Venlafaxine

Source: UK SPC (eMC) for Efexor XL 150 mg hard prolonged release capsules, §4.2 (https://www.medicines.org.uk/emc/product/1219/smpc). MAJOR DEPRESSIVE EPISODES: start 75 mg once daily; patients not responding may benefit from increases up to a maximum of 375 mg/day, at intervals of 2 weeks or more (if clinically warranted by symptom severity, increases can be made at more frequent intervals but not less than 4 days). GENERALISED ANXIETY DISORDER: start 75 mg once daily; increases up to a maximum of 225 mg/day at intervals of 2 weeks or more. SOCIAL ANXIETY DISORDER: 75 mg once daily — there is no evidence that higher doses confer additional benefit, but in individual patients not responding, increases up to a maximum of 225 mg/day may be considered at intervals of 2 weeks or more. PANIC DISORDER: 37.5 mg/day for 7 days, then increase to 75 mg/day; patients not responding may benefit from increases up to a maximum of 225 mg/day at intervals of 2 weeks or more. In all indications, because of the risk of dose-related adverse effects, dose increments should be made only after a clinical evaluation, and the lowest effective dose should be maintained. Patients should be treated for a sufficient period of time, usually several months or longer, with regular reassessment; antidepressive treatment should continue for at least six months following remission. ELDERLY: no specific dose adjustments considered necessary based on age alone, but caution should be exercised (possible renal impairment, changes in neurotransmitter sensitivity with ageing); the lowest effective dose should always be used with careful monitoring when an increase is required. HEPATIC IMPAIRMENT: in mild and moderate impairment, in general a 50% dose reduction should be considered; in severe impairment (limited data) caution is advised and a dose reduction by more than 50% should be considered, weighing potential benefit against risk. PAEDIATRIC: venlafaxine is NOT RECOMMENDED for use in children and adolescents — controlled studies in children and adolescents with major depressive disorder failed to demonstrate efficacy, and efficacy and safety for other indications under age 18 have not been established. Hence paedDose is null. Verify any under-18 use against a children's formulary. WITHDRAWAL: abrupt discontinuation should be avoided; the dose should be gradually reduced over a period of at least one to two weeks, though tapering time and dose reduction may depend on dose, duration of therapy and the individual patient — in some patients discontinuation may need to occur very gradually over periods of months or longer. SWITCHING: patients on immediate-release tablets may be switched to prolonged-release capsules at the nearest equivalent daily dosage, e.g. immediate-release 37.5 mg twice daily to prolonged-release 75 mg once daily; individual dosage adjustments may be necessary. The insoluble portion of the prolonged-release spheroids is eliminated and may be seen in faeces. Note: §4.5 was not retrieved in this bundle — the interactions listed below are taken from §4.3 of the UK SPC and from the US label; verify the full §4.5.