Drug Action
A serotonin and noradrenaline re-uptake inhibitor.
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Drug reference
A serotonin and noradrenaline re-uptake inhibitor.
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Major depression ▶BY MOUTH USING IMMEDIATE-RELEASE MEDICINES ▶Adult: Initially 75 mg daily in 2 divided doses, then increased if necessary up to 375 mg daily, dose to be increased if necessary at intervals of at least 2 weeks, faster dose titration may be necessary in some patients; maximum 375 mg per day ▶BY MOUTH USING MODIFIED-RELEASE MEDICINES ▶Adult: Initially 75 mg once daily, increased if necessary up to 375 mg once daily, dose to be increased if necessary at intervals of at least 2 weeks, faster dose titration may be necessary in some patients; maximum 375 mg per day Generalised anxiety disorder ▶BY MOUTH USING MODIFIED-RELEASE MEDICINES ▶Adult: 75 mg once daily, increased if necessary up to 225 mg once daily, dose to be increased at intervals of at least 2 weeks; maximum 225 mg per day Social anxiety disorder ▶BY MOUTH USING MODIFIED-RELEASE MEDICINES ▶Adult: 75 mg once daily, there is no evidence of greater efficacy at higher doses, increased if necessary up to 225 mg once daily, dose to be increased if necessary at intervals of at least 2 weeks; maximum 225 mg per day Panic disorder ▶BY MOUTH USING MODIFIED-RELEASE MEDICINES ▶Adult: Initially 37.5 mg once daily for 7 days, increased to 75 mg once daily, increased if necessary up to 225 mg once daily, dose to be increased at intervals of at least 2 weeks; maximum 225 mg per day Menopausal symptoms, particularly hot flushes, in women with breast cancer ▶BY MOUTH USING MODIFIED-RELEASE MEDICINES ▶Adult: 37.5 mg once daily for one week, then increased if necessary to 75 mg once daily l UNLICENSED USE g Venlafaxine is used for menopausal symptoms, h but it is not licensed for this indication.
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Uncontrolled hypertension
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Conditions associated with high risk of cardiac arrhythmia. diabetes. heart disease (monitor blood pressure). history of bleeding disorders. history of epilepsy. history or family history of mania. susceptibility to angle-closure glaucoma
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→Appendix 1: venlafaxine
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▶Common or very common Anxiety. appetite decreased. arrhythmias. asthenia. chills. confusion. constipation. depersonalisation. diarrhoea. dizziness. dry mouth. dyspnoea. headache. hot flush. hypertension. menstrual cycle irregularities. movement disorders. muscle tone increased. mydriasis. nausea. palpitations. paraesthesia. sedation. sexual dysfunction. skin reactions. sleep disorders. sweat changes. taste altered. tinnitus. tremor. urinary disorders. vision disorders. vomiting. weight changes. yawning ▶Uncommon Alopecia. angioedema. apathy. behaviour abnormal. derealisation. haemorrhage. hallucination. hypotension. mood altered. photosensitivity reaction. syncope ▶Rare or very rare Agranulocytosis. angle closure glaucoma . bone marrow disorders. delirium. hepatitis. hyponatraemia. neuroleptic malignant syndrome. neutropenia. pancreatitis. QT interval prolongation. respiratory disorders. rhabdomyolysis. seizure. serotonin syndrome. severe cutaneous adverse reactions (SCARs). SIADH. thrombocytopenia ▶Frequency not known Suicidal tendencies. vertigo. withdrawal syndrome SIDE-EFFECTS, FURTHER INFORMATION Symptoms of sexual dysfunction may persist after treatment has stopped.
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Avoid unless potential benefit outweighs risk—toxicity in animal studies. Risk of withdrawal effects in neonate.
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Present in milk—avoid.
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Manufacturer advises caution (inter-individual variability in clearance; limited information available in severe impairment). Dose adjustments Manufacturer advises consider dose reduction of 50% in mild to moderate impairment and of more than 50% in severe impairment.
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Use with caution. Dose adjustments Use half normal dose (immediate-release tablets may be given once daily) if eGFR less than 30 mL/minute/1.73 m2.
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There can be variation in the licensing of different medicines containing the same drug. Forms available from special-order manufacturers include: oral suspension, oral solution Modified-release tablet CAUTIONARY AND ADVISORY LABELS 3, 21, 25 ▶Sunveniz XL (Sun Pharmaceutical Industries Europe B.V.) Venlafaxine (as Venlafaxine hydrochloride) 75 mg Sunveniz XL 75mg tablets | 30 tablet P £11.14 DT = £2.60 Venlafaxine (as Venlafaxine hydrochloride) 150 mg Sunveniz XL 150mg tablets | 30 tablet P £18.64 DT = £3.90 ▶Venladex XL (Dexcel-Pharma Ltd) Venlafaxine (as Venlafaxine hydrochloride) 75 mg Venladex XL 75mg tablets | 28 tablet P £11.20 Venlafaxine (as Venlafaxine hydrochloride) 150 mg Venladex XL 150mg tablets | 28 tablet P £18.70 Venlafaxine (as Venlafaxine hydrochloride) 225 mg Venladex XL 225mg tablets | 28 tablet P £31.36 ▶Venlalic XL (Ethypharm UK Ltd) Venlafaxine (as Venlafaxine hydrochloride) 37.5 mg Venlalic XL 37.5mg tablets | 30 tablet P £6.60 DT = £6.60 Venlafaxine (as Venlafaxine hydrochloride) 75 mg Venlalic XL 75mg tablets | 30 tablet P £2.60 DT = £2.60 Venlafaxine (as Venlafaxine hydrochloride) 150 mg Venlalic XL 150mg tablets | 30 tablet P £3.90 DT = £3.90 Venlafaxine (as Venlafaxine hydrochloride) 225 mg Venlalic XL 225mg tablets | 30 tablet P £33.60 DT = £33.60 Venlafaxine (as Venlafaxine hydrochloride) 300 mg Venlalic XL 300mg tablets | 30 tablet P £35.00 Nervous system ▶ViePax XL (Dexcel-Pharma Ltd) Venlafaxine (as Venlafaxine hydrochloride) 75 mg ViePax XL 75mg tablets | 28 tablet P £2.60 Venlafaxine (as Venlafaxine hydrochloride) 150 mg ViePax XL 150mg tablets | 28 tablet P £3.90 Venlafaxine (as Venlafaxine hydrochloride) 225 mg ViePax XL 225mg tablets | 28 tablet P £31.36 Tablet CAUTIONARY AND ADVISORY LABELS 3 ▶Venlafaxine (Non-proprietary) Venlafaxine (as Venlafaxine hydrochloride) 37.5 mg Venlafaxine 37.5mg tablets | 56 tablet P £8.37 DT = £2.98 Venlafaxine (as Venlafaxine hydrochloride) 75 mg Venlafaxine 75mg tablets | 56 tablet P £18.30 DT = £6.90 Modified-release capsule CAUTIONARY AND ADVISORY LABELS 3, 21, 25 ▶Venlafaxine (Non-proprietary) Venlafaxine (as Venlafaxine hydrochloride) 225 mg Venlafaxine 225mg modified-release capsules | 30 capsule P £44.75 ▶Alventa XL (Consilient Health Ltd) Venlafaxine (as Venlafaxine hydrochloride) 75 mg Alventa XL 75mg capsules | 28 capsule P £19.12 DT = £2.60 Venlafaxine (as Venlafaxine hydrochloride) 150 mg Alventa XL 150mg capsules | 28 capsule P £31.88 DT = £3.90 ▶Depefex XL (Chiesi Ltd) Venlafaxine (as Venlafaxine hydrochloride) 75 mg Depefex XL 75mg capsules | 28 capsule P £10.40 DT = £2.60 Venlafaxine (as Venlafaxine hydrochloride) 150 mg Depefex XL 150mg capsules | 28 capsule P £17.40 DT = £3.90 ▶Efexor XL (Upjohn UK Ltd) Venlafaxine (as Venlafaxine hydrochloride) 75 mg Efexor XL 75mg capsules | 28 capsule P £22.08 DT = £2.60 Venlafaxine (as Venlafaxine hydrochloride) 150 mg Efexor XL 150mg capsules | 28 capsule P £36.81 DT = £3.90 Venlafaxine (as Venlafaxine hydrochloride) 225 mg Efexor XL 225mg capsules | 28 capsule P £47.11 DT = £47.11 ▶Majoven XL (Bristol Laboratories Ltd) Venlafaxine (as Venlafaxine hydrochloride) 37.5 mg Majoven XL 37.5mg capsules | 28 capsule P £5.25 DT = £5.25 Venlafaxine (as Venlafaxine hydrochloride) 75 mg Majoven XL 75mg capsules | 28 capsule P £22.08 DT = £2.60 Venlafaxine (as Venlafaxine hydrochloride) 150 mg Majoven XL 150mg capsules | 28 capsule P £36.81 DT = £3.90 ▶Politid XL (Actavis UK Ltd) Venlafaxine (as Venlafaxine hydrochloride) 75 mg Politid XL 75mg capsules | 28 capsule P £23.41 DT = £2.60 Venlafaxine (as Venlafaxine hydrochloride) 150 mg Politid XL 150mg capsules | 28 capsule P £39.03 DT = £3.90 ▶Venaxx XL (Advanz Pharma) Venlafaxine (as Venlafaxine hydrochloride) 75 mg Venaxx XL 75mg capsules | 28 capsule P £10.40 DT = £2.60 Venlafaxine (as Venlafaxine hydrochloride) 150 mg Venaxx XL 150mg capsules | 28 capsule P £17.40 DT = £3.90 ▶Vencarm XL (Aspire Pharma Ltd) Venlafaxine (as Venlafaxine hydrochloride) 37.5 mg Vencarm XL 37.5mg capsules | 28 capsule P £3.30 DT = £5.25 Venlafaxine (as Venlafaxine hydrochloride) 75 mg Vencarm XL 75mg capsules | 28 capsule P £2.59 DT = £2.60 Venlafaxine (as Venlafaxine hydrochloride) 150 mg Vencarm XL 150mg capsules | 28 capsule P £3.89 DT = £3.90 Venlafaxine (as Venlafaxine hydrochloride) 225 mg Vencarm XL 225mg capsules | 28 capsule P £9.90 DT = £47.11 ▶Venlablue XL (Zentiva) Venlafaxine (as Venlafaxine hydrochloride) 37.5 mg Venlablue XL 37.5mg capsules | 28 capsule P £5.25 DT = £5.25 Venlafaxine (as Venlafaxine hydrochloride) 75 mg Venlablue XL 75mg capsules | 28 capsule P £6.95 DT = £2.60 Venlafaxine (as Venlafaxine hydrochloride) 150 mg Venlablue XL 150mg capsules | 28 capsule P £9.95 DT = £3.90 ▶Venlasov XL (Sovereign Medical Ltd) Venlafaxine (as Venlafaxine hydrochloride) 75 mg Venlasov XL 75mg capsules | 28 capsule P £2.45 DT = £2.60 Venlafaxine (as Venlafaxine hydrochloride) 150 mg Venlasov XL 150mg capsules | 28 capsule P £3.75 DT = £3.90 ▶Vensir XL (Morningside Healthcare Ltd) Venlafaxine (as Venlafaxine hydrochloride) 75 mg Vensir XL 75mg capsules | 28 capsule P £2.60 DT = £2.60 Venlafaxine (as Venlafaxine hydrochloride) 150 mg Vensir XL 150mg capsules | 28 capsule P £3.90 DT = £3.90 Venlafaxine (as Venlafaxine hydrochloride) 225 mg Vensir XL Nervous system 225mg capsules | 28 capsule P £21.90 DT = £47.11 ▶Venzip XL (Milpharm Ltd) Venlafaxine (as Venlafaxine hydrochloride) 75 mg Venzip XL 75mg capsules | 28 capsule P £22.08 DT = £2.60 Venlafaxine (as Venlafaxine hydrochloride) 150 mg Venzip XL 150mg capsules | 28 capsule P £36.81 DT = £3.90 ANTIDEPRESSANTS › SEROTONIN UPTAKE INHIBITORS
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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.
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Driving and skilled tasks May affect performance of skilled tasks (e.g. driving).
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Initially 75 mg daily in 2 divided doses, then
First-line fragment. Read the complete Indications and Dose section above.
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Initially 75 mg once daily, increased if necessary
First-line fragment. Read the complete Indications and Dose section above.
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75 mg once daily, increased if necessary up to
First-line fragment. Read the complete Indications and Dose section above.
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75 mg once daily, there is no evidence of greater
First-line fragment. Read the complete Indications and Dose section above.
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Initially 37.5 mg once daily for 7 days, increased
First-line fragment. Read the complete Indications and Dose section above.
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37.5 mg once daily for one week, then increased
First-line fragment. Read the complete Indications and Dose section above.
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