Effexor (Venlafaxine) Prescription

Generic Name: Venlafaxine

Common Brand Name: Effexor, Effexor XR

Buy Venlafaxine (generic Effexor XR) Without Prescription

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Medical uses:
Effexor is an antidepressant, used to relieve symptoms of depression, generalized anxiety disorder, social anxiety disorder (social phobia) and panic disorder. This medication is sometimes prescribed for other uses. Effexor blocks the ability of the nerve terminals in the brain to bind and break down serotonin and norepinephrine so that more is available for the brain to use. Abnormally low levels of serotonin and norepinephrine may play a role in conditions such as depression and anxiety disorder.

Contraindications:

• Not to be used with MAOIs or within 2 weeks of stopping MAOI therapy. MAOI treatment should not be started until 2 weeks after discontinuing venlafaxine.

Dosage:

• Major Depressive Disorder
  Adults (immediate-release): 75 mg/day in 2 or 3 divided doses; titrate to clinical effect, adding up to 75 mg/day at intervals of at least 4 days (max, 375 mg/day).
  Adults (XR extended-release): 75 mg/day administered as single dose either in the morning or evening at approximately same time once daily. Some patients may need to start at 37.5 mg/day for 4 to 7 days before increasing to 75 mg/day. Titrate to clinical effect, in increments of up to 75 mg/day at intervals of not less than 4 days (max, 375 mg/day).
• Generalized Anxiety Disorder, Social Anxiety Disorder
  Adults (XR extended-release): 75 mg/day administered as single dose either in the morning or evening at approximately same time once daily. Some patients may need to start at 37.5 mg/day for 4 to 7 days before increasing to 75 mg/day. Titrate to clinical effect, in increments of up to 75 mg/day at intervals of not less than 4 days (max, 225 mg/day).

Swallow the controlled-release capsule (Effexor XR) whole, without crushing or chewing.

It may take up to 4 weeks or more to notice the improvement in symptoms. Do not stop your prescription without first talking to your doctor. You may get severe withdrawal side effects if you stop taking antidepressant suddenly.

Dosage adjustment:

• Hepatic Function Impairment: Adults: Reduce total daily dose 50% in patients with moderate hepatic impairment.
• Renal Function Impairment: Adults: Reduce venlafaxine extended-release total daily dose 25% to 50% in patients with renal impairment (Ccr 10 to 70 mL/min). Reduce total daily dose of venlafaxine immediate-release 25% in patients with mild to moderate renal impairment. Reduce total daily dose 50% in patients undergoing hemodialysis. Withhold dose until dialysis treatment is completed.

Effexor XR possible side effects:

• Central nervous system: headache (25% to 34%), insomnia (15% to 23%), somnolence (12% to 23%), nervousness (6% to 21%), dizziness (11% to 20%), abnormal dreams (3% to 7%), anxiety (5% to 6%), yawning (3% to 5%), agitation (2% to 4%), chills (3%), confusion (2%), abnormal thinking (2%), depersonalization (1%), depression (1% to 3%), fever, migraine, amnesia, hypoesthesia, trismus, vertigo.
• Gastrointestinal: nausea (21% to 58%), xerostomia (12% to 22%), anorexia (8% to 20%), constipation (8% to 15%), diarrhea (6% to 8%), vomiting (3% to 6%), dyspepsia (5%), abdominal pain (4%), flatulence (3% to 4%), taste perversion (2%), weight loss (1% to 4%), appetite increased, weight gain.
• Genitourinary: abnormal ejaculation/orgasm (2% to 16%), impotence (4% to 10%), urinary frequency (3%), urination impaired (2%), urinary retention (1%), prostatic disorder.
• Neuromuscular & skeletal: weakness (8% to 17%), tremor (4% to 10%), hypertonia (3%), paresthesia (2% to 3%), twitching (1% to 2%), neck pain, arthralgia.
• Cardiovascular: hypertension (dose related; 3% in patients receiving <100 mg/day, up to 13% in patients receiving >300 mg/day), vasodilation (3% to 4%), palpitation (3%), tachycardia (2%), chest pain (2%), postural hypotension (1%), edema.
• Dermatologic: rash (3%), pruritus (1%), bruising.
• Endocrine & metabolic: libido decreased (3% to 9%).
• Ocular: abnormal or blurred vision (4% to 6%), mydriasis (2%).
• Otic: tinnitus (2%) .
• Respiratory: pharyngitis (7%), sinusitis (2%), cough increased, dyspnea.
• Miscellaneous: infection (6%), flu-like syndrome (6%), trauma (2%).

Precautions:

• Pediatric use: Safety and effectiveness in the pediatric population have not been established. The studies that have been done suggest that Effexor may adversely affect weight and height.
• CNS depression: Has a low potential to impair cognitive or motor performance; caution operating hazardous machinery or driving.
• Insomnia and nervousness: May cause increase in anxiety, nervousness, and insomnia.
• Platelet aggregation: May impair platelet aggregation, resulting in bleeding.
• Serotonin syndrome: The development of a potentially life-threatening serotonin syndrome may occur with Effexor treatment, particularly with concomitant use of serotonergic drugs (including SSRIs, SNRIs and triptans) and with drugs that impair metabolism of serotonin (including MAOIs). Serotonin syndrome symptoms include mental status changes (e.g., agitation, hallucinations, coma), autonomic instability (e.g., tachycardia, labile blood pressure, hyperthermia), neuromuscular aberrations (e.g., hyperreflexia, incoordination) and/or gastrointestinal symptoms (e.g., nausea, vomiting diarrhea)
• Sustained hypertension: Venlafaxine treatment is associated with sustained increases in blood pressure in some patients. Sustained increases of SDBP could have adverse consequences. Cases of elevated blood pressure requiring immediate treatment have been reported in post marketing experience. Pre-existing hypertension should be controlled before treatment with venlafaxine. It is recommended that patients receiving Effexor have regular monitoring of blood pressure. For patients who experience a sustained increase in blood pressure while receiving venlafaxine, either dose reduction or discontinuation should be considered.
• Narrow-angle glaucoma: May cause mydriasis; use caution in patients with increased intraocular pressure or at risk of acute narrow-angle glaucoma.
• Hyponatremia: Hyponatremia and/or the syndrome of inappropriate antidiuretic hormone secretion (SIADH) may occur with venlafaxine. This should be taken into consideration in patients who are, for example, volume-depleted, elderly, or taking diuretics.
• Activation of mania/hypomania: Has been reported.
• Seizures: Use with caution in patients with a history of seizures or with conditions that potentially lower the seizure threshold. Discontinue use if seizures occur.

Drug Interactions:

• Buspirone: Concurrent use may result in serotonin syndrome.
• Cimetidine: Venlafaxine plasma concentrations may be increased. Caution is advised in patients with hypertension or hepatic dysfunction.
• Clozapine: Plasma levels may be increased. CNS-active drugs (eg, serotonin reuptake inhibitors [eg, fluoxetine], lithium) Because this interaction has not been studied, caution is warranted when coadministering these agents with venlafaxine.
• Cyproheptadine: Decreased pharmacologic effects of venlafaxine.
• Desipramine, haloperidol: Plasma levels of these drugs may be elevated by venlafaxine, increasing the risk of adverse effects.
• Indinavir: Plasma concentrations may be decreased by venlafaxine.
• Lithium: Concurrent use increases the risk of serotonin syndrome.
• MAO inhibitors: MAO inhibitors have produced serious, even fatal, reactions when given concomitantly with venlafaxine. Do not use venlafaxine together with MAO inhibitors or within 14 days of MAO inhibitor use. Wait at least 7 days after stopping venlafaxine before using MAO inhibitors.
• Meperidine, Mirtazapine, Sibutramine, Tramadol, Trazodone, Tricyclic antidepressants: Concurrent use increases risk of serotonin syndrome.
• Nefazodone: Concurrent use increases risk of serotonin syndrome; in addition, nefazodone may inhibit the metabolism of venlafaxine.
• Serotonin agonists (eg, triptans): Concurrent use of venlafaxine with these agents increass e the risk of serotonin syndrome; monitor.
• Selegiline: Concurrent use may predispose to serotonin syndrome; avoid concurren.
• St. John's wort: Increased sedative-hypnotic effects.
• Warfarin: May increase PT, aPT, or INR with coadministration.

Pregnancy
Pregnancy Category C.

Effexor did not cause malformations in offspring of rats or rabbits given doses up to 2.5 times (rat) or 4 times (rabbit) the maximum recommended human daily dose on a mg/m2 basis. However, in rats, there was a decrease in pup weight, an increase in stillborn pups, and an increase in pup deaths during the first 5 days of lactation, when dosing began during pregnancy and continued until weaning. The cause of these deaths is not known. These effects occurred at 2.5 times (mg/m2) the maximum human daily dose. The no effect dose for rat pup mortality was 0.25 times the human dose on a mg/m2 basis. There are no adequate and well-controlled studies in pregnant women. Because animal reproduction studies are not always predictive of human response, Venlafaxine should be used during pregnancy only if clearly needed.

Nursing Mothers
Effexor (Venlafaxine) and ODV have been reported to be excreted in human milk. Because of the potential for serious adverse reactions in nursing infants from Effexor XR, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.

Overdose:
Symptoms of overdose include altered consciousness (somnolence to coma), tachycardia, mydriasis, seizures, and vomiting. Predominantly occurs in combination with ethanol and/or other drug use. Most overdoses resolve with only supportive treatment, though ECG monitoring would be prudent considering the risk of arrhythmia. Postmarketing experience suggests that the risk of fatal outcome associated with overdose may be higher than that observed with SSRI-associated overdoses.

Missed dose:
If a dose is missed, take it as soon as possible. If several hours have passed or if it is nearing time for the next dose, do not double the dose to catch up, unless advised by your doctor. If more than one dose is missed, contact your doctor or pharmacist.

Storage:
Store this medication between 68 to 77 degrees F away from heat and light. Protect from moisture. Keep this and all medications out of the reach of children.

Purchase & Price:
Venlafaxine, generic Effexor, is available for purchase without a prescription from your doctor. Pharmacies, listed above, provide a quite affordable prices.

References:

• 1. U.S. Food and Drug Administration. Effexor XR (Venlafaxine) U.S. Prescribing Information. Available at (PDF format): Prescribing Information