Venlafaxine (Effexor®) Interactions
Taking Venlafaxine with:
Venlafaxine Drug Interactions:
Venlafaxine has minimal inhibition of isoenzymes CYP1A2, CYP3A4, or CYP2C 3 and has a low potential for drug interaction.
- Buspirone: Concurrent use may result in serotonin syndrome.
- Cyproheptadine: Decreased pharmacologic effects of venlafaxine.
- Desipramine, haloperidol: Plasma levels of these drugs may
be elevated by venlafaxine, increasing the risk of adverse effects.
- 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
- Serotonergic drugs (e.g. meperidine, mirtazapine, sibutramine, antidepressants): Risk of serotonin syndrome.
- Selegiline: Concurrent use may predispose to serotonin syndrome.
- St. John's wort: Increased sedative effects.
- Warfarin: May increase PT, aPT, or INR with coadministration.
Can you take Venlafaxine and Amitriptyline?
Combined use with tricyclic antidepressants increases the risk of serotonin syndrom 1. Caution is needed when venlafaxine and amitriptyline are used concurrently.
Can you take Venlafaxine and Alprazolam (Xanax®)?
No special precautions are required during the concurrent use of venlafaxine and alprazolam1, 2.
One report describes that combination of venlafaxine and alprazolam caused symptomatic hypotension 4.
Can you take Venlafaxine and Diazepam (Valium®)?
There are no clinically significant drug interactions and no special precautions are required during the concurrent use of venlafaxine and diazepam 1, 5.
One report describes that combination of venlafaxine and diazepam caused symptomatic hypotension 4.
Can you take Venlafaxine and Lorazepam (Ativan®)?
No special precautions are required during the concurrent use of venlafaxine and lorazepam 1.
Can you take Venlafaxine and Gabapentin (Neurontin®)?
There are no drug interactions between venlafaxine and gabapentin 1. The combination gabapentin plus venlafaxine is safe and effective for the management of nerve pain 6.
Can you take Venlafaxine and Pregabalin (Lyrica®)?
There are no drug interactions between venlafaxine and pregabalin1. The combination of SNRI antidepressant with pregabalin is used to treat severe anxiety disorders16.
Can you take Venlafaxine and Phentermine (Adipex®)?
There are no reported drug interactions between venlafaxine and phentermine1. Concomitant use is allowable upon doctor's recommendation.
Can you take Venlafaxine and Tramadol?
Combined use of venlafaxine and tramadol may cause serotonin syndrom1. Caution is required when venlafaxine is used with tramadol.
Can you take Venlafaxine and Bupropion (Wellbutrin®)?
Augmentation of venlafaxine with bupropion is often considered in patients with treatment resistant depression or for venlafaxine-induced side effects 7, 10. However, pharmacokinetic interaction between venlafaxine and bupropion can occur.
Bupropion inhibits the enzyme CYP2D6, which is responsible for metabolizing venlafaxine. As a result combination treatment with these drugs can raise venlafaxine levels and adverse effects can occur8, 9.
So combination treatment with venlafaxine and bupropion should be undertaken under close medical supervision.
Can you take Venlafaxine and Fluoxetine (Prozac®)?
Fluoxetine moderately inhibits the isoenzyme CYP2D6, which is responsible for metabolizing venlafaxine. Concomitant use may therefore increase venlafaxine levels, leading to adverse effects11. Therefore if venlafaxine and fluoxetine are taken at the same time be alert for any signs of increased side effects. Also the concurrent use of the venlafaxine and SSRIs may increase the risk of the serotonin syndrome.
Can you take Venlafaxine and Sertraline (Zoloft ®)?
Both venlafaxine and sertraline are serotonergic drugs, and simultaneous use can precipitate serotonin syndrome. Concurrent use of venlafaxine and sertraline is not contraindicated, but should be undertaken with caution.
Can you take Venlafaxine and Mirtazapine (Remeron®)?
Venlafaxine plus mirtazapine combination is increasingly used in clinical practice to treat refractory depression17, 18. However, concurrent use of venlafaxine and sertraline should be undertaken with caution due to the risk of serotonin syndrome and greater risk of side effects19.
Can you take Venlafaxine and Quetiapine (Seroquel®)?
There are no interactions between venlafaxine and Quetiapine, simultaneous use can be safe1. Venlafaxine augmentation with an atypical antipsychotic Quetiapine is often used for severe depression, and have shown good efficacy and safety 12, 13.
Can you take Venlafaxine and Zolpidem (Ambien®)?
Venlafaxine label does not provide specific warnings regarding concurrent use with zolpidem1. Concurrent use of zolpidem and venlafaxine may lead to hallucinations in susceptible individuals 14.
Can you take Venlafaxine and Suboxone®?
Venlafaxine label does not provide specific warnings regarding concurrent use with buprenorphine/naloxonezolpidem, the active ingredients in Suboxone®1.
Can you take Venlafaxine and Propranolol (Inderal®)?
There are no significant drug interactions between venlafaxine and propranolol, a nonselective beta blocker1. One case report describes pneumonitis in a patient treated with venlafaxine and propanolol 15.
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
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.
Effexor (Venlafaxine) and O-desmethylvenlafaxine have been reported to be excreted in human
milk. Because of the potential for serious adverse reactions in nursing
infants, a decision should be made whether to discontinue
nursing or to discontinue Effexor.
- 1. U.S. FDA Effexor XR (Venlafaxine) Prescribing Information
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- 3. Owen JR, Nemeroff CB. New antidepressants and the cytochrome P450 system: focus on venlafaxine, nefazodone, and mirtazapine. Depress Anxiety. 1998;7 Suppl 1:24-32. PubMed
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- 12. Li X, Xing B, Yu E, Chen W, Wu H. The combined treatment of venlafaxine and quetiapine for treatment-resistant depression: a clinical study. J Neuropsychiatry Clin Neurosci. 2013 Spring;25(2):157-60. PubMed
- 13. McIntyre A, Gendron A, McIntyre A. Quetiapine adjunct to selective serotonin reuptake inhibitors or venlafaxine in patients with major depression, comorbid anxiety, and residual depressive symptoms: a randomized, placebo-controlled pilot study. Depress Anxiety. 2007;24(7):487-94. PubMed
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