Venlor (venlafaxine hydrochloride) is a prescription serotonin-norepinephrine reuptake inhibitor (SNRI) developed for the comprehensive management of major depressive disorder (MDD), generalized anxiety disorder (GAD), social anxiety disorder, and panic disorder. As a dual reuptake inhibitor, it modulates two critical neurotransmitter systems simultaneously, offering a distinct pharmacological profile from selective serotonin reuptake inhibitors (SSRIs). Its extended-release formulation (Venlor XR) ensures stable 24-hour plasma concentrations, supporting consistent therapeutic effect and improved tolerability. This medication is indicated for adults and requires careful medical supervision throughout treatment.

Features

• Active pharmaceutical ingredient: Venlafaxine hydrochloride.
• Available in immediate-release (IR) tablets and extended-release (XR) capsules.
• XR formulation designed for once-daily dosing.
• Potent inhibitor of serotonin and norepinephrine reuptake.
• Weak inhibitor of dopamine reuptake.
• Multiple dosage strengths for precise titration.

Benefits

• Provides effective relief from the core emotional and physical symptoms of major depression.
• Dual mechanism of action may offer efficacy in patients with an inadequate response to SSRIs.
• The extended-release formulation minimizes peak-to-trough plasma level fluctuations, reducing the potential for side effects.
• Can improve energy levels, interest in daily activities, and overall sense of well-being.
• Effective in reducing excessive worry and anxiety associated with generalized anxiety disorder.
• Helps manage the frequency and severity of panic attacks.

Common use

Venlor is primarily prescribed for the treatment of major depressive disorder (MDD). It is also widely used and approved for the management of generalized anxiety disorder (GAD), social anxiety disorder (SAD), and panic disorder with or without agoraphobia. Its use is based on a confirmed diagnosis by a qualified healthcare professional following established diagnostic criteria (e.g., DSM-5).

Dosage and direction

For Major Depressive Disorder (MDD) and Generalized Anxiety Disorder (GAD) with Venlor XR:

• Initial Dose: 75 mg administered once daily, with food, in the morning or evening.
• Titration: Depending on patient response and tolerability, the dose may be increased by 75 mg increments at intervals of no less than 4 days.
• Maximum Dose: The maximum recommended dose is 225 mg per day. For certain patients, doses up to 375 mg per day (in divided doses) may be used under close medical supervision.
• Administration: Capsules must be swallowed whole with fluid and must not be divided, crushed, chewed, or placed in water.

Dosage for other indications and for the immediate-release formulation differs. All dosing must be individualized and strictly adhere to the prescribing physician’s instructions.

Precautions

• Clinical Worsening/Suicide Risk: Close monitoring of all patients, particularly adolescents and young adults, is essential for worsening depression, suicidality, or unusual changes in behavior, especially during initial treatment and dose adjustments.
• Screening for Bipolar Disorder: Prior to initiating treatment, patients should be screened for bipolar disorder, as venlafaxine is not approved for treating bipolar depression and may induce a manic episode.
• Sustained Hypertension: Dose-dependent increases in blood pressure can occur. Regular monitoring of blood pressure is recommended, especially after dose increases.
• Mydriasis: Venlafaxine can cause pupillary dilation, which may trigger an episode of angle-closure glaucoma in patients with anatomically narrow angles.
• Discontinuation Syndrome: Abrupt cessation can lead to symptoms such as dizziness, nausea, lethargy, and headache. A gradual taper under medical guidance is required to discontinue treatment.
• Bleeding Risk: SNRIs and SSRIs may increase the risk of bleeding events. Caution is advised when using with NSAIDs, aspirin, warfarin, or other anticoagulants.

Contraindications

• Hypersensitivity to venlafaxine hydrochloride or any excipients in the formulation.
• Concomitant use with, or within 14 days of stopping, a monoamine oxidase inhibitor (MAOI) due to the risk of serotonin syndrome. A minimum 7-day washout period is required after stopping venlafaxine before initiating an MAOI.
• Concomitant use with linezolid or intravenous methylene blue.

Possible side effect

Common side effects (≥5% and twice that of placebo) include:

• Nausea
• Headache
• Drowsiness or insomnia
• Dry mouth
• Dizziness
• Constipation
• Nervousness
• Sweating
• Asthenia (weakness)

Other important side effects requiring medical attention include:

• Sustained increase in blood pressure
• Significant changes in heart rate
• Symptoms of serotonin syndrome (agitation, hallucinations, fever, tachycardia, incoordination, nausea/vomiting, diarrhea)
• Hyponatremia (low sodium levels)
• Seizures
• Abnormal bleeding
• Manic episodes
• Angle-closure glaucoma
• Interstitial lung disease and eosinophilic pneumonia (rare)

Drug interaction

Venlor has several clinically significant drug interactions:

• MAOIs: Absolute contraindication (risk of serotonin syndrome, hyperthermia, rigidity, myoclonus, autonomic instability).
• Other Serotonergic Drugs: Caution with other SSRIs, SNRIs, triptans, tramadol, tryptophan, and St. John’s Wort due to additive serotonergic effects and potential for serotonin syndrome.
• Drugs that Prolong QTc Interval: Use with caution with other drugs known to prolong the QTc interval (e.g., certain antipsychotics, antiarrhythmics).
• CNS Depressants: May potentiate the effects of alcohol, benzodiazepines, opioids, and other sedatives.
• Drugs Metabolized by CYP2D6: Venlafaxine is a potent inhibitor of CYP2D6 and can increase plasma levels of drugs metabolized by this enzyme (e.g., risperidone, tricyclic antidepressants, beta-blockers like metoprolol).
• Anticoagulants/Antiplatelets: May enhance the anticoagulant effect of warfarin and increase the risk of bleeding with NSAIDs and aspirin.

Missed dose

If a dose is missed, it should be taken as soon as it is remembered. However, if it is close to the time for the next scheduled dose, the missed dose should be skipped and the regular dosing schedule resumed. Do not take a double dose to make up for a missed one.

Overdose

Overdose experience includes symptoms ranging from mild to fatal. Symptoms may include:

• Extended-release capsules may be slower to manifest symptoms.
• Tachycardia, changes in level of consciousness (ranging from somnolence to coma), seizures, and vomiting.
• Serotonin syndrome manifestations.
• ECG changes, including QTc prolongation.
• Fatal outcomes have been reported, primarily with mixed overdoses involving multiple drugs.

In case of suspected overdose, seek immediate emergency medical attention. Treatment is supportive and symptomatic. There is no specific antidote. Ensure adequate oxygenation and ventilation, monitor cardiac rhythm and vital signs, and consider gastric lavage with a protected airway.

Storage

• Store at room temperature, 20°C to 25°C (68°F to 77°F), with excursions permitted between 15°C and 30°C (59°F and 86°F).
• Keep in the original container, tightly closed, to protect from moisture and light.
• Keep out of reach of children and pets.

Disclaimer

This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or medication. Never disregard professional medical advice or delay in seeking it because of something you have read here. The content has not been evaluated by all regulatory agencies and is not intended to diagnose, treat, cure, or prevent any disease.

Reviews

“After struggling with treatment-resistant depression for years, my psychiatrist switched me to Venlor XR. The titration process was managed carefully, and while the initial side effects were challenging, the sustained efficacy I’ve experienced has been life-changing. My energy levels and focus have improved significantly.” – Patient, 42

“From a clinical perspective, Venlor is a valuable tool in our arsenal, particularly for patients with comorbid fatigue and anhedonia where its noradrenergic activity can be beneficial. The key is slow titration and diligent monitoring of blood pressure.” – Consulting Psychiatrist

“The extended-release formulation offers clear advantages in adherence and tolerability over the immediate-release version. It provides a steady-state concentration that helps avoid the peaks and troughs associated with multiple daily dosing.” – Clinical Pharmacist