or less than the standard recommended dose.

Missed Dose

If you miss a dose of Effexor XR, take it as soon as you can. If it is close to the time of your next dose, take your next dose without doubling up and then resume your regular medication schedule.

Overdose: What Happens If I Take Too Much Effexor XR?

Taking very high amounts of Effexor XR can cause adverse effects.

Symptoms of an overdose can include:

  • Extreme tiredness
  • Dizziness
  • Nausea
  • Hot and cold spells that can last for five days after an overdose

Get medical attention if you take too much Effexor XR. You may need medical observation, including surveillance of your vital signs and breathing. If you develop signs of an overdose, you may need medical treatment.

What Happens If I Overdose on Effexor XR?

If you think you or someone else may have overdosed on Effexor XR, call a healthcare provider or the Poison Control Center (800-222-1222).

If someone collapses or isn't breathing after taking Effexor XR, call 911 immediately.

Precautions

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If you will be taking this medicine for a long time, it is very important that your doctor check you at regular visits. This will allow your doctor to see if the medicine is working properly and to decide if you should continue to take it.

Do not take venlafaxine with a monoamine oxidase (MAO) inhibitor (eg, isocarboxazid (Marplan®), phenelzine (Nardil®)], selegiline (Eldepryl®), tranylcypromine (Parnate®)). Do not start taking venlafaxine during the 14 days after you stop a MAO inhibitor and wait 7 days after stopping venlafaxine before you start taking a MAO inhibitor. If you take them together or do not wait the proper amount of time, you may develop confusion, agitation, restlessness, stomach or intestinal symptoms, a sudden high body temperature, an extremely high blood pressure, or severe seizures.

Venlafaxine may cause a serious condition called serotonin syndrome if taken together with certain medicines. Do not use venlafaxine with buspirone (Buspar®), fentanyl (Abstral®, Duragesic®), linezolid (Zyvox®), lithium (Eskalith®, Lithobid®), methylene blue injection, tryptophan, St John's wort, amphetamines, or some pain or migraine medicines (eg, rizatriptan, sumatriptan, tramadol, Frova®, Imitrex®, Maxalt®, Relpax®, Ultram®, Zomig®). Check with your doctor first before taking any other medicines with venlafaxine.

This medicine may cause some teenagers and young adults to be agitated, irritable, or display other abnormal behaviors. It may also cause some people to have suicidal thoughts and tendencies or to become more depressed. Some people may have trouble sleeping, get upset easily, have a big increase in energy, or start to act reckless. If you or your caregiver notice any of these unwanted effects, tell your doctor right away. Let the doctor know if you or anyone in your family has bipolar disorder (manic-depressive) or has tried to commit suicide.

Do not suddenly stop taking this medicine without checking first with your doctor. Your doctor may want you to gradually reduce the amount you are taking before stopping it completely. This will decrease the chance of side effects, such as agitation, anxiety, blurred vision, confusion, diarrhea, dizziness, fast or irregular heartbeat, headache, irritability, nausea or vomiting, numbness or tingling feeling, restlessness, seizures, sweating, thoughts of hurting yourself or others, trouble sleeping, unusual dreams, or unusual drowsiness, tiredness, or weakness.

This medicine may cause hyponatremia (low sodium in the blood). This is more common in elderly patients, those who take diuretic medicines, or those who have a low amount of fluid in the body due to severe diarrhea or vomiting. Check with your doctor right away if you have a headache, trouble concentrating, memory problems, confusion, weakness, or feel unsteady when standing.

Venlafaxine may increase your risk for bleeding problems. Make sure your doctor knows if you are also using other medicines that thin the blood, including aspirin, NSAID pain or arthritis medicines (eg, diclofenac, ibuprofen, naproxen, Advil®, Aleve®, Celebrex®, Voltaren®), or warfarin (Coumadin®, Jantoven®).

Tell your doctor right away if you are having chest pain or discomfort, dry cough, fever, general feeling of tiredness or weakness, skin rash, or trouble breathing with this medicine. These might be symptoms of a serious lung problem, including interstitial lung disease and eosinophilic pneumonia.

Venlafaxine may cause some people to become drowsy or have blurred vision. Make sure you know how you react to this medicine before you drive, use machines, or do anything else that could be dangerous if you are not alert or able to see clearly. It is best to avoid alcohol with venlafaxine.

Before you have any medical tests, tell the medical doctor in charge that you are taking this medicine. The results of some tests may be affected by this medicine.

Check with your doctor right away if you have decreased interest in sexual intercourse, delayed or inability to have and orgasm in women, inability to have or keep an erection in men, or loss in sexual ability, desire, drive, or performance. These could be symptoms of sexual dysfunction.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal (eg, St. John's wort) or vitamin supplements.

What Are Reasons I Shouldn’t Take Effexor XR?

You should not use this medication if you have ever had an allergic reaction to any of the ingredients used in the capsules or the tablets.

What Other Medications Interact With Effexor XR?

Some medications can interact with Effexor XR, increasing the risk of serotonin syndrome.

Interactions that can increase the risk of serotonin syndrome include:

  • Monoamine oxidase inhibitors (MAOIs), such as Emsam (selegiline) 
  • Triptans, such as sumatriptan
  • Selective serotonin reuptake inhibitors (SSRIs), such as Zoloft (sertraline)
  • Other SNRIs
  • Linezolid, an antibiotic 
  • Lithium, a medication used for treating mood disorders
  • Tramadol, a medication used for treating pain
  • St. John’s wort, an over-the-counter therapy sometimes used for depression

You should not take Effexor XR while also using an MAOI. Never start Effexor XR until at least 14 days after stopping an MAOI. You must wait at least seven days after stopping Effexor XR to start taking an MAOI.

What Medications Are Similar?

There are many other SNRIs used for indications similar to Effexor XR. Other SNRIs include Cymbalta (duloxetine), Fetzima (levomilnacipran), Pristiq (desvenlafaxine), and Savella (milnacipran).

Additionally, Effexor is available in an immediate-release formulation to take twice or three times a day. If your healthcare provider switches you from the immediate formulation to Effexor XR, you would have the same total dose.

Frequently Asked Questions

  • What is Effexor XR used for?

    This medication is prescribed to manage major depressive disorder, generalized anxiety disorder, social anxiety disorder, and panic disorder.

  • How does Effexor XR work?

    Effexor XR prolongs the action of serotonin and norepinephrine by preventing their reuptake (and the cessation of their action). It is a serotonin and norepinephrine reuptake inhibitor (SNRI).

  • What drugs should not be taken with Effexor XR?

    You should not take this medication with other medications that prolong or increase the action of serotonin or norepinephrine, including other SNRIs.

  • What are the side effects of Effexor XR?

    This medication can cause many side effects. Common side effects include nausea, fatigue, dry mouth, sexual dysfunction, sweating, decreased appetite, and constipation. Severe potential side effects can include serotonin syndrome; suicidal thoughts or actions; mania; kidney, liver, or lung damage; low sodium levels; high blood pressure; abnormal bleeding; and angle closure glaucoma.

  • How do I safely stop taking Effexor XR?

    You should not suddenly stop taking this medication. If you need to stop taking it, your healthcare provider will give you a gradually decreasing dosing schedule.

How Can I Stay Healthy While Taking Effexor XR?

If you are taking Effexor XR, it is important to take it as directed. Tell your healthcare provider if you develop any new medical conditions while you are already taking Effexor XR, because this may require a dose change. 

Be aware of the side effects, and tell your provider if you have any mild or moderate side effects. Have a plan in place to get medical attention if you develop severe side effects.

Make sure you are also managing the underlying health condition that Effexor XR is prescribed to treat. Consider counseling, therapy, and behavioral interventions to manage the effects of your condition.

Medical Disclaimer

Verywell Health's drug information is meant for education purposes only and not intended as a replacement for medical advice, diagnosis, or treatment from a healthcare professional. Consult your doctor before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.

5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  3. Aiyer R, Barkin RL, Bhatia A. Treatment of neuropathic pain with venlafaxine: A systematic review. Pain Med. 2017 Oct 1;18(10):1999-2012. doi:10.1093/pm/pnw261

  4. Solmi M, Fornaro M, Ostinelli EG, et al. Safety of 80 antidepressants, antipsychotics, anti-attention-deficit/hyperactivity medications and mood stabilizers in children and adolescents with psychiatric disorders: a large scale systematic meta-review of 78 adverse effects. World Psychiatry. 2020 Jun;19(2):214-232. doi:10.1002/wps.20765

  5. Wathra R, Mulsant BH, Thomson L, et al. Hypertension and orthostatic hypotension with venlafaxine treatment in depressed older adults. J Psychopharmacol. 2020 Oct;34(10):1112-1118. doi:10.1177/0269881120944154

By Heidi Moawad, MD
Heidi Moawad is a neurologist and expert in the field of brain health and neurological disorders. Dr. Moawad regularly writes and edits health and career content for medical books and publications.