effexor reviews Uses, Dosage, Side Effects, Precautions & Warnings

effexor reviews >> Generic drug of the therapeutic class: Neurology–psychiatry
active ingredients: Venlafaxine

what is effexor used for and indication?

• Treatment of major depressive episodes.
• Prevention of recurrence of major depressive episodes.
• Treatment of generalized anxiety disorder.
• Treatment of social anxiety disorder (social phobia).
• Treatment of panic disorder, with or without agoraphobia.

what is the usual dosage for effexor

effexor dosage for adults

• . In depressions , in ambulatory treatment, the initial dosage is usually 75 mg / day (in 2 or 3 doses). After two weeks, if necessary, it can be raised up to 150 mg / day (in 2 or 3 shots).
• . In the so-called “severe” forms of depression (see section on pharmacodynamic properties), the recommended daily dose is 150 to 225 mg.
• It can be increased up to 350 mg / day in the hospitalized patient. In these cases, the dosage will be administered in 3 daily doses and the dose increase will be done in stages every 2 or 3 days depending on the efficacy and adverse effects of treatment.
• – After obtaining the desired therapeutic response, the treatment can be gradually reduced to the minimum dosage compatible with the maintenance of efficiency and good tolerance.
• – The maximum dosage allowed is 375 mg / day.
• – EFFEXOR 50 mg tablets should always be taken during a meal.

– In case of renal and / or hepatic impairment :

• . In case of renal insufficiency , the dosage should be reduced. This reduction will be 50% if the glomerular filtration rate is less than 30 ml / min.
• The product should not be administered during a dialysis session.
• . In case of mild to moderate hepatic impairmentthe dosage should be reduced by half. A reduction of more than 50% may be necessary in some patients.

effexor dose for elderly

• In the elderly, take into account the reduction of glomerular filtration frequently encountered; moreover, as with any antidepressant, vigilance is required when initiating treatment or adjusting the dosage.

– Duration of treatment :

• The treatment of major depressive episodes generally requiring a continuous medication prescription for several months, it is appropriate to re-evaluate periodically and on a case-by-case basis.

– Stop treatment :

• When stopping venlafaxine treatment, it is recommended to proceed with a gradual decrease of the dosage to prevent the possible occurrence of a withdrawal syndrome (see section cautionary statements and precautions). use and side effects).
• Thus, beyond a treatment of 6 weeks, this decrease will be done in at least 2 weeks.
•  The decay period may depend on the dose, the duration of the treatment and the patient himself.
• The patient will be advised not to interrupt the treatment on his own.
  

Prevention of recurrence of major depressive episodes :

• The efficacy of venlafaxine has been demonstrated in the prevention of depressive recurrence in patients who responded to venlafaxine in the last episode. In the vast majority of cases, the recommended dosage during prophylactic maintenance is the same as that used to treat the current episode.
• The patient should be re-evaluated periodically and the benefit of prophylaxis should be evaluated.
  When discontinuing prophylaxis, it is recommended to gradually decrease the dose over a period of approximately 2 weeks.
• This phase of decreasing dosage will be longer as the dosage used will have been high and the duration of treatment extended.

Contraindications

CONTRA-INDICATE:

• This medicine MUST NEVER BE prescribed in the following cases:
  • Known hypersensitivity to venlafaxine.
  • Breast-feeding: Due to the significant passage of this drug in breast milk, breast-feeding is contraindicated.
  • Association with non-selective MAO inhibitors (iproniazid) (see Interactions).
• Due to the presence of lactose , this drug is contraindicated in cases of congenital galactosemia, glucose and galactose malabsorption syndrome or lactase deficiency. 

NOT RECOMMENDED:

• This medication SHOULD NOT GENERALLY BE prescribed in the following cases:
  
  • Combinationsparenteral alpha and beta sympathomimetics (adrenaline, norepinephrine and dopamine), A-selective MAOIs (moclobemide, toloxatone), linezolid.
• Although no clear interaction has been demonstrated with alcohol, consumption is not recommended, as with any psychotropic drug.
• Use in children and adolescents under 18: the use of EFFEXOR is not recommended for children and adolescents under 18.

how effexor works?

OTHER ANTIDEPRESSANTS.

ATC Code: N06AX16.

1. – The mechanism of the antidepressant effect of venlafaxine in humans is related to a potentiation of mono-aminergic activity in the central nervous system.
2. Venlafaxine and its main metabolite are potent inhibitors of serotonin and norepinephrine reuptake, and are weak in dopamine reuptake.
3. Furthermore, in animals, venlafaxine, in acute and chronic administration, decreases the sensitivity of central beta-adrenergic receptors.
4. Venlafaxine has virtually no affinity for cholinergic (muscarinic), histaminergic and adrenergic receptors.
5. – Venlafaxine has been shown to be effective in the treatment of severe forms of major depressive episodes in comparative, randomized, double-blind clinical trials.

– Additional information on clinical trials :

The efficacy of venlafaxine on the prevention of depressive recurrence over a period of 12 months was evaluated in a double-blind placebo-controlled clinical trial. This study included unipolar patients who responded to venlafaxine treatment during the last depressive episode. A statistically significant difference in favor of venlafaxine was observed.

effexor side effects

The incidence and severity of nausea (assessed by visual analogue scale) was reduced by 2 or 3 with the use of venlafaxine extended-release form compared with the immediate-release form, in healthy volunteers, and during clinical tests.

What are the most common side effects of Effexor?

1. nausea, constipation, anorexia, dizziness, dryness of the mouth, insomnia, drowsiness, nervousness, asthenia, hypersudation (nocturnal in particular), disorders of ejaculation and orgasm.
2. . A rise in blood pressure, systolic and diastolic, can be observed under venlafaxine. Discrete at doses less than 200 mg per day, the incidence of its occurrence is then similar to that seen with imipramine antidepressants; at higher doses, particularly 300 to 375 mg per day, this rise is more sensitive.
3.  It is recommended to monitor the blood pressure of patients treated with venlafaxine, especially at doses of 200 mg / day or more (see section on warnings and precautions for use).
4. . Increases in cholesterol levels have been observed, especially during prolonged administration and / or in high doses.

– Clinical adverse events observed at a lower frequency are:

1. . abdominal pain, dyspepsia, diarrhea, flatulence, vomiting, weight loss, exceptionally weight gain
2. . headache, anxiety, agitation, aggression, delusions, tremor, paresthesia, abnormal dreams
3. . seizures (see warnings and precautions)
4. . mydriasis, accommodation disorders,
5. . pollakiuria, dysuria, urinary retention,
6. . hypotension, orthostatic hypotension, palpitations, vasodilation
7. . decreased libido, impotence
8. . rashes sometimes maculopapular, erythematous, pruritus, cutaneo-mucous bleeding (see section on warnings and precautions for use), exceptional cases of erythema multiforme have been reported,
9. . alopecia.

– Uncommon side effects are:

• tinnitus.
• Cases of serotonin syndrome have been exceptionally observed in combination (see section interactions).

– The rare side effects observed are:

• . elevations of hepatic transaminases and hepatitis. In case of abnormal liver function, discontinuation of treatment is required. It usually results in a return to normal
• . hyponatraemia (see section on warnings and precautions for use).

– The Very rare side effects are:

• . leukopenia, neutropenia and pancytopenia,
• . increases in prolactin
• . of extrapyramidal symptoms (including dystonia and tardive dyskinesia or not)
• . pancreatitis
• . urticaria
• . closed angle glaucoma.

– The following withdrawal symptoms were observed during the abrupt or gradual discontinuation of treatment or when the dosage was decreased: anxiety, agitation, dizziness, convulsions, sleep disorders, asthenia, paresthesia, headache, tinnitus, nausea .

– In addition, the side effects are related to the nature of depressive illness:

1. . lifting of psychomotor inhibition, with suicidal risk
2. . reversal of mood with onset of manic episodes,
3. . reactivation of a delirium in psychotic subjects
4. . paroxysmal manifestations of anxiety.

effexor reviews interactions with other drugs

CONTRAINDICATED ASSOCIATIONS :

Non-selective MAOI (iproniazid) :

Risk of occurrence of serotonin syndrome *.

Respect a delay of two weeks between stopping MAOI and initiation of venlafaxine, and at least one week between discontinuation of venlafaxine and initiation of MAOI.

* Serotonin syndrome :

Some overdosages or some drugs ( lithium ) can lead to serotonin syndrome that can stop treatment immediately.

This is manifested by the simultaneous (or sudden) occurrence (simultaneous or sequential) of a set of symptoms that may require

These symptoms can be order

1. . psychic (agitation, confusion, hypomania)
2. . Motor (myoclonus, tremor, hyperreflexia, rigidity, hyperactivity)
3. . vegetative (hypo- or hypertension, tachycardia, chills, sweating, hyperthermia, optionally coma)
4. . digestive (diarrhea).

Strict adherence to recommended doses is an essential factor in preventing the onset of this syndrome.

ASSOCIATIONS NOT RECOMMENDED :

– Sympathomimetics alpha and beta (adrenaline, norepinephrine, dopamine) :

In the case of a parenteral action .

Paroxysmal hypertension with possible rhythm disturbances (inhibition of sympathomimetic entry into the sympathetic fiber).

– MAOI selective A (moclobemide, toloxatone) :

• Risk of occurrence of serotonin syndrome * (see above).
• If the association can not be avoided, very close clinical supervision. Start the combination at the recommended minimum dosages.

– Linézolide :

• Risk of occurrence of a serotonin syndrome * (see above).
• If the association can not be avoided, very close clinical supervision. Start the combination at the recommended minimum dosages.
  

ASSOCIATIONS WITH PRECAUTIONS OF EMPLOYMENT :

Sympathomimetics alpha and beta (adrenaline, norepinephrine, dopamine): adrenaline for local hemostatic action by subcutaneous and gingival injections .

1. Paroxysmal hypertension with possible rhythm disturbances (inhibition of sympathomimetic entry into the sympathetic fiber).
2. Limit intake, for example less than 0.1 mg adrenaline in 10 minutes or 0.3 mg in one hour, in adults.

– The risk of skin or mucosal bleeding may be increased during treatment with venlafaxine. Special attention is recommended in patients treated simultaneously with oral anticoagulants , with drugs that affect platelet functionsuch as NSAIDs and aspirin or other drugs that may increase the risk of bleeding.

ASSOCIATIONS TO BE TAKEN INTO ACCOUNT :

– Ritonavir, nelfinavir :

• Increased concentrations of venlafaxine, with risk of overdose.

– Ketoconazole, itraconazole, voriconazole :

• Increased concentrations of venlafaxine, with risk of overdose.

– Erythromycin, clarithromycin, telithromycin :

• Increased concentrations of venlafaxine, with risk of overdose.

effexor warnings and precautions

effexor warnings

As with any antidepressant treatment, the risk of suicide in depressed patients persists at the beginning of treatment, the removal of psychomotor inhibition may precede the actual antidepressive action of the drug.

• – Patients treated with venlafaxine should be monitored for worsening of clinical condition and suicidal risk, especially at the start of treatment and when there is a change in dosage. The risk of suicide attempt should be taken into consideration especially in all depressed patients. The rate of renewal of the prescription should be adapted accordingly (see section on adverse effects).
• – A dose-dependent rise in blood pressure that may occur during administration of venlafaxine, blood pressure monitoring is required during treatment, especially at doses of 200 mg or greater (see section 4.8).
• – In case of a history of drug dependence, it is important to look for manifestations suggestive of abuse or misuse.
• – The prevention of depressive recurrence is aimed at patients who have presented (including the episode during treatment) at least three major depressive episodes, of moderate to severe intensity.
• – Due to the presence of lactoseThis medication is contraindicated in cases of congenital galactosemia, glucose-galactose malabsorption syndrome, or lactase deficiency.

– Use in children and adolescents under 18 years :

The use of EFFEXOR is not recommended for children and adolescents under 18 years of age. Suicidal (suicidal attempts and suicidal ideation) and hostile-type behaviors (mainly aggression, oppositional behavior and anger) were more frequently observed in clinical studies in children and adolescents treated with antidepressants compared to those placebo treated. If, in the event of clinical necessity, the decision to treat is nevertheless taken, the patient will have to be carefully monitored to detect the appearance of suicidal symptoms. In addition, there are no long-term safety data available in children and adolescents regarding growth, maturation, and cognitive and behavioral development.

1. – In epileptic patients or patients with a history of epilepsy, it is prudent to strengthen clinical and electrical monitoring.
   The occurrence of seizures necessitates stopping treatment.
2. – Venlafaxine should be used with caution in patients with high intraocular pressure or at risk of acute angle-closure glaucoma, with reports of mydriasis and glaucoma. Close monitoring will be required.
3. – In the event of a frank manic shift, venlafaxine treatment will be discontinued and, most often, a prescribed sedative neuroleptic (see section 4.8).
4. – As with other antidepressants, venlafaxine should be used with caution in patients with a history of bipolar disorder.
5. – Aggressive behavior may occur in a small proportion of patients who have received antidepressant therapy, including venlafaxine – during treatment, discontinuation or dose reduction.
6. As with other antidepressants, venlafaxine should be used with caution in patients with a history of aggressive behavior.
7. – The possibility of occurrence of hyponatremia, a fortiori when co-prescription with drugs likely to cause this electrolyte abnormality, must be known, especially in the elderly, especially if it is malnourished, and cirrhotic.
8. – The risk of skin or mucosal bleeding may be increased during treatment with venlafaxine. Special attention is advised in patients with a history of hemostasis abnormalities and in patients treated concurrently with oral anticoagulants, platelet function medications such as NSAIDs and aspirin or other medicines that may increase the risk of bleeding.
9. – In hypertensive patients or patients with heart disease, it is recommended to reinforce clinical surveillance, as venlafaxine may increase heart rate in some patients.
10. – In patients with renal impairment or hepatic impairment, venlafaxine should be used with caution. The dosage should be reduced due to an increase in the duration of elimination (see section dosage and method of administration).
11. – Although no clear interaction has been demonstrated with alcohol, consumption is discouraged, as with any psychotropic medication.
12. – As with other antidepressants, a withdrawal syndrome may occur, requiring a very gradual decrease in dosage and monitoring of the patient (see sections on dosage and administration and side effects).
13. – Associations subject to precautions for use : sympathomimetics alpha and beta (adrenaline, norepinephrine, dopamine): adrenaline for local hemostatic action by subcutaneous and gingival injections.

Drive and use machines

In healthy volunteers, venlafaxine produced no psycho-behavioral changes.

However, as with all psychotropic drugs, it will be advisable for the patient to ensure that the treatment is well supported before performing certain tasks such as driving or using machines.

PREGNANCY / BREAST FEEDING / FERTILITY

effexor during pregnancy

1. Studies in animals have not shown any teratogenic effect. In the absence of teratogenic effect in animals, a malformative effect in the human species is not expected.
2. Indeed, to date, the substances responsible for malformations in humans have been teratogenic in animals in well-conducted studies on two species.
3. In clinical practice, there are currently no data of sufficient relevance to assess the possible malformative or foetotoxic effect of venlafaxine when administered during pregnancy.
4. Therefore, as a precaution, it is best not to use venlafaxine during pregnancy.
5. With some IRS used until a date close to birth, or until birth, the following effects: irritability, tremor, hypotonia, constant crying, feeding difficulties, sleep disorders …, have been reported in the newborn.
6. They can translate either the occurrence of an impregnation or the occurrence of a weaning, the time of appearance and the duration of these symptoms are in theory function of the elimination half-life of the product.
   

Breast-feeding

• Due to a significant passage of this drug into breast milk, breast-feeding is contraindicated.

what happens when you overdose on effexor?

• Cases of overdose with venlafaxine have been reported mainly during polydrug intoxication and / or with alcohol. These may include: changes in ECG (QT prolongation, branch block, QRS prolongation), sinus and ventricular tachycardia, bradycardia, hypotension, dizziness, disturbances of consciousness (ranging from drowsiness to coma) ), convulsions.
• There is no specific antidote for venlafaxine.
  In case of overdose, the treatment is symptomatic and may include gastric lavage (if it can be performed quickly after ingestion or in symptomatic patients) possibly supplemented by the administration of activated charcoal to limit the absorption of product.
•  Induced vomiting is not recommended if there is a risk of miscarriage.
  Cardiovascular, respiratory, neurological and vital signs monitoring is required.
  Forced diuresis, hemodialysis, hemoperfusion or exchange transfusion have not been shown to be effective.
  Venlafaxine and its metabolite O-desmethylvenlafaxine are not dialysable.

What is  Forms and Composition ?

Pale pink tablet in the shape of a pentagon, the W laboratory logo and 50 engraved on one side.