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General Recommendation: It is recommended that venlafaxine extended-release capsules be taken with food, at approximately the same time each day. Capsules must be swallowed whole with fluid and not divided, crushed, chewed, or dissolved, or it may be administered by carefully opening the capsule and sprinkling the entire contents on a spoonful of applesauce. This drug/food mixture should be swallowed immediately without chewing and should be followed with a glass of water to ensure complete swallowing of the pellets.
With the exception of patients with social anxiety disorder (SAD) (see as follows), patients not responding to the 75 mg/day dose may benefit from dose increases in increments of up to 75 mg/day to a maximum of 225 mg/day. Extended-release venlafaxine dosage increases can be made at intervals of 2 weeks or more, but not less than 4 days.
Patients treated with venlafaxine immediate-release tablets may be switched to venlafaxine extended-release capsules at the nearest equivalent daily dosage. For example, venlafaxine immediate-release tablets 37.5 mg twice daily may be switched to venlafaxine extendedrelease capsules 75 mg once daily. Individual dosage adjustments may be necessary.
Major Depressive Disorder: The recommended starting dose of venlafaxine extended-release capsules is 75 mg given once daily. Patients not responding to the initial 75 mg/day dose may benefit from dose increases to a maximum of 225 mg/day.
The venlafaxine dose can be titrated up to 225 mg/day in moderately depressed patients and 375 mg/day for severely depressed patients.
Generalized Anxiety Disorder: The recommended starting dose of venlafaxine extended-release capsules is 75 mg given once daily. Patients not responding to the initial 75 mg/day dose may benefit from dose increases to a maximum of 225 mg/day.
Social Anxiety Disorder: The recommended dose of venlafaxine extended-release capsules is 75 mg, given once daily. There is no evidence that higher doses confer any additional benefit.
Panic Disorder: It is recommended that a dose of 37.5 mg/day of venlafaxine extended-release capsules be used for 7 days. The dose should then be increased to 75 mg/day. Patients not responding to the 75 mg/day dose may benefit from dose increases to a maximum of 225 mg/day.
Discontinuing Venlafaxine: Gradual dose tapering is recommended when discontinuing venlafaxine therapy (see Precautions and Adverse Reactions). In clinical trials with venlafaxine extended-release capsules, tapering was achieved by reducing the daily dose by 75 mg at 1-week intervals. However, the time period required for tapering and the amount of dose reduction may depend on the dose, duration of therapy, and the individual patient. In some patients, discontinuation may need to occur very gradually over periods of months or longer.
Use in Patients with Renal Impairment: The total daily dose of venlafaxine should be reduced by 25% to 50% in patients with renal impairment with a glomerular filtration rate (GFR) of 10 to 70 mL/min.
The total daily dose of venlafaxine should be reduced by 50% in hemodialysis patients.
Because of individual variability in clearance in these patients, individualization of dosage may be desirable.
Use in Patients with Hepatic Impairment: The total daily dose of venlafaxine should be reduced by 50% in patients with mild to moderate hepatic impairment. Reductions of more than 50% may be appropriate for some patients.
Because of individual variability in clearance in these patients, individualization of dosage may be desirable.
Use in Children and Adolescents: There is insufficient experience with the use of venlafaxine in patients younger than 18 years of age (see Precautions & Adverse Reactions).
Use in Elderly Patients: No specific dose adjustments of venlafaxine are recommended based on patient age.
