What time of day should I take effexor?


Effexor XR (Venlafaxine) Drug Information

  • Why
  • How
  • Other Uses
  • Precautions
  • Special Dietary
  • If I Forget
  • Side Effects
  • Storage Conditions
  • Overdose
  • Other Information
  • Brand Names
  • Why is this medication prescribed?

    Effexor XR (venlafaxine) is used to treat depression. Effexor XR (venlafaxine) extended-release (long-acting) capsules are also used to treat generalized anxiety disorder (GAD; excessive worrying that is difficult to control), social anxiety disorder (extreme fear of interacting with others or performing in front of others that interferes with normal life), and panic disorder (sudden, unexpected attacks of extreme fear and worry about these attacks). Effexor XR (venlafaxine) is in a class of medications called selective serotonin and norepinephrine reuptake inhibitors (SNRIs). It works by increasing the amounts of serotonin and norepinephrine, natural substances in the brain that help maintain mental balance.

  • How should this medicine be used?

    Effexor XR (venlafaxine) comes as a tablet or extended-release capsule to take by mouth. The tablet is usually taken two or three times a day with food. The extended-release capsule is usually taken once daily in the morning or evening with food. Take Effexor XR (venlafaxine) at around the same time(s) every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take Effexor XR (venlafaxine) exactly as directed. Do not take more or less of it or take it more often or for a longer period of time than prescribed by your doctor.

    Swallow the extended-release capsule whole; do not split, chew, or crush it, or place it in water. If you cannot swallow the extended-release capsule, you may carefully open the capsule and sprinkle the entire contents on a spoonful of applesauce. Swallow (without chewing) this mixture immediately after preparation and then drink a glass of water to make sure that you have swallowed all of the medication.

    Your doctor will probably start you on a low dose of Effexor XR (venlafaxine) and gradually increase your dose, not more often than once every 4 to 7 days. Tell your doctor how you are feeling during your treatment so that your doctor can adjust your dose properly.

    Effexor XR (venlafaxine) controls depression but does not cure it. It may take 6 to 8 weeks or longer for you to feel the full benefit of this medication. Continue to take Effexor XR (venlafaxine) even if you feel well. Do not stop taking Effexor XR (venlafaxine) without talking to your doctor. Your doctor will probably decrease your dose gradually. If you suddenly stop taking Effexor XR (venlafaxine), you may experience withdrawal symptoms such as agitation; anxiety; confusion; sad mood; irritability; frenzied or abnormal excitement; lack of coordination; trouble falling asleep or staying asleep; nightmares; nausea; vomiting; loss of appetite; diarrhea; dry mouth; sweating; ringing in the ears; seizures; or burning, tingling, numbness, or electric shock-like feelings in any part of the body. Tell your doctor if you experience any of these symptoms while you are decreasing your dose of Effexor XR (venlafaxine) or soon after you stop taking Effexor XR (venlafaxine).

  • Other uses for this medicine

    Effexor XR (venlafaxine) is also sometimes used to treat hot flashes (hot flushes; sudden strong feelings of heat and sweating) in women who have experienced menopause (‘change of life’; the end of monthly menstrual periods) or who are taking medication to treat breast cancer. Talk to your doctor or pharmacist about the risks of using Effexor XR (venlafaxine) to treat your condition.

    This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.

  • What special precautions should I follow?

    Before taking Effexor XR (venlafaxine):

    • tell your doctor and pharmacist if you are allergic to Effexor XR (venlafaxine), any other medications, or any of the ingredients in Effexor XR (venlafaxine) tablets or extended-release capsules. Ask your pharmacist for a list of the ingredients.
    • tell your doctor if you are taking a monoamine oxidase (MAO) inhibitor, such as isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Eldepryl, Emsam, Zelapar), and tranylcypromine (Parnate), or if you have stopped taking one of these medications within the past 14 days. Your doctor will probably tell you that you should not take Effexor XR (venlafaxine). If you stop taking Effexor XR (venlafaxine), your doctor will tell you that you should wait at least 7 days before you start to take an MAO inhibitor.
    • tell your doctor and pharmacist what other prescription and nonprescription medications, and vitamins you are taking or plan to take. Be sure to mention any of the following: anticoagulants (‘blood thinners’) such as warfarin (Coumadin); amiodarone (Cordarone, Pacerone); other antidepressants; cimetidine (Tagamet); clozapine (Clozaril); diuretics (‘water pills’); duloxetine (Cymbalta); haloperidol (Haldol); imipramine (Tofranil); indinavir (Crixivan); ketoconazole (Nizoral); linezolid (Zyvox); lithium; medications for anxiety, mental illness, pain, seizures, or weight loss; medications for migraine such as almotriptan (Axert), eletriptan (Relpax), frovatriptan (Frova), naratriptan (Amerge), rizatriptan (Maxalt), sumatriptan (Imitrex), and zolmitriptan (Zomig); methadone (Dolophine); phentermine (Adipex P, Ionamin); ritonavir (Norvir); sedatives; selective serotonin reuptake inhibitors (SSRIs) such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox), paroxetine (Paxil), and sertraline (Zoloft); sibutramine (Meridia); sleeping pills; tramadol (Ultram); and tranquilizers. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
    • tell your doctor what nutritional supplements and herbal products you are taking, especially St. John’s wort and tryptophan.
    • tell your doctor if you have ever used illegal drugs or overused prescription medications. Also tell your doctor if you have recently had a heart attack
    • tell your doctor if you have ever used illegal drugs or overused prescription medications. Also tell your doctor if you have recently had a heart attack and if you have or have ever had high blood pressure, high blood cholesterol glaucoma (an eye disease), high pressure in the eyes (a condition that can lead to glaucoma), seizures, or heart, kidney, liver, or thyroid disease.
    • tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking Effexor XR (venlafaxine), call your doctor.
    • if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking Effexor XR (venlafaxine).
    • you should know that this medication may make you drowsy. Do not drive a car or operate machinery until you know how this medication affects you.
    • remember that alcohol can add to the drowsiness caused by this medication.
  • What special dietary instructions should I follow?

    Unless your doctor tells you otherwise, continue your normal diet.

  • What should I do if I forget a dose?

    Take the missed dose as soon as you remember it. However, if it is almost time for your next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are taking the extended-release capsules, do not take more than one dose per day.

  • What side effects can this medication cause?

    Effexor XR (venlafaxine) may cause side effects. Call your doctor if any of the following symptoms are severe or do not go away:

    • drowsiness
    • weakness or tiredness
    • dizziness
    • headache
    • nightmares
    • nausea
    • vomiting
    • stomach pain
    • constipation
    • diarrhea
    • gas
    • heartburn
    • burping
    • dry mouth
    • change in ability to taste food
    • loss of appetite
    • weight loss
    • uncontrollable shaking of a part of the body
    • pain, burning, numbness, or tingling in part of the body
    • muscle tightness
    • twitching
    • yawning
    • sweating
    • hot flashes or flushing
    • frequent urination
    • difficulty urinating
    • sore throat, chills, or other signs of infection
    • ringing in the ears
    • changes in sexual desire or ability
    • enlarged pupils (black circles in the middle of the eyes)

    Some side effects can be serious. If you experience any of the following symptoms or those listed in the IMPORTANT WARNING section, call your doctor immediately:

    • rash
    • hives
    • itching
    • difficulty breathing or swallowing
    • chest pain
    • fast, pounding, or irregular heartbeat
    • seizures
    • unusual bruising or bleeding
    • small purple spots on the skin
    • eye pain or redness
    • changes in vision
    • fever, sweating, confusion, fast or irregular heartbeat, and severe muscle stiffness
    • problems with coordination
    • hallucinations (seeing things or hearing voices that do not exist)
    • coma (loss of consciousness for a period of time)

    Effexor XR (venlafaxine) may slow growth and weight gain in children. If your child is taking Effexor XR (venlafaxine), your child’s doctor will watch your child’s growth carefully. Talk to your child’s doctor about the risks of giving Effexor XR (venlafaxine) to your child.

    Effexor XR (venlafaxine) may cause other side effects. Call your doctor if you have any unusual problems while you are taking this medication.

    If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration’s (FDA) MedWatch Adverse Event Reporting program online or by phone .

  • What storage conditions are needed for this medicine?

    Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

  • In case of emergency/overdose

    In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.

    Symptoms of overdose may include:

    • dizziness
    • nausea
    • vomiting
    • burning, tingling, or numbness of the hands and feet
    • increased size of the pupil (black center of the eye)
    • muscle pain
    • hot and cold spells
    • sleepiness
    • seizures
    • fast, slow, or irregular heartbeat
    • coma (loss of consciousness for a period of time)
  • What other information should I know?

    Keep all appointments with your doctor and the laboratory. Your doctor will check your blood pressure often and order certain lab tests to check your response to Effexor XR (venlafaxine).

    Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

    It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

  • Brand Names

    • Effexor®
    • Effexor® XR

Recommended doses of venlafaxine

▪️ The recommended dose of venlafaxine will vary from person to person, depending on the severity of the depression.

▪️ The usual starting dose of venlafaxine is 75 mg daily, but you may be prescribed a lower dose if you have kidney or liver problems.

▪️ It takes a while for venlafaxine to build up its effects, so keep taking it as prescribed even if you feel it’s not working at first. Do not take more than the dose prescribed by your doctor. If your doctor feels it’s necessary, your dose may be gradually increased after a few weeks. However, you should never increase your dose on your own.

How long does venlafaxine take to work?

▪️ It can take between two to four weeks of taking venlafaxine before it starts to work, so it’s very important that you keep taking it, even if it doesn’t seem to make much difference at first. You’ll usually need to keep taking venlafaxine every day for several months, and for at least six months after you feel better. You should keep taking it for as long as your doctor asks you to.

▪️ If you feel your depression or anxiety has got worse, or if you have any distressing thoughts, or feelings about suicide or harming yourself in the first few weeks, or indeed at any point during treatment or after stopping treatment, then it is very important to talk to your doctor.

How long do I need to take venlafaxine for?

▪️ You should keep taking venlafaxine every day for as long as your doctor asks you to. This may be for several months. With depression it’s normal for your doctor to ask you to keep taking your antidepressants for at least six months after you feel better (at least two years if you’ve had several bouts of depression), as this has been shown to reduce the risk of your depression coming back. With anxiety it’s usually recommended that you keep taking your antidepressant for at least 12 months after you feel better.

▪️ Do not suddenly stop taking venlafaxine unless your doctor tells you to, as this can cause withdrawal symptoms. These may include headaches, tremor, agitation or anxiety, feeling sick, vomiting, sweating, dizziness, palpitations, diarrhoea, pins and needles or electric shock sensations, emotional instability, difficulty sleeping and abnormal dreams. Withdrawal symptoms are temporary and are not due to addiction or dependence on the medicine. They can usually be avoided by stopping the medicine gradually, usually by reducing the dose slowly over a period of weeks or months, depending on your individual situation. Follow the instructions given by your doctor when it’s time to stop treatment with venlafaxine.

▪️ Withdrawal symptoms are temporary and are not due to addiction or dependence on the medicine. They can usually be avoided by stopping the medicine gradually, usually by reducing the dose slowly over a period of weeks or months, depending on your individual situation. Follow the instructions given by your doctor when it’s time to stop treatment with venlafaxine.

How to take venlafaxine

▪️ If you’ve been prescribed standard immediate-release venlafaxine tablets, these should be taken twice a day, morning and evening.

▪️ If you’ve been prescribed extended-release or modified-release venlafaxine tablets or capsules, these should be taken once a day. You can take your daily dose at any time of day but try to stick to the same time each day. Modified-release tablets and capsules release the medicine gradually over the day as they pass through the gut.

▪️ Modified release formulations usually have XL in their brand name, for example Efexor XL. You must swallow this type of tablet or capsule whole with a drink. Do not break, crush or chew the tablet or capsule, as this will damage the modified-release action.

Should you take venlafaxine with or without food?

▪️ Immediate-release venlafaxine tablets can be taken either with or without food, on a full or empty stomach.

▪️ Modified-release venlafaxine tablets and capsules should be taken with food, or just after eating.

What should you do if I miss a venlafaxine dose?

▪️ Try to always take your venlafaxine at the same time(s), as part of your regular daily routine – this will help you remember to take it.

▪️ If you forget to take a dose at your usual time, take it as soon as you remember – unless it’s nearly time for your next dose. In this case just leave out the missed dose and take your next dose as usual. Do not take a double dose to make up for a missed dose.

▪️ Some people may experience withdrawal symptoms after accidentally missing a dose of venlafaxine, but these should go when you take your next dose.

Read more about venlafaxine

  • What is venlafaxine used for and how does it work?
  • What you should know before taking venlafaxine
  • What are the possible side effects of venlafaxine?
  • Can I take other medicines with venlafaxine?

Last updated: 21.08.2019

Rita Ghelani (BPharm, MRPharmS) Pharmacist A UK registered practising pharmacist with over 20 years’ experience, Rita is a member of the medical journalists’ association (MJA) and has a wealth of experience in community pharmacy.

EFFEXOR XR® (venlafaxine) extended-release capsules Information for Patients

Medication Guide

EFFEXOR XR(e-fex-or)
(venlafaxine hydrochloride)
(Extended-Release Capsules)

Read the Medication Guide that comes with EFFEXOR XR before you start taking it and each time you get a refill. There may be new information. This Medication Guide does not take the place of talking to your healthcare provider about your medical condition or treatment. Talk with your healthcare provider if there is something you do not understand or want to learn more about.

What is the most important information I should know about EFFEXOR XR?

EFFEXOR XR and other antidepressant medicines may cause serious side effects, including:

1. Suicidal thoughts or actions:

  • EFFEXOR XR and other antidepressant medicines may increase suicidal thoughts or actions in some children, teenagers, or young adults within the first few months of treatment or when the dose is changed.
  • Depression or other serious mental illnesses are the most important causes of suicidal thoughts or actions.
  • Watch for these changes and call your healthcare provider right away if you notice:
    • New or sudden changes in mood, behavior, actions, thoughts, or feelings, especially if severe.
    • Pay particular attention to such changes when EFFEXOR XR is started or when the dose is changed.

    Keep all follow-up visits with your healthcare provider and call between visits if you are worried about symptoms.
    Call your healthcare provider right away if you have any of the following symptoms, or call 911 if an emergency, especially if they are new, worse, or worry you:

    • attempts to commit suicide
    • acting on dangerous impulses
    • acting aggressive or violent
    • thoughts about suicide or dying
    • new or worse depression
    • new or worse anxiety or panic attacks
    • feeling agitated, restless, angry or irritable
    • trouble sleeping
    • an increase in activity or talking more than what is normal for you
    • other unusual changes in behavior or mood
    • Visual problems
      • eye pain
      • changes in vision
      • swelling or redness in or around the eye

      Only some people are at risk for these problems. You may want to undergo an eye examination to see if you are at risk and receive preventative treatment if you are.

Call your healthcare provider right away if you have any of the following symptoms, or call 911 if an emergency. EFFEXOR XR may be associated with these serious side effects:

2. Serotonin Syndrome
This condition can be life-threatening and may include:

  • agitation, hallucinations, coma or other changes in mental status
  • coordination problems or muscle twitching (overactive reflexes)
  • racing heartbeat, high or low blood pressure
  • sweating or fever
  • nausea, vomiting, or diarrhea
  • muscle rigidity

3. Changes in blood pressure. EFFEXOR XR may:

  • increase your blood pressure. Control high blood pressure before starting treatment and monitor blood pressure regularly

4. Enlarged pupils (mydriasis).

5. Anxiety and insomnia.

6. Changes in appetite or weight.

7. Manic/hypomanic episodes:

  • greatly increased energy
  • severe trouble sleeping
  • racing thoughts
  • reckless behavior
  • unusually grand ideas
  • excessive happiness or irritability
  • talking more or faster than usual

8. Low salt (sodium) levels in the blood. Elderly people may be at greater risk for this. Symptoms may include:

  • headache
  • weakness or feeling unsteady
  • confusion, problems concentrating or thinking or memory problems

9. Seizures or convulsions.

10. Abnormal bleeding: EFFEXOR XR and other antidepressant medicines may increase your risk of bleeding or bruising, especially if you take the blood thinner warfarin (Coumadin®, Jantoven®), a non-steroidal anti-inflammatory drug (NSAIDs, like ibuprofen or naproxen), or aspirin.

11. Elevated cholesterol.

12. Lung disease and pneumonia: EFFEXOR XR may cause rare lung problems. Symptoms include:

  • worsening shortness of breath
  • cough
  • chest discomfort

13. Severe allergic reactions:

  • trouble breathing
  • swelling of the face, tongue, eyes or mouth
  • rash, itchy welts (hives) or blisters, alone or with fever or joint pain.

Do not stop EFFEXOR XR without first talking to your healthcare provider. Stopping EFFEXOR XR too quickly or changing from another antidepressant too quickly may cause serious symptoms including:

  • anxiety, irritability
  • feeling tired, restless or problems sleeping
  • headache, sweating, dizziness
  • electric shock-like sensations, shaking, confusion, nightmares
  • vomiting, nausea, diarrhea


EFFEXOR XR is a prescription medicine used to treat depression. It is important to talk with your healthcare provider about the risks of treating depression and also the risks of not treating it. You should discuss all treatment choices with your healthcare provider. EFFEXOR XR is also used to treat:

  • Generalized Anxiety Disorder (GAD)
  • Social Anxiety Disorder (SAD)
  • Panic Disorder (PD)

Talk to your healthcare provider if you do not think that your condition is getting better with EFFEXOR XR treatment.

Who should not take EFFEXOR XR?

Do not take EFFEXOR XR if you:

  • are allergic to EFFEXOR XR or any of the ingredients in EFFEXOR XR. See the end of this Medication Guide for a complete list of ingredients in EFFEXOR XR.
  • have uncontrolled angle-closure glaucoma
  • take a Monoamine Oxidase Inhibitor (MAOI). Ask your healthcare provider or pharmacist if you are not sure if you take an MAOI, including the antibiotic linezolid.
    • Do not take an MAOI within 7 days of stopping EFFEXOR XR unless directed to do so by your physician.
    • Do not start EFFEXOR XR if you stopped taking an MAOI in the last 2 weeks unless directed to do so by your physician.

    People who take EFFEXOR XR close in time to an MAOI may have serious or even life-threatening side effects. Get medical help right away if you have any of these symptoms:

    • high fever
    • uncontrolled muscle spasms
    • stiff muscles
    • rapid changes in heart rate or blood pressure
    • confusion
    • loss of consciousness (pass out)

What should I tell my healthcare provider before taking EFFEXOR XR? Ask if you are not sure.

Before starting EFFEXOR XR, tell your healthcare provider if you:

  • Are taking certain drugs such as:
    • Amphetamines
    • Medicines used to treat migraine headaches such as:
      • triptans
    • Medicines used to treat mood, anxiety, psychotic or thought disorders, such as:
      • tricyclic antidepressants
      • lithium
      • SSRIs
      • SNRIs
      • antipsychotic drugs
    • Medicines used to treat pain such as:
      • tramadol
    • Medicines used to thin your blood such as:
      • warfarin
    • Medicines used to treat heartburn such as:
      • Cimetidine
    • Over-the-counter medicines or supplements such as:
      • Aspirin or other NSAIDs
      • Tryptophan
      • St. John’s Wort
  • have heart problems
  • have diabetes
  • have liver problems
  • have kidney problems
  • have thyroid problems
  • have or had seizures or convulsions
  • have bipolar disorder or mania
  • have low sodium levels in your blood
  • have high blood pressure
  • have high cholesterol
  • have or had bleeding problems
  • are pregnant or plan to become pregnant. It is not known if EFFEXOR XR will harm your unborn baby. Talk to your healthcare provider about the benefits and risks of treating depression during pregnancy
  • are breast-feeding or plan to breast-feed. Some EFFEXOR XR may pass into your breast milk. Talk to your healthcare provider about the best way to feed your baby while taking EFFEXOR XR.

Tell your healthcare provider about all the medicines that you take, including prescription and non-prescription medicines, vitamins, and herbal supplements. EFFEXOR XR and some medicines may interact with each other, may not work as well, or may cause serious side effects.

Your healthcare provider or pharmacist can tell you if it is safe to take EFFEXOR XR with your other medicines. Do not start or stop any medicine while taking EFFEXOR XR without talking to your healthcare provider first.

If you take EFFEXOR XR, you should not take any other medicines that contain (venlafaxine) including: venlafaxine HCl.

How should I take EFFEXOR XR?

  • Take EFFEXOR XR exactly as prescribed. Your healthcare provider may need to change the dose of EFFEXOR XR until it is the right dose for you.
  • EFFEXOR XR is to be taken with food.
  • If you miss a dose of EFFEXOR XR, take the missed dose as soon as you remember. If it is almost time for the next dose, skip the missed dose and take your next dose at the regular time. Do not take two doses of EFFEXOR XR at the same time.
  • If you take too much EFFEXOR XR, call your healthcare provider or poison control center right away, or get emergency treatment.
  • When switching from another antidepressant to EFFEXOR XR your doctor may want to lower the dose of the initial antidepressant first to avoid side effects

What should I avoid while taking EFFEXOR XR?

EFFEXOR XR can cause sleepiness or may affect your ability to make decisions, think clearly, or react quickly. You should not drive, operate heavy machinery, or do other dangerous activities until you know how EFFEXOR XR affects you. Do not drink alcohol while using EFFEXOR XR.

What are the possible side effects of EFFEXOR XR?

EFFEXOR XR may cause serious side effects, including:

  • See “What is the most important information I should know about EFFEXOR XR?”
  • Increased cholesterol- have your cholesterol checked regularly
  • Newborns whose mothers take EFFEXOR XR in the third trimester may have problems right after birth including:
    • problems feeding and breathing
    • seizures
    • shaking, jitteriness or constant crying
  • Angle-closure glaucoma

Common possible side effects in people who take EFFEXOR XR include:

  • unusual dreams
  • sexual problems
  • loss of appetite, constipation, diarrhea, nausea or vomiting, or dry mouth
  • feeling tired, fatigued or overly sleepy
  • change in sleep habits, problems sleeping
  • yawning
  • tremor or shaking
  • dizziness, blurred vision
  • sweating
  • feeling anxious, nervous or jittery
  • headache
  • increase in heart rate

Tell your healthcare provider if you have any side effect that bothers you or that does not go away. These are not all the possible side effects of EFFEXOR XR. For more information, ask your healthcare provider or pharmacist.


How should I store EFFEXOR XR?

  • Store EFFEXOR XR at room temperature between 68°F and 77°F (20°C to 25°C).
  • Keep EFFEXOR XR in a dry place.

Keep EFFEXOR XR and all medicines out of the reach of children.

General information about EFFEXOR

Medicines are sometimes prescribed for purposes other than those listed in a Medication Guide. Do not use EFFEXOR XR for a condition for which it was not prescribed. Do not give EFFEXOR XR to other people, even if they have the same condition. It may harm them.

This Medication Guide summarizes the most important information about EFFEXOR XR. If you would like more information, talk with your healthcare provider. You may ask your healthcare provider or pharmacist for information about EFFEXOR XR that is written for healthcare professionals.

For more information about EFFEXOR XR call 1-800-438-1985 or go to www. EFFEXOR XR.com.

What are the ingredients in EFFEXOR XR?

Active ingredient: (venlafaxine)

Inactive ingredients:

  • Extended-Release Capsules: cellulose, ethylcellulose, gelatin, hypromellose, iron oxides, and titanium dioxide.

This Medication Guide has been approved by the U.S. Food and Drug Administration for all antidepressants.

This product’s label may have been updated. For current full prescribing information, please visit www.pfizer.com


Revised: December 2018

What is Effexor?

Effexor is an antidepressant medication known as a serotonin-norepinephrine reuptake inhibitor. Effexor is used to treat depression, and the extended-release version of the medication is used to treat generalized anxiety disorder, social anxiety disorder, and panic disorder.

When did the U.S. Food and Drug Administration (FDA) approve the medication?

Effexor was first approved by the FDA in 1993.

Is there a generic version of Effexor?

Yes, the generic version of Effexor is known as venlafaxine and is sold in the U.S.

Are there any major differences between Effexor and other mental health medications?

Effexor is a serotonin-norepinephrine reuptake inhibitor (SNRI). SNRIs work by increasing levels of serotonin and norepinephrine in the brain. The extended-release version of the medication is also prescribed to treat anxiety disorders. If you have bipolar disorder and take an SNRI, you may be at risk for triggering a manic episode if you are not also taking a mood stabilizer. Talk to your doctor about your specific symptoms, other health concerns, and other medications you take so they can make the best recommendation for your condition and symptoms.

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Can children take Effexor?

The safety and efficacy of Effexor has not been established for children.

Are there potential interaction issues for people taking Effexor and any other drugs?

Talk to your doctor if you take MAO inhibitors. There are hundreds of drugs which are known to interact with Effexor in major, moderate, or mild ways, so let your doctor know what other medications you are taking before you begin taking the medication. Some of these include anticoagulants, other antidepressants, anxiety medications, weight loss medications, pain medications, seizure medications, migraine medications, cimetidine, clozapine, diuretics, duloxetine, haloperidol, imipramine, indinavir, ketoconazole, linezolid, lithium, methadone, methylene blue, phentermine, ritonavir, sedatives, sibutramine, sleeping medications, tramadol, and tranquilizers.

Are there any other medical conditions that would make someone ineligible for Effexor therapy?

Talk to your doctor about other medical conditions before you take Effexor, such as heart attack, heart disease, high blood pressure, high cholesterol, seizures, liver disease, heart disease, kidney disease, or thyroid disease. Also tell your doctor if you are allergic to any medications, have a history of abusing medication, or a history of suicidal thoughts or behavior.

What is the typical dose that would be prescribed to someone taking Effexor?

Dosage will vary depending on the condition being treated and whether you are taking Effexor tablets or extended-release capsules.

What do I do if I miss a dose?

Take the dose of Effexor when you remember, but skip the missed dose if it is almost time for your next dose. You should never take extra doses of the medication to make up for missed doses, and you should not take more than one dose per day if you take extended-release capsules.

How long does it take for Effexor to reach full efficacy?

It may take several weeks or longer for the medication to be fully effective and for initial side effects to decrease.

What side effects can Effexor cause?

Common side effects can include:

  • nausea
  • headaches
  • diarrhea
  • dry mouth
  • restlessness
  • fatigue
  • sleepiness
  • feeling nervous
  • insomnia
  • increased sweating
  • increased blood pressure
  • sexual side effects

It also is recommended that you wait to drive or operate machinery until you know how the medication affects you. It is also recommended that people avoid alcohol and illegal drugs while on the medication, as they can worsen adverse effects. Report side effects to your doctor immediately. Serious side effects can include rash, hives, seizures, chest pain, difficulty breathing or swallowing, irregular heartbeat, eye pain, fever, confusion, bleeding or bruising, coordination problems, muscle stiffness, hallucinations, and coma. You can also report side effects to the FDA at 1-800-FDA-1088 or online.

What are the potential psychological side effects of taking Effexor?

A small percentage of teens and young adults who take antidepressants experience an increase in suicidal thoughts and behavior. Seek medical help if you experience these thoughts or other changes in behavior or mood.

What are the potential long-term effects of taking Effexor?

Effexor may cause angle-closure glaucoma, so talk to your doctor about the risks and about setting up an eye examination.

Is it safe for a woman who is pregnant, about to become pregnant, or nursing to take Effexor?

Birth defects and fetal harm are possible when Effexor is taken during pregnancy, but the risk is very low. The drug may be transferred via breast milk. Therefore, talk to your doctor about the risks and benefits if you are pregnant, planning to become pregnant, or are nursing before you take Effexor.

Can symptoms occur if Effexor is discontinued?

It’s important not to discontinue use of the drug before talking with your doctor. Withdrawal symptoms of Effexor can include anxiety, agitation, vertigo, nausea, diarrhea, vomiting, sleep problems, nightmares, headache, fatigue, and dry mouth.

What should I do if I overdose on Effexor?

An overdose of Effexor could be fatal, so seek immediate help or call the Poison Help Line at 1-800-222-1222 if you overdose. Overdose symptoms can include dizziness, vomiting, nausea, muscle pain, sleepiness, hot and cold spells, tingling or numbness in hands and feet, increased pupil size, seizures, changes in heartbeat, and coma.

Is Effexor habit-forming?

Effexor is not habit-forming, but it is not recommended that you discontinue use of the drug before talking with your doctor, as withdrawal symptoms can occur.

How much does Effexor cost?

According to goodrx.com, 30 capsules of 75 mg generic venlafaxine ER cost approximately $130. 30 capsules of 75 mg Effexor XR cost approximately $400.

Are there any disadvantages to Effexor?

The biggest disadvantages of Effexor are the potential side effects. Talk to your doctor about what medication is best for you.

DISCLAIMER: The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other healthcare provider. This article mentions drugs that were FDA-approved and available at the time of publication and may not include all possible drug interactions or all FDA warnings or alerts. The author of this page explicitly does not endorse this drug or any specific treatment method. If you have health questions or concerns about interactions, please check with your physician or go to the FDA site for a comprehensive list of warnings.

Article Sources Last Updated: Jan 13, 2020

When Tabitha Dow was six, she had her first migraine.

Now and again she’d be stuck with headaches, but when she hit 29 they became more regular and more severe. Soon her migraines were debilitating, so she sought out medical support at the National Migraine Centre in London.

There, Tabitha was advised to ask her doctor for the antidepressant Venlafaxine at a maximum dose of 150mg. She was told that this would help not only with her migraines, but also with her persistent low moods.

‘This was the start of my downfall,’ Tabitha tells Metro.co.uk.

‘Neither the neurologist, nor the GP who subsequently prescribed the drug, explained that it was extremely chemically addictive.

‘I was not told how long to take it for, it was prescribed indefinitely, and there was no mention that coming off the drug would likely result in severe withdrawal symptoms and a need to taper off like you would heroin.

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‘Neither mentioned that one of the common withdrawal effects of Venlafaxine are migraines.’

Venlafaxine didn’t work to help Tabitha’s mood, so after a year, she decided she wanted to come off it.

Asking her GP about a plan to taper off the antidepressant, Tabitha was told that the medical professional had ‘no idea’ how to proceed.

‘I was completely by myself,’ says Tabitha.

She followed the instructions recommended by her GP, but was quickly confront with severe and debilitating withdrawal symptoms. The plan the doctor recommended was fast and drastic, and Tabitha feels she was left completely unprepared for what she was about to face.

Tabitha before withdrawal. Picture: Tabitha Dow)

‘The migraines increased dramatically and on top of these I developed intense crushing pressure in my forehead which was constant and unbearable for months,’ Tabitha remembers.

‘I also experienced chronic fatigue, internal tremors, startling easily, sensitivity to light and sound, sensory overload, anger, brain zaps, pressure behind my eyes, tired eyes, extreme fear, panic, confusion, being unable to speak, being unable to move, my brain feeling sick, my heart beating fast when I stood up, mental turmoil, night terrors, hypnagogic hallucinations, night sweats, gasping in my sleep, feeling unwell after a bath/shower, severe difficulty waking up in the morning, feeling drowsy and stuck until several hours after waking, feeling drugged and toxic after napping and sleeping, a sensation of my brain moving from side-to-side, squeezing/tight sensation inside my head, right eye-brow pulling upwards, a chemical “metally” sensation in my forehead, vibrating and electrical sensation in my head, being unable to cope with everyday tasks, deterioration in mood, agitation, feeling like my brain was shutting down, light-headed when I stood up, feeling like my body was rocking as if on a boat, feeling catatonic, scrambled thinking, feeling as if there was a block in my thinking, difficulty planning, difficulty carrying out sequential tasks, and feeling detached from my environment.’

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Having found out that she has a lesion in the frontal lobe in her brain, Tabitha believes she may have even had a seizure during this time.

‘I’ve had two episodes where I couldn’t speak,’ she says. ‘It felt like an electrical storm in my head, which I’ve read is what a seizure feels like.’

Tabitha during withdrawal. (Picture: Tabitha Dow)

At first Tabitha didn’t realise that her symptoms were the direct result of withdrawal from Venlafaxine. When she asked her doctor for help and her test results came back normal, she was offered no further support.

‘I was left to cope alone,’ she says.

NICE’s current guidelines on Venlafaxine, and what Tabitha wants to change:

‘Associated with a higher risk of withdrawal effects compared with other antidepressants.

‘Gastro-intestinal disturbances, headache, anxiety, dizziness, paraesthesia, tremor, sleep disturbances, and sweating are most common features of withdrawal if treatment stopped abruptly or if dose reduced markedly; dose should be reduced over several weeks.’

Tabitha suggests that the recommendation to reduce the dose over several weeks isn’t accurate. It takes months to come off the antidepressant safely, and two years later she’s still experiencing debilitating symptoms.

She notes that NICE’s guidelines also fail to mention that Venlafaxine can cause withdrawal symptoms even when not stopped abruptly, and tapered off in accordance with GP’s tapering guidelines.

Unable to work, Tabitha had to quit her job and leave her flat in West London to move home with her parents, so they could look after her.


She lost everything – her job, her health, her home, and yet, she says, doctors still refuse to listen to her struggles.

The doctors Tabitha has seen don’t believe that withdrawal can cause the severe symptoms Tabitha listed. The only psychiatrist she could find to back up her claims is Dr Healy, who’s dedicated his time to researching the effects of Venlafaxine’s withdrawal symptoms. Dr Healy wrote a letter to Tabitha’s GP confirming that she was experiencing intense withdrawal symptoms, but Tabitha says she’s still not receiving any help.

It was only when Tabitha found a Facebook group dedicated to Venlafaxine withdrawal that she learned she wasn’t alone in experiencing her symptoms.

Scrolling through the group, Tabitha found comment after comment repeating her experience, listing a ‘crushing pressure in their foreheads every single day’, that feels like your head is ‘in a vice’ or you’re being ‘smashed in the head with a brick’.

‘It’s ruined my life’ (Picture: Tabitha Dow)

‘It wasn’t until I joined this group and saw that there were hundreds of people in the group all experiencing the same symptoms as me,’ Tabitha tells us, ‘and that I realised that my symptoms were caused by Venlafaxine withdrawal.

‘I told two GPs that I was experiencing withdrawal symptoms from Venlafaxine. One didn’t comment but agreed to refer me to see Dr Healy, the other disagreed even once I had written evidence from Dr Healy.’

Doctors Tabitha has seen believe that the symptoms she’s experiencing are not the result of coming off Venlafaxine, but are simply her original condition returning.


We spoke to a psychiatrist with experience in Venlafaxine, Dr Cosmo Hallstrom, who told us that it’s one of the most popular antidepressants out there, and is generally regarded as the most effective.

While legally, GPs are required to give patients all the information regarding drugs they prescribe, Dr Hallstrom says that the reality is quite different.

‘A doctor’s interest is to get patients treated, and to persuade them to take medication that will help,’ Dr Hallstrom tells Metro.co.uk. ‘So maybe they don’t start listing off all the possible side effects.’

He notes that a GP’s perception of risk is different to that of a patient, and doctors may be reluctant to note all the possible risks in case it puts a patient off getting help.

Two years later, Tabitha is still experiencing withdrawal symptoms. (Picture: Tabitha Dow)

SSRIs do have withdrawal symptoms, Dr Hallstrom explains, but these tend to be short-lived. He states that data shows that in the majority of patients who believe they’re having withdrawal symptoms, what they’re actually experiencing is the return of their initial condition.

He does admit, however, that there’s a chance some people may experience genuine withdrawal – but recommends a simple ‘test, retest’ as a way to check it out.

‘I understand that a lot of patients might not want to take the medication again, having been through a bad experience,’ Dr Hallstrom says. ‘They say “that stuff’s poison”.

‘But if it is withdrawal, when they start taking the drug again their symptoms should disappear within 24 or 48 hours. That’s a simple test.’

But having been ‘traumatised’ by her experience, Tabitha is reluctant to go near medication again – especially as Venlafaxine didn’t work to remedy her depression in the first place, and she doesn’t want to be tied to taking medication for the rest of her life.

Two years on, she’s still debilitated by withdrawal symptoms. She’s unable to work, relies on PIP and ESA benefits, and is now trying to raise money to fund alternative therapies to help her cope – not only with her side effects, but with her thyroid cancer, which she was diagnosed with in the last few years.

It’s the withdrawal symptoms that concern her most.

‘I’d rather have thyroid cancer than go through coming off Venlafaxine,’ Tabitha tells her. ‘Thyroid cancer doesn’t cause any symptoms. Withdrawal ruins my life every thirty seconds.

‘I have really bad cognitive symptoms. It was like my brain had been drugged.

‘I feel like my intelligence has gone, along with my memory.’

Naturally, the experience has put Tabitha off taking medication. She now relies on alternative therapies, but as this is a huge financial burden, she’s taken to GoFundMe to ask for help.

Now, by sharing her story, Tabitha hopes she can affect change.

‘It’s too late for me,’ she tells us. ‘Taking Venlafaxine has ruined my life; I’ve lost my income, my social life and my independence.

‘But I would like doctors to believe me. I’d like them to listen.

‘I want there to be better information about coming off antidepressants and I want there to be a change to the NICE guidelines, so no one has to go through this again.’

MORE: Sleeping less than eight hours a night makes you more likely to experience intrusive thoughts

MORE: Talking openly about my mental health is the best thing I’ve ever done

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Withdrawal reaction associated with venlafaxine


In response to the paper by Johnson et al. entitled “Withdrawal
reaction associated with Venlafaxine” (BMJ 1998; 317:787)

Physicians should note that on 3 March 2000 the US Food and Drug
Administration approved important safety related drug labelling changes
which acknowledge the existence of a Venlafaxine withdrawal syndrome.

The drug labelling changes also confirm that the likelihood and
severity of withdrawal reactions on Venlafaxine discontinuation or dose
reduction increase with both dose and time.

The drug labelling changes are reproduced below and are available on
the Medwatch web site at:

Physicians should further note that Venlafaxine withdrawal reactions
have been reported after missing just a single dose. and .


EFFEXOR & EFFEXOR XR (venlafaxine HCl) Tablets

Physical and Psychological Dependence: New third paragraph –

“Discontinuation effects have been reported in patients receiving

Discontinuing Effexor (venlafaxine HCl): First sentence revised –

“When discontinuing Effexor after more than 1 week of therapy, it is
generally recommended that the dose be tapered to minimize the risk of
discontinuation symptoms. Patients who have received Effexor for more than
6 weeks or more should have their dose tapered gradually over at least a 2
-week period.”

New second paragraph –

“Discontinuation symptoms have been systematically evaluated in
patients taking venlafaxine, to include prospective analyses of clinical
trials in Generalized Anxiety Disorder and retrospective surveys of trials
in depression. Abrupt discontinuation or dose reduction of venlafaxine at
various doses has been found to be associated with the appearance of new
symptoms, the frequency of which increased with increased dose level and
with longer duration of treatment. Reported symptoms include agitation,
anorexia, anxiety, confusion, coordination impaired, diarrhoea, dizziness,
dry mouth, dysphoric mood, fasciculation, fatigue, headaches, hypomania,
insomnia, nausea, nervousness, nightmares, sensory disturbances (including
shock-like electrical sensations), somnolence, sweating, tremor, vertigo,
and vomiting. It is therefore recommended that the dosage of Effexor be
tapered gradually and the patient monitored. The period required for
tapering may depend on the dose, duration of therapy and the individual
patient. Discontinuation effects are well known
to occur with antidepressants.”

Discontinuing Effexor XR:

“When discontinuing Effexor XR after more than 1 week of therapy, it
is generally recommended that the dose be tapered to minimize the risk of
discontinuation symptoms. In clinical trials with Effexor XR, tapering was
achieved by reducing the daily dose by 75 mg at one week intervals.
Individualization of tapering may be necessary. and replaced with –

“Discontinuation symptoms have been systematically evaluated in
patients taking venlafaxine, to include prospective analyses of clinical
trials in Generalized Anxiety Disorder and retrospective surveys of trials
in depression. Abrupt discontinuation or dose reduction of venlafaxine at
various doses has been found to be associated with the appearance of new
symptoms, the frequency of which increased with increased dose level and
with longer duration of treatment. Reported symptoms include agitation,
anorexia, anxiety, confusion, coordination impaired, diarrhoea, dizziness,
dry mouth, dysphoric mood, fasciculation, fatigue, headaches, hypomania,
insomnia, nausea, nervousness, nightmares, sensory disturbances (including
shock-like electrical sensations), somnolence, sweating, tremor, vertigo,
and vomiting. It is therefore recommended that the dosage of Effexor XR be
tapered gradually and the patient monitored. The period required for
tapering may depend on the dose, duration of therapy and the individual
patient. Discontinuation effects are well known to occur with


1. Parker G, Blennerhassett J. Withdrawal reactions associated with
venlafaxine. Aust N Z J Psychiatry 1998; 32:291-4

2. Pinzani V, Ginies E, Robert L, Peyriere H, Abbar M, Blayac J.P.
Venlafaxine withdrawal syndrome: Report of six cases and literature
review. Rev Med Interne 2000; 21:282-4

What is Effexor?

Effexor (chemically known as venlafaxine) is an antidepressant in the serotonin-norepinephrine reuptake inhibitor (SNRI) class. In recent years, it has risen to become one of the most popular antidepressants on the market. This makes it easy to obtain. Due to Effexor’s popularity and ease of acquisition, it lends itself to being easily abused. Effexor is designed to treat major depressive disorder (MDD), generalized anxiety disorder, social phobia and panic disorder. Effexor is known to be a physically non-addictive antidepressant. However, a psychological addiction to Effexor can still be developed through continued abuse. An Effexor addiction can result when a person continues to abuse the drug in an attempt to get high (an intense euphoric reaction to a drug). Effexor may be physically addictive, but there are some harsh unwanted side effects that can occur such as stomach cramps, increased risk of suicide, erectile dysfunction and memory problems.


Addiction or abuse studies are not performed for Effexor also known as venlafaxine. As a result, formal Effexor addiction statistics are not available.

Causes of Effexor Addiction

Effexor is supposed to be a non-addictive antidepressant that is a serotonin-norepinephrine reuptake inhibitor (SNRI). An SNRI helps elevate a person’s mood by leaving more active neurotransmitters in the brain. Frequently, someone abusing Effexor is trying to attain some sort of high. This “high” is not possible with antidepressants. However, by abusing the venlafaxine, an Effexor addiction can be created. This most often occurs when a man or women has co-occurring anxiety or other mood disorders, related substance abuse like alcohol addiction, or an eating disorder that compel them to misuse Effexor. Major events like family deaths, loss of a job, or a relationship falling apart also lead to Effexor abuse.

Signs of Effexor Use, Addiction and Dependence

There are signs and symptoms that arise when someone has an Effexor dependency. Some of these warning signals touch both the physical and psychological parts of the body. Even though using Effexor is not supposed to result in an addiction, there are some unwanted withdrawal symptoms that result of having an Effexor addiction. Some of the forewarning signals include:

  • Stomach cramps
  • Increased risk of suicide
  • Erectile Dysfunction
  • Memory problems
  • Panic attacks
  • Abnormal dreams
  • Tremors
  • Nausea
  • Aggression
  • Hallucinations
  • Insomnia
  • Irritability

Effexor Effects

Effexor is stated to be non-addictive. While this may be correct, there can still be some rather negative effects that result from abruptly quitting an Effexor addiction. These unwanted consequences affect both the physical and psychological components of the body. The abuser’s personal life will be greatly affected as well. Some of the physical results from Effexor addiction include:

  • Stomach cramps
  • Tremors
  • Insomnia
  • Decreased libido
  • Flu-like symptoms
  • Nausea
  • Chills
  • Fatigue
  • Erectile Dysfunction
  • Drowsiness
  • Constipation
  • Dizziness

Psychological responses to Effexor overuse:

  • Hostility
  • Memory problems
  • Panic attacks
  • Increased risk of suicide
  • Depression
  • Hallucinations
  • Abnormal dreams
  • Confusion and incoherent thoughts
  • Irritability
  • Aggression
  • Nervousness and anxiety

Effexor dependency social effects include:

  • Impair relationships
  • Hinder job responsibilities
  • Financial hardships
  • Become isolated
  • End personal activities

Effexor Withdrawal

The medical community states that Effexor is non-addictive like other antidepressants. However, if a person has been abusing venlafaxine and abruptly stops taking the drug, they can experience what is called SSRI discontinuation syndrome, which mimics withdrawal symptoms. These withdrawal symptoms occur when the person suddenly stops taking the drug, decreasing the dose too rapidly, or even after skipping an individual dose. In addition to these physical effects, an Effexor addiction can produce unwanted psychological results as well. Some of the consequences experienced may include nausea, depression, suicidal thoughts, disorientation, stomach cramps, panic attack, sexual dysfunction, headaches and confused thinking

Effexor Addiction Treatment

There is not a great deal of information available on Effexor addiction. This is due to the drug not being considered addictive or habit forming. However, if a person misuses venlafaxine long enough a dependency will be formed. In order to effectively treat the Effexor addiction, the person should wean off the drug under medical direction such as an Effexor treatment center or licensed therapist. Also, the person fighting the dependency should reach out to loved ones. A life without an Effexor addiction is available. The first step to that new life is admitting there is a problem and asking for help.

Last Updated & Reviewed By: Jacquelyn Ekern, MS, LPC on April 1, 2014
Published on AddictionHope.com, Addiction & Abuse Treatment Directory

Accelerated Hypertension after Venlafaxine Usage


Venlafaxine is the first antidepressant that acts via inhibiting serotonin and noradrenaline reuptake. Hypertension is observed in doses exceeding 300 mg/day and is the most feared complication. We report a patient with accelerated hypertension after venlafaxine use observed at a dose of 150 mg/day. A 23-year-old patient with symptoms of insomnia, depression, anhedonia, fatigue admitted our clinic. Venlafaxine at a dose of 75 mg/day was initiated after he was diagnosed with major depressive disorder. After 5 months, venlafaxine dose was uptitrated to 150 mg/day due to inadequate response to drug. After using venlafaxine for ten months at the dose of 150 mg/day, he admitted our clinic with headache and epistaxis. He was hospitalized after his blood pressure was measured as 210/170 mmHg. No secondary causes for hypertension were found, and venlafaxine treatment was considered possible etiologic factor. After stopping venlafaxine treatment, his blood pressure was reverted back to normal limits. While mild elevation of blood pressure could be observed after venlafaxine treatment, this case shows that accelerated hypertension with a diastolic blood pressure rise above 120 mmHg could be observed at relatively low doses of venlafaxine. Close monitoring of blood pressure is necessary after initiation of treatment, as accelerated hypertension could cause endorgan damage with potentially catastrophic results.

1. Introduction

Major depressive disorder (MDD) is the fourth most common disease diagnosed worldwide, with an annual prevalence of 6.6% and a lifelong prevalence of 16.2% . It affects both genders and is prevalent in all age groups.

Venlafaxine is the first product that was commercially available for the treatment of major depression among all the serotonin-norepinephrine reuptake inhibitors . At high doses, the effect of venlafaxine appears earlier than that of the other antidepressants. Adverse effects of venlafaxine include nausea, somnolence, dry mouth, dizziness, nervousness, constipation, asthenia, blurred vision, abnormal ejaculation or orgasm, erectile dysfunction and impotence . However, increase in blood pressure is the most feared complication of venlafaxine, which is usually observed in administration of the doses higher than 300 mg/dL . In most cases, the rise in blood pressure is mild and self-limiting. Accelerated hypertension, in which the diastolic blood pressure rises above 120 mmHg accompanied by complications or alone, is rarely observed with the therapeutic doses and has not been reported before with the use of venlafaxine alone.

In this paper, we report a patient with MDD who experienced accelerated hypertension with blood pressure measurements as high as 210/170 during venlafaxine use. No other secondary causes for hypertension were found, and blood pressure decreased to normal levels right after the drug was stopped.

2. Case Report

A 23-year-old male patient diagnosed with major depressive disorder, visited our institution, and was complaining from persistent symptoms despite the antidepressant therapy. At his initial visit, the patient had been suffering from insomnia, depression, anhedonia, irritability, inability to concentrate, and fatigue for about a year.

Psychological examination revealed slowing of movements, reduced facial expressions, and decrease in his self-care. He had normal orientation of time, space, and person.

Cardiovascular examination was normal at the initial visit, with a blood pressure of 120/70 mmHg and a heart rate of 76 beats/per minute. He had no family history for essential hypertension, chronic renal disorders, or similar chronic diseases.

He was diagnosed with major depressive disorder according to the Structured Clinical Interview for DSM-IV (SCID-1) and 75 mg/day venlafaxine was prescribed. The efficacy of the treatment was planned to be evaluated at monthly intervals. However, the patient did not have regular visits and could only be examined five months later.

Despite missing his visits, the patient said that he was strictly obeying the medication schedule. However, his symptoms had not regressed and the dose of venlafaxine was increased to 150 mg/day.

At the 10th month of the therapy, he readmitted our institution with a complaint of headache and epistaxis. On physical examination, his blood pressure was measured as 210/170 mmHg, and he was subsequently hospitalized with a diagnosis of accelerated hypertension.

After hospitalization, his blood pressure was normalised with the administration of a short acting oral ACE inhibitor. Biochemical analyses including urinalysis and renal function tests, echocardiographic examination, and fundoscopic examination were performed to rule out end organ damage and malignant hypertension. Left ventricular dimensions, wall thickness, and ejection fraction were found to be normal on the echocardiography. Both fundoscopy and renal function tests revealed normal results.

Venlafaxine treatment was stopped as it was thought to be the main predisposal factor for the patient’s high blood pressure levels, while a secondary cause was continued to be searched. Renal Doppler ultrasound examination revealed normal renal dimensions and parenchyma without any stenosis.

The protein and vinyl mandelic acid levels were measured within normal limits in the 24-hour urine test. Other biochemical analyses, including blood sodium and potassium levels, were all normal. After stopping venlafaxine treatment, a decrease below 140/90 mmHg in the blood pressure was observed; no additional drug use was needed for lowering the blood pressure.

The patient was discharged from hospital one week after the initial admission. A 24-hour ambulatory blood pressure monitoring was performed one month after the index event and average blood pressure values which were measured 2 times a day (in the morning and at night) were below 130/80 mmHg.

3. Discussion

Venlafaxine is used in the treatment of major depressive disorder, generalized anxiety disorder, treatment-resistant depression, and chronic pain syndrome . The drug has dual antidepressive effect since it activates both the serotonin and the norepinephrine receptors. Although venlafaxine binds to both the serotonin and the norepinephrine receptors, at therapeutic doses, its affinity to serotonin receptors is 30 times higher than norepinephrine receptors .

At higher doses, the drug also inhibits the dopamine reuptake . At doses exceeding 150 mg/day, the adrenergic effects of venlafaxine became more prevalent . While the adverse effect profile of venlafaxine is similar to other antidepressants, it has fewer drug-drug interactions .

At lower doses, the adverse effects of venlafaxine, including nausea, vomiting, gastrointestinal adverse effects, and sexual dysfunction, are similar to that of other SSRIs, while at higher doses it becomes similar to that of norepinephrine reuptake inhibitors . While adrenergic effects of venlafaxine appear with doses administrated more than 150 mg/day, apparent increase in blood pressure and increased heart rate are observed when the daily dose exceeds 300 mg . In a previous study by Mbaya et al., 12.5% of the patients who were receiving venlafaxine treatment developed hypertension . According to a review published in 1995, increased blood pressure is seen to be 5% in patients using doses lower than 100 mg/daily, 6% using between 100 and 200 mg daily, and 13% using more than 300 mg daily. It is reported that the use of 300/375 mg day for six weeks causes about 7 mmHg increase in blood pressure . Although, higher doses of venlafaxine are associated with higher hypertension rates, doses below 100 mg/day can also cause hypertension. Polymorphism of the genes CYP2D6 and CYP2C19 which are involved in the metabolism of venlafaxine may change the pharmacokinetics of the agent and cause the adverse side effects at different drug levels. A poor metabolisation activity of the CYP2D6 (maybe in combination with the poor metabolisation activity of CYP2C19) might be the reason for the increased toxicity of the comparatively low dose of venlafaxine .

In our case, the blood pressure increased after increasing daily venlafaxine dose to 150 mgs. However, the diastolic blood pressure over 120 mmHg was much more than the expected level. Although we did not observe any complications—such as acute encephalopathy, heart failure, or papilledema—in our patient, such an acute and dramatic increase of blood pressure could be life-threatening.

Depressive mood correlates with blood pressure and depression is a risk factor for developing hypertension . Having chronic hypertension is not a risk factor for aggravated blood pressure response during venlafaxine use .

To our knowledge, only one case of accelerated hypertension (where diastolic blood pressure raised above 120 mmHg) after venlafaxine use has been reported previously. It was a female patient treated for anxiety, depression, and alcohol abuse, and her blood pressure was measured as 220/140 mmHg nine days after the initiation of risperidone and 75 mg/day venlafaxine . In contrast to our case, this patient was also on risperidone treatment, which could also be responsible for the increase of blood pressure.

Two other cases were reported to have developed hypertension after venlafaxine use; however, in both cases, the diastolic pressure was below 120 mmHg. In the first case, a female patient with high-normal blood pressure became hypertensive one week after the initiation of 150 mg/day venlafaxine treatment. Repeated measurement was planned one week after the first measurement which revealed a blood pressure of 162/110 mmHg . In the second case reported by Eren et al., a previously normotensive elder male patient with panic disorder became hypertensive after six-day use of venlafaxine 225 mg/day along with hydroxyzine 22.5 mg/day and clonazepam 4 mg/day. His blood pressure was measured as 175/95 mmHg two weeks after the venlafaxine administration .

Our patient was younger than these patients reported previously, thus we looked for a secondary cause for hypertension. Particularly, pheochromocytoma was searched, as we hypothesised that venlafaxine could enhance hypertensive crises observed in this condition. However, the urine analysis for vanillylmandelic acid, a metabolite for catecholamines, revealed normal results. Urinalysis, renal ultrasound, and renal artery Doppler examinations were all normal, which ruled out the possibility for any renal diseases. Similarly, congenital vascular lesions that may cause hypertension, such as aortic coarctation, were not observed. The dramatic decrease soon after the venlafaxine treatment stopped also pointed out to drug-induced hypertension.

In conclusion, venlafaxine use was identified as the predisposal factor for the accelerated hypertension in our patient. So far, reports and studies showed venlafaxine may cause mild elevation in blood pressure, which are more important in the long term. However, our study suggests that accelerated hypertension with a diastolic blood pressure rise above 120 mmHg could be observed soon after the venlafaxine administration. While hypertensive complications did not develop in our patient, such a sudden increase in blood pressure could cause stroke or similar disabling conditions. Therefore, patients on venlafaxine should be warned for a potential rise in blood pressure, and a regular followup should be planned for hypertension.

Conflict of Interests

No authors have any financial or other conflict of interests in regard to the present work. This study was performed without any financial or other contractual agreements that may cause conflict of interests.

For the past 10 months I’ve been taking Efexor XL (Venlafaxine), the much-hyped, wonder-drug antidepressant. I was put on this medication to treat various symptoms of anxiety and depression: panic attacks, chronic fatigue, insomnia, loss of appetite, poor concentration, no interest in going out, crying over the slightest thing, and worst of all, thoughts of killing myself.

The first few days on Efexor XL I felt like I’d been fitted with an IV drip that pumped freshly made espresso into my bloodstream. My GP had warned that the drug might have this effect: ‘You might hit the roof on this stuff, let’s be careful.’

I not only hit the roof, I went into orbit. I couldn’t sleep. I couldn’t sit still. I had to constantly be doing something. And then, thankfully, this amphetamine-like buzz wore off and the business of rewiring my brain got under way.

As the medication stabilised my mood, erased all traces of panic attacks, dulled my reaction to anxious thoughts, removed my tendency to obsess, kick-started an era of prolific work, turned me into a socialite, induced nights of perfect sleep and banished all thoughts of suicide, the side-effects came on. The constipation was hardly a surprise: it goes hand in hand with most antidepressants. Weight gain is also a common side-effect. But not on this scale. In the months that followed – despite exercising five times a week and no change from my usual low-fat vegetarian diet – I gained 25lb.

I launched two-hour sessions at the gym, burning off 1,000 calories at a time, and still the scales kept creeping higher. Then there was the sweating. At first I thought it was the weight gain. But then I scoured the web and found dozens of posts from fellow Efexor-heads saying they were sweating like the world had turned into one big sauna. In the mildest of yoga classes, I found myself dripping.

Mentally, there were problems, too. Overnight I turned into a caricature of a stoner. I forgot things, arrived days early or late for appointments, lost my train of thought mid-sentence and managed to bump into any piece furniture in my path. So why keep taking it, you ask. Well, the simple answer is this: I felt better. I was prepared to have myself morphed into a stoned, sweaty, constipated beach ball if it meant no more panic attacks, no more excruciating mornings where I couldn’t get out of bed, no more days staring morosely into a blank computer screen.

In January, my GP decided it was time to start weaning me off the medication and cut my dose from 150mg a day to 75mg. Having just spent Christmas in Milan, I was still high on la dolce vita and willing to give it a go. After the first few days everything started going a bit Memento, the whole sequence of side-effects unfolding in reverse.

I stopped bumping into furniture.

I became dazzlingly lucid. I stopped sweating so much. I lost 5lb in 10 days. And then the end of my constipation announced itself in a never-ending series of dashes to the bathroom. By this point I felt like a slowly deflating beach ball. All the oomph was oozing out of me, too. My brain was wired up to a dimmer switch and someone was turning it down, down, down. A decent night’s sleep was the first thing to go. I lay awake obsessing about the blind woman I’d seen in the supermarket that day, wondering how she coped, hoping there was somebody who loved her and took care of her. Or I lay awake obsessing about the three little girls my wife and I sponsor in Central America and whether they had had the medical treatment they were due. Confusingly, the more tired I got, the faster my brain seemed to be going. Thoughts were taking off 10 at a time. And then other prominent edifices in Efexor-land crumbled, too: seeing friends started feeling like a chore again; I stopped going to the gym because it required too much effort; I had a bright blazing panic attack while out shopping, and instead of working I spent entire days making coffee and gazing absent-mindedly out the window. By the third week on 75mg a day, my wife looked exhausted and ordered me to go back and see my GP. Pronto.

Alarmed to see that I had gone from looking like a relaxed, healthy poster-boy for the Italian lifestyle to resembling Michael Keaton in Beetlejuice in less than a month, she said I clearly wasn’t ready to start coming off the medication and restored my dose to 150mg a day. Within seven days all was fine again. I was piling the pounds on, sweating like a malaria victim and crashing into chairs and tables.

Just like the old days. Except I was sick of being on this medication.

So now I’ve been on 150mg a day of Efexor XL for 10 months and I’ve come to accept that the side-effects are a fair trade for not feeling like that. But I do want to get off this drug. So why the severe reaction to tapering off? Was it really some kind of cold-turkey scenario? Or was it all in my mind?

According to Mind, ‘Withdrawal or discontinuation reactions can occur with all major types of antidepressants.’ The Royal College of Psychiatrists concurs: ‘Studies have shown that up to a third of people have withdrawal symptoms for a short time when they stop antidepressants. These include flu-like symptoms, anxiety, dizziness, vivid dreams, or sensations that feel like electric shocks.’ Since this was my sixth episode of anxiety with depression that needed medical treatment, I’m no stranger to coming on and off medication.

Having taken the antiquated tricyclic antidepressant Prothiaden numerous times, as well as the SSRI antidepressant Citalopram, I can vouch that I’ve always had problems tapering off. Granted I have a disposition towards dependency (I’m a recovering alcoholic), but plenty of people without addiction issues report similar problems with getting off antidepressants. The main problem is that these drugs create an artificial reality, and going back to ‘the real world’ after a season in a parallel chemical universe is both a shock and a letdown. Go on and off antidepressants enough times and you end up having no idea what you should naturally feel like. Nowadays, my normal is a medicated normal. Having lived a chemically enhanced life, the tape counter of my natural self can never be set back to zero again.

When coming off antidepressants, my biggest fear is always that another episode is lurking around the corner and that I’ll again have no choice but to take Efexor XL, or whatever the new miracle drug de jour is. I’m not alone in feeling this way. My friend April went through the same thing last year while weaning off Wellbutrin. ‘When I stop taking the pills, I always hope that it won’t re-emerge to cripple me. Only it does, each time more severe than the last. The months go by, then I see the doctor, teary-eyed, and begin a cycle of medication again. It’s like a carousel; sometimes I’m on, sometimes I’m off. Years pass and I’ve been on and off medication eight times, always ripped in two by the desire to end the depression versus the desire to be pill-free.’ Ill again, she was prescribed Efexor XL six weeks ago and is now feeling better.

By the end of the summer, I hope to be medication-free. Aside from trusting your GP to safely guide you off the medication, there’s no fix-all solution. The dose needs to be lowered both incrementally and slowly, and the patient’s progress monitored on a regular basis. In preparation for the tapering off, I am in training. Each week I take three yoga classes – Kundalini, Astanga and Hatha – as well as working out at the gym and doing Pilates. I’m also nurturing my spiritual self, drawing strength and wisdom from the Bhagavad-Gita, the Kabbalah, Lao-Tze’s Tao Te Ching, Confucius’s Analects, the teachings of the Dalai Lama, The Tibetan Book of the Dead, St Augustine’s Confessions, the Koran and Patanjali’s Sutras.

As with conquering a dependence on anything, it requires a backbone of spirituality to break free. Otherwise you’ve got nothing to build on. As Lao-Tze so wisely said: ‘A journey of a thousand miles begins with a single step.’ Mine, according to my GP, will begin with dropping to 112.5mg for a month.

Venlafaxine Side Effects

Medically reviewed by Drugs.com. Last updated on Jan 21, 2019.

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In Summary

Commonly reported side effects of venlafaxine include: anorgasmia, asthenia, constipation, dizziness, drowsiness, insomnia, nausea, nervousness, headache, anorexia, decreased appetite, delayed ejaculation, diaphoresis, and xerostomia. Other side effects include: abdominal pain, anxiety, blurred vision, hypertension, impotence, tremor, visual disturbance, vomiting, diarrhea, dyspepsia, increased serum cholesterol, pharyngitis, vasodilation, weight loss, decreased libido, increased dream activity, yawning, abnormal dreams, and flatulence. See below for a comprehensive list of adverse effects.

For the Consumer

Applies to venlafaxine: oral capsule extended release, oral tablet, oral tablet extended release


Oral route (Capsule, Extended Release)

Antidepressants increased the risk of suicidal thoughts and behavior in children, adolescents, and young adults in short-term studies. These studies did not show an increase in the risk of suicidal thoughts and behavior with antidepressant use in patients older than 24 years; there was a reduction in risk with antidepressant use in patients aged 65 or older. In patients of all ages who are started on antidepressant therapy monitor closely for clinical worsening and emergence of suicidal thoughts and behaviors. Venlafaxine is not approved for use in pediatric patients.

Oral route (Tablet; Tablet, Extended Release)

Antidepressants increased the risk of suicidal thinking and behavior in children, adolescents, and young adults in short-term studies with major depressive disorder (MDD) and other psychiatric disorders. Short-term studies did not show an increase in the risk of suicidality with antidepressants compared to placebo in adults older than 24 years, and there was a reduction in risk with antidepressants compared with placebo in adults aged 65 or older. This risk must be balanced with the clinical need. Monitor patients closely for clinical worsening, suicidality, or unusual changes in behavior. Families and caregivers should be advised of the need for close observation and communication with the prescriber. Not approved for use in pediatric patients

Along with its needed effects, venlafaxine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur while taking venlafaxine:

More common

  • Lack or loss of strength
  • severe headache
  • sweating

Less common

  • Blurred vision
  • chest pain
  • fast or irregular heartbeat
  • mood or mental changes
  • ringing or buzzing in the ears
  • suicidal thoughts


  • Actions that are out of control
  • convulsions
  • high fever
  • irritability
  • itching or skin rash
  • lightheadedness or fainting, especially when getting up suddenly from a sitting or lying position
  • menstrual changes
  • nervousness
  • problems with urinating or holding urine
  • severe muscle stiffness
  • talking, feeling, and acting with excitement that you cannot control
  • trouble breathing
  • unusually pale skin

Incidence not known

  • Agitation
  • bloody, black, or tarry stools
  • bloody stool or urine
  • dark urine
  • decreased frequency or amount of urine
  • diarrhea
  • drowsiness
  • fever
  • general feeling of tiredness or weakness
  • headache
  • increased thirst
  • light-colored stools
  • muscle cramps, spasms, or pain
  • nausea or vomiting
  • nosebleeds
  • overactive reflexes
  • poor coordination
  • red or purple spots on the skin
  • restlessness
  • shivering
  • stomach pain on the upper right side
  • swelling of the face, lower legs, ankles, hands, or fingers
  • trembling or shaking that is hard to control
  • twitching
  • unusual bruising
  • unusual tiredness or weakness
  • vomiting of blood or material that looks like coffee grounds
  • yellow eyes or skin

Some side effects of venlafaxine may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

  • Abnormal dreams
  • chills
  • constipation
  • decrease in sexual desire or ability
  • diarrhea
  • dry mouth
  • heartburn
  • increased sweating
  • loss of appetite
  • nausea
  • stomach pain or gas
  • stuffy or runny nose
  • tingling, burning, or prickly sensations
  • trouble sleeping
  • vomiting
  • weight loss

Less common

  • Change in taste
  • muscle tension
  • yawning

Incidence not known

  • Night sweats

For Healthcare Professionals

Applies to venlafaxine: oral capsule extended release, oral tablet, oral tablet extended release


The most commonly reported side effects were nausea, headache, somnolence, and dizziness.


Very common (10% or more): Nausea (up to 58%), dry mouth (up to 22%), constipation (up to 15%)

Common (1% to 10%): Abdominal pain, diarrhea, dyspepsia, eructation, flatulence, vomiting

Uncommon (0.1% to 1%): Circumoral paresthesia, colitis, dysphagia, esophagitis, gastritis, gastroenteritis, gastrointestinal hemorrhage, gastrointestinal ulcer, gingivitis, glossitis, hemorrhoids, melena, mouth ulceration, oral moniliasis, rectal hemorrhage, stomatitis, tongue edema

Rare (less than 0.1%): Abdominal distention, buccoglossal syndrome, cheilitis, cholecystitis, cholelithiasis, duodenitis, esophageal spasm, gastroesophageal reflux disease, gum hemorrhage, hematemesis, hyperchlorhydria, ileitis, increased salivation, intestinal obstruction, pancreatitis, parotitis, periodontitis, proctitis, salivary gland enlargement, soft stools, tongue discoloration

Nervous system

Very common (10% or more): Headache (up to 38%), somnolence (up to 26.1%), dizziness (up to 23.9%), tremor (up to 10.2%)

Very rare (less than 0.01%): Extrapyramidal reactions, tardive dyskinesia

Frequency not reported: Impaired coordination, sensory disturbance

Postmarketing reports: Coordination abnormal, impaired balance, involuntary movements, NMS-like reactions, shock-like electrical sensations


Very common (10% or more): Insomnia (up to 24%), nervousness (up to 21.3%), abnormal orgasm (up to 12.5%), anxiety (up to 11.2%)

Common (1% to 10%): Abnormal dreams, abnormal thinking, agitation, anorgasmia, confusion, depersonalization, depression, libido decreased, orgasm disturbance, orgasmic dysfunction

Rare (less than 0.1%): Alcohol abuse, delirium, delusions, homicidal ideation, hysteria, impulse control difficulties, paranoid reaction, psychotic depression, psychomotor restlessness

Frequency not reported: Aggression, delayed orgasm, increased dreaming, intense dreams, nightmares, other sleep disorders, self-harm, sleep disturbances, suicidal behaviors, vivid dreams, withdrawal symptoms

Postmarketing reports: Catatonia, confusional state, panic, paranoia, psychotic disorder


Very common (10% or more): Sweating (up to 19.3%), night sweats (up to 11.4%)

Common (1% to 10%): Ecchymosis, hyperhidrosis, pruritus, rash

Rare (less than 0.1%): Cellulitis, erythema multiforme, erythema nodosum, exfoliative dermatitis, furunculosis, granuloma, hair discoloration, hirsutism, leukoderma, lichenoid dermatitis, miliaria, mucocutaneous hemorrhage, petechial rash, pruritic rash, purpura, pustular rash, seborrhea, skin atrophy, skin discoloration, skin striae, Stevens-Johnson syndrome, sweating decreased, toxic epidermal necrolysis, vesiculobullous rash


Very common (10% or more): Anorexia (up to 20%)

Common (1% to 10%): Blood cholesterol increased, decreased appetite, increased appetite, weight gain, weight loss

Rare (less than 0.1%): Alcohol intolerance, diabetes mellitus, gout, hemochromatosis, hypercholesteremia, hyperkalemia, hyperphosphatemia, hyperuricemia, hypocholesteremia, hypoglycemia, hypophosphatemia, hypoproteinemia

Frequency not reported: Height changes, loss of appetite, weight changes

Postmarketing reports: Lactate dehydrogenase (LDH) increased


Very common (10% or more): Asthenia (up to 19%)

Common (1% to 10%): Accidental injury, chills, fatigue, fever, tinnitus, trauma

Uncommon (0.1% to 1%): Hyperacusis, intentional injury, malaise, otitis media

Frequency not reported: Discontinuation syndrome, pain

Postmarketing reports: Congenital anomalies


Very common (10% or more): Abnormal ejaculation (up to 16%)

Common (1% to 10%): Albuminuria, enlarged prostate, erectile dysfunction, impotence, metrorrhagia, pollakiuria, prostatic disorder, prostatitis, urinary frequency, urinary hesitation, urinary retention, urination impaired, vaginitis

Rare (less than 0.1%): Balanitis, breast discharge, breast engorgement, breast enlargement, calcium crystalluria, cervicitis, endometriosis, galactorrhea, hypercalcinuria, hypomenorrhea, lactation (female), mastitis, menstrual disorders associated with increased bleeding or increased irregular bleeding, ovarian cyst, orchitis, prolonged erection, salpingitis, urolithiasis, uterine hemorrhage, uterine spasm, vaginal dryness

Frequency not reported: Delayed ejaculation, dysmenorrhea

Postmarketing reports: Proteinuria


Uncommon (0.1% to 1%): Angina pectoris, arrhythmia, bradycardia, cold feet, cold hands, extrasystoles, hypotension, orthostatic hypotension, peripheral vascular disorder, thrombophlebitis

Rare (less than 0.1%): Aortic aneurysm, arteritis, bigeminy, bundle branch block, capillary fragility, cardiovascular disorder (mitral valve and circulatory disturbance), coronary artery disease, congestive heart failure, cyanosis, ECG QT prolonged, first-degree atrioventricular block, heart arrest, hematoma, myocardial infarct, pallor, sinus arrhythmia, torsade de pointes, ventricular fibrillation, ventricular tachycardia

Postmarketing reports: Atrial fibrillation, deep vein thrombophlebitis, ECG abnormalities, stress cardiomyopathy, supraventricular tachycardia, Takotsubo cardiomyopathy, ventricular extrasystole


Common (1% to 10%): Bronchitis, cough increased, dyspnea, pharyngitis, sinusitis, yawn/yawning

Rare (less than 0.1%): Atelectasis, hemoptysis, hypoventilation, hypoxia, interstitial lung disease, larynx edema, pleurisy, pulmonary embolus, pulmonary eosinophilia, sleep apnea

Frequency not reported: Rhinitis, upper respiratory infection, upper respiratory tract infection


Common (1% to 10%): Abnormality of accommodation, abnormal vision, blurred vision, mydriasis

Uncommon (0.1% to 1%): Cataract, conjunctivitis, corneal lesion, diplopia, dry eyes, eye pain, photophobia

Rare (less than 0.1%): Angle-closure glaucoma, blepharitis, chromatopsia, conjunctival edema, decreased pupillary reflex, exophthalmos, eye hemorrhage, keratitis, miosis, papilledema, retinal hemorrhage, scleritis, subconjunctival hemorrhage, uveitis

Frequency not reported: Difficulty focusing eyes


Common (1% to 10%): Neck pain, trismus, twitching

Uncommon (0.1% to 1%): arthritis, arthrosis, bone pain, bone spurs, bursitis, leg cramps, myasthenia, neck rigidity, tenosynovitis

Rare (less than 0.1%): Muscle cramp, muscle spasms, musculoskeletal stiffness, myopathy, osteoporosis, osteosclerosis, pathological fracture, plantar fasciitis, rhabdomyolysis, rheumatoid arthritis, tendon rupture

Frequency not reported: Arthralgia, back pain, myalgia

Postmarketing reports: Bone fracture, creatine phosphokinase (CPK) increased


Common (1% to 10%): Flu syndrome, infection

Uncommon (0.1% to 1%): Moniliasis

Rare (less than 0.1%): Appendicitis, bacteremia


Rare (less than 0.1%): Agranulocytosis, aplastic anemia, basophilia, blood dyscrasias, eosinophilia, lymphocytosis, neutropenia, pancytopenia, prolonged bleeding time

Postmarketing reports: INR increased, prolonged partial thromboplastin time, prothrombin time increased


Uncommon (0.1% to 1%): Abnormal liver function tests, ALT increased, AST increased

Rare (less than 0.1%): Biliary pain, bilirubinemia, cholecystitis, cholelithiasis, hepatitis, jaundice, liver tenderness

Postmarketing reports: Fatty liver, GGT elevation, hepatic reactions, liver damage, liver failure, liver necrosis


Uncommon (0.1% to 1%): Kidney calculus, kidney pain

Postmarketing reports: Renal failure


Uncommon (0.1% to 1%): Angioedema

Rare (less than 0.1%): Anaphylactic reaction, anaphylaxis

Frequency not reported: Hypersensitivity


Rare (0.1% to 0.01%): Goiter, gynecomastia (male), hyperthyroidism, hypothyroidism, inappropriate antidiuretic hormone secretion (SIADH)/syndrome of inappropriate antidiuretic hormone secretion, thyroid nodule, thyroiditis

Very rare (less than 0.01%): Blood prolactin increased


Rare (less than 0.1%): Carcinoma, fibrocystic breast, multiple myeloma

1. Cerner Multum, Inc. “Australian Product Information.” O 0

2. Cerner Multum, Inc. “UK Summary of Product Characteristics.” O 0

3. “Product Information. Effexor XR (venlafaxine).” Wyeth-Ayerst Laboratories, Philadelphia, PA.

4. “Product Information. Effexor (venlafaxine).” Wyeth-Ayerst Laboratories, Philadelphia, PA.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Some side effects may not be reported. You may report them to the FDA.

Medical Disclaimer

More about venlafaxine

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  • Drug class: serotonin-norepinephrine reuptake inhibitors
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Other brands: Effexor, Effexor XR

Professional resources

  • Venlafaxine Hydrochloride (AHFS Monograph)
  • … +4 more

Related treatment guides

  • Autism
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  • … +18 more


Effexor was approved by the FDA in 1993. Wyeth markets this drug to treat depression, anxiety, and some types of panic disorders.

It was the first antidepressant in a drug class called serotonin-norepinephrine reuptake inhibitors (SNRIs). By 2007, Effexor became the sixth most popularly-prescribed drug of its class with more than 17 million prescriptions in the United States.

SNRIs regulate serotonin and norepinephrine reabsorption. Many patients taking Effexor may notice sudden and painful conditions in the form of side effects.

What Is Effexor?

Effexor (venlafaxine hydrochloride) is an antidepressant drug doctors prescribe to patients to treat depression, anxiety, panic disorders, and social phobia. Effexor can help treat pain caused by severe migraines and diabetic neuropathy. While some patients taking Effexor get no symptoms, others struggle with serious side effects.

Common Effexor Side Effects

As with any medication, patients may experience some side effects when taking Effexor. Some occur often and in a mild fashion, but others may be serious.

A list of common Effexor side effects may include:

  • Dry mouth
  • Dizziness
  • Nausea
  • Increased sweating
  • Nervousness
  • Drowsiness
  • Fatigue
  • Insomnia
  • Headache
  • Blurred vision
  • Constipation
  • Strange dreams
  • Appetite and weight change
  • Decreased libido, sex drive, and difficulty achieving orgasm

Although this list is not inclusive, they can be the most common side effects for Effexor. Individuals should consult immediately with a doctor if these symptoms worsen.

Severe Effexor Side Effects

In addition to common side effects, patients can experience more severe side effects while taking Effexor. These issues call for immediate medical or emergency attention.

Severe Effexor side effects can include:

  • Trouble breathing or tightness in the chest
  • Memory
  • Hallucination
  • Seizures
  • Fever, nausea, or vomiting
  • Increased heart rate or blood pressure
  • Hostility, agitation, aggression
  • Suicidal thoughts or behavior
  • Sudden changes in moods or behavior
  • Anxiety or panic attacks

Effexor can be linked with any of the above symptoms, though the list is not inclusive. Call 911 if any symptoms escalate when taking Effexor. Doctors also warn against taking any other prescription that can lead to a serotonin overdose. Too much serotonin in the brain can cause this syndrome.

Serotonin syndrome needs immediate treatment. Symptoms include:

  • sudden spikes in blood pressure or heart rate
  • Higher than normal body temperature
  • Hyperthermia

If these symptoms arise, patients should contact a doctor. This condition can be fatal.

Experts recommend that patients consult a physician before stopping Effexor use. Stopping too soon can lead to discontinuation syndrome.

This condition includes the following symptoms:

  • loss of coordination
  • stomach cramps
  • severe headaches/migraines
  • extreme sleepiness
  • fatigue

Talk to your doctor about the best way to avoid these symptoms.

Pregnant or nursing mothers face serious risks. Effexor carries the potential risk of birth defects in some pregnancies. After birth, nursing infants may still develop side effects related to Effexor use from their mothers.

Newborns may develop symptoms such as:

  • Irregular appetite or difficulties feeding
  • Heart defects
  • Growth or development defects
  • Jitteriness or shaking
  • Seizures
  • Consistent or abnormally frequent crying

Effexor Lawsuits

Because Effexor carries the potential risk of many side effects, several lawsuits against the Wyeth exist. You may be able to recover money with the help of an attorney.

Pfizer acquired Wyeth in 2009. A majority of claims involve mothers whose newborns experience birth defects. They believe Effexor causes defects while the mother is pregnant or nursing. Other patients develop physical and mental issues taking Effexor.

An individual may be entitled to compensation if Effexor causes them health problems. Those women who took Effexor while pregnant may also file a claim if their child’s birth defects impact their life seriously.

These individuals can seek the help of an experienced attorney for filing a claim. If you think your injuries are tied to Effexor use, the right lawyer can help protect your legal rights.

NOTICE: The Drug Law Center is no longer accepting these type of cases. This page is strictly for informational purposes. We appreciate your cooperation and understanding by not contacting our office on these cases. We are actively investigating and prosecuting cases involving Valsartan cancers. For information on Valsartan lawsuits, look here.

The Effexor injury case attorneys at the Drug Law Center have successfully resolved many antidepressant lawsuits and compensation claims after our clients suffered mild to severe injuries.


The popular anti-depressant medication Effexor (venlafaxine HCI), manufactured, marketed, and promoted by pharmaceutical giant Pfizer, Inc. has generated more than $3 billion in sales annually worldwide. The medication is classified as an SSNRI (selective serotonin and norepinephrine uptake inhibitor). Both the brand-name Effexor and its generic form venlafaxine HCI effects specific chemicals in the brain that might be unbalanced and individuals suffering from depression. Almost since it was first introduced in the medical marketplace, doctors have prescribed Effexor to treat panic disorder, anxiety, and major depressive disorder. Almost since its initial launch, Effexor (venlafaxine HCI) has been better at treating depression compared to the competition. However, it also likely has greater side effect incident rates were many patients experience withdrawal symptoms.

The History of Effexor

Wyeth Pharmaceuticals scientist first synthesized venlafaxine HCI in the early 1980s. It was soon discovered to be an effective treatment of depression. In 1994, the company promoted the brand-name Effexor and the generic form venlafaxine HCI after approval from the Food and Drug Administration (FDA).

By 1997, the company sold Effexor ER (the extended-release formulation) after approval by the FDA. It was prescribed as a single dose taking each day, which produced slightly lower nausea rates, especially when the therapy was just beginning.

To date, the Food and Drug Administration has approved the medication to treat major depressive disorder, panic disorder, social anxiety disorder, and GAD (generalized anxiety disorder). However, some doctors prescribed the medication for off-label uses that include:

  • PTSD (posttraumatic stress disorder)
  • Fibromyalgia
  • Classes
  • Chronic pain syndrome
  • Migraine prophylaxis
  • Diabetic neuropathy
  • Irritable bowel syndrome (IBS)
  • Fatigue syndrome
  • Tension-type headaches
  • Bipolar depression
  • Cocaine dependency
  • Attention deficit hyperactivity disorder (ADD/ADHD)
  • Premenstrual dysphoric disorder (PMDD)

The Advantages and Disadvantages of Effexor

Now that the medication has been in use for over two decades, there are significant advantages and disadvantages to taking Effexor. Some of these include:

  • Significant Advantages:
    • Effexor (venlafaxine HCI) is thought to be highly effective, compared to SSRIs (selective serotonin reuptake inhibitors) in treating major depression
    • Research indicates that Effexor (venlafaxine HCI) produces exceedingly high therapeutic success rates
    • Has been proven to be effective when SSRIs are unresponsive to treat a case of depression
    • Tends to improve memory
    • Has better remission rates than paroxetine and fluoxetine
    • Seems to have recurrence prevention properties
    • Seems to be highly effective for quick onset of anxiolytic and antidepressant activities
  • Significant Disadvantages:
    • Many patients experience withdrawal syndrome even after missing just one dose. This is thought to occur because venlafaxine HCI has a short half-life.
    • Is highly toxic when overdosed, especially compared to SSRIs (selective serotonin reuptake inhibitors)
    • Can cause elevated blood pressure
    • Has a higher incident rate of causing vomiting and nausea
    • Is known to have a high potential risk of suicide

Effexor Withdrawal Symptoms

Many patients experience severe withdrawal symptoms when they stop taking Effexor (venlafaxine HCI). The most common symptoms include irritability, vomiting, nausea, nightmares, paresthesia (a tingling, prickly sensation on the skin), headaches, and feeling dizzy. Many of these withdrawal symptoms occur just hours after reducing or stopping the usual dose of Elektra plus. Because of that, drivers and those operating machines are urged to stop that activity or adhere to a strict drug routine that can minimize the potential of experiencing withdrawal symptoms.

Effexor Side Effects

Like all other medications and over-the-counter remedies, Effexor has serious side effects that should be considered before, during and after taking the drug. However, the many side effects caused by Effexor (venlafaxine HCI) often do not require medical attention. This is because the body normally adjusts to the medication quickly and the side effects can go away over time. However, some significant major side effects require immediate medical attention.

The mildest side effects that Effexor (venlafaxine HCI) produces include:

  • Runny or stuffy nose
  • Gas or stomach pain
  • Loss of appetite
  • Heartburn
  • Drowsiness
  • Diarrhea
  • Reduced libido (diminished sexual drive or ability)
  • Difficulty in sleeping
  • Weight loss
  • Unusual weakness or tiredness
  • Constipation or diarrhea
  • Abnormal dreams

However, there are serious to severe major side effects that Effexor produces that could affect the health and well-being of the patient. More common major side effects include:

  • High blood pressure
  • Excessive sweating
  • Loss or diminished strength
  • Severe headaches

Less common major side effects involved:

  • Blurry vision
  • Mental or mood changes
  • Irregular fast heartbeat
  • Chest pain
  • Suicidal ideation (thinking about committing suicide)
  • Buzzing or ringing in the ears

There are significant major side effects that rarely occur. These include:

  • Action or behavior that becomes out-of-control
  • Dramatic change in perception
  • Uncoordinated muscular movement
  • Circulatory problems
  • Major irritability
  • Involuntary quivering
  • Stomach cramps
  • Heart rate instability
  • Infrequent or incomplete bowel movements
  • The inability to produce or maintain an erection
  • Ejaculation difficulties
  • Over-responsiveness to reflexes
  • Severe muscle stiffness
  • Menstrual changes
  • Skin rashes and itching
  • Convulsions
  • Gastrointestinal discomfort
  • Low or high blood pressure
  • Fainting or lightheadedness especially when standing suddenly
  • High fever
  • Acting, feeling, or talking that becomes out-of-control
  • Nervousness
  • Effexor Discontinuation Syndrome

Effexor discontinuation syndrome SSRI withdrawal is a common occurrence. Typically, these symptoms tend to be nonspecific and very broad whenever the patient discontinued taking Effexor (venlafaxine HCI). To avoid SSRI discontinuation syndrome, it is important that:

  • Treating physicians should never prescribe Effexor (venlafaxine HCI) to adolescents or children because it increases suicidal ideation (thinking about committing suicide) or self-harm.
  • Effexor is known to increase eye pressure which can be extremely harmful to patients with glaucoma.
  • Taking Effexor (venlafaxine HCI) concomitantly with MAOIs) monoamine oxidase inhibitors is strictly prohibited, doctors are advised to prescribe one medication after the other medication was stopped for at least 14 days.

Effexor Contraindications

Nearly every prescription medication, including Effexor (venlafaxine HCI), will have contraindications, where patient suffering from a medical condition, experiencing symptoms, or taking other medications should avoid taking the antidepressant altogether.

Patients should avoid taking Effexor (venlafaxine HCI) if they suffer from any one of the following:

  • Suicidal ideation (thinking about committing suicide)
  • Had a recent heart attack
  • Suffers from liver problems
  • Was diagnosed with liver hardening
  • Suffers from High Cholesterol
  • Has moderate to severe kidney impairment
  • Was diagnosed with Serotonin Syndrome – Adverse Medication Interaction
  • Suffers from blood clotting disorder
  • Experiences seizures
  • Has been diagnosed with Inappropriate Anti-Diuretic Hormone Secretion syndrome
  • Suffers from severe uncontrolled high blood pressure
  • Has an increased potential risk of bleeding


Within just a couple of years after the generic version of Effexor, venlafaxine HCI, became available the medical marketplace, plaintiffs for filing lawsuits against Wyeth Pharmaceuticals alleging that the company had misrepresented or exaggerated claims on Effexor’s effectiveness and safety for consumers. Even today, plaintiffs are claiming that the drug is dangerous because it produces suicidal ideation and thoughts of self-harm.

Scientist and doctors have known for a long time that Effexor can produce violent behavior toward others and to the patient taking the medication. In fact, most SSRIs (serotonin reuptake inhibitors) have been known to produce violent occurrences. However, lawyers have often found it difficult to prove the correlation between violent behavior and taking Effexor (venlafaxine HCI) when presenting evidence in court.

Some plaintiffs are claiming that Effexor (venlafaxine HCI) causes birth defects. To date, there are many lawsuits yet to be heard in both federal and state court concerning the correlation between birth defects and taking Effexor (venlafaxine HCI) during pregnancy.

  • Pfizer Inc. Facing Baby Heart Defect Effexor Lawsuit

December 2014 – Parents of a son born with serious life-threatening heart defects as files a monetary compensation lawsuit against Pfizer, Inc., the manufacturer of the popular antidepressant Effexor medication. The lawsuit was filed in the U.S. District Court for the Eastern District of Pennsylvania. In February 2010, the plaintiffs’ son was born with significant congenital heart problems. Lawsuit documents reveal that the plaintiffs are claiming the mother’s use of antidepressant medication during her pregnancy caused her son’s defects.

The Missouri couple is seeking monetary recompense to recover their ongoing medical expenses, nursing costs, additional surgeries, off and on hospitalization, constant treatment, pharmaceutical costs, the need for rehabilitation and all other costs that are unforeseeable in the child’s future. Lawyers working on behalf of the Missouri plaintiffs are also asking for punitive damages to hold Pfizer morally accountable for their failure to warn the public of serious birth defects caused by their dangerous drug.

  • Lawsuit Alleges Birth Defect Caused by Mothers Effexor Use

January 2014 – A Minnesota couple has filed suit against Pfizer, claiming the mother’s use of the antidepressant Effexor was linked to her son’s birth defects. The plaintiffs in the case are alleging that Pfizer, Inc. Makers of Effexor (venlafaxine HCI) failed to warn them of the serious side effects of the product including its correlation with birth defects. Lawsuit documents reveal that the suit is based on negligence, failure to warn, and product liability.

Lawyers have built the case on behalf of their plaintiffs by stating that the Minnesota mother had been prescribed and took Effexor during her pregnancy. Since childbirth, the newborn required numerous surgeries to repair multiple defects and will likely require additional surgeries in the years ahead. The plaintiffs are suggesting that had the mother known or been made aware of known Effexor side effects on newborns and fetuses, she would have never taken the medication and likely would have chosen alternative methods for treating her depression.

The plaintiffs are claiming that Pfizer was aware, or should have been aware, that Effexor (venlafaxine HCI) can impact the health of the fetus by crossing through the placenta. Lawsuit documents reveal that animal testing occurring in the mid-1990s directly linked the development of birth defects with taking Effexor.

Let Us Handle Your Effexor Lawsuit Compensation Claim

The Effexor injury case attorneys at the Drug Law Center are currently handling antidepressant lawsuits and optimization claims for victims of Effexor and those who have died because of complications when taking the medication. We accept all medical malpractice, product liability, personal injury, and wrongful death lawsuits on contingency. This means we postpone payment of our legal services and are paid only after we have successfully resolved your case through a negotiated settlement or through a jury trial award.

Contact us today to schedule a comprehensive, free initial consultation. Speak with one of our competent personal injury attorneys who specializes in cases just like yours. You are under no obligation to move forward with your case and all information and evidence you provide our law firm is always kept confidential. We can provide various legal remedies while protecting your rights to receive financial compensation from any party who caused you harm. This could include the pharmaceutical manufacturer, the distributor, the supplier, the hospital, doctor’s office, or health care provider.

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