Before Taking Effexor:
Before you take Effexor, tell your doctor if you are taking or have taken within the last 2 weeks any MAO inhibitors [phenelzine (Nardil) or tranylcypromine (Parnate)]. You should not take Effexor if you are taking either of these medications.

Uses: Effexor is used to treat mental depression. It is also used to treat certain anxiety disorders or to relieve the symptoms of anxiety. However, it usually is not used for anxiety or tension caused by the stress of everyday life. Effexor is used to relieve symptoms of depression such as feelings of sadness, worthlessness, or guilt; loss of interest in daily activities; changes in appetite; tiredness and sleeping too much. Effexor is also used to relieve symptoms of generalized anxiety disorder.

How To Take This Medication: Effexor comes as a tablet to take by mouth. It is usually taken two or three times a day and should be taken with food. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take Effexor exactly as directed to benefit your condition as much as possible. Do not take more or less of it or take it more often than prescribed by your doctor. Take this medicine only as directed by your doctor and do not take it for a longer time than your doctor ordered.

You may have to take Effexor for 4 weeks or longer before you begin to feel better. Also, you will probably need to keep taking this medicine for at least 6 months, even if you feel better, to help prevent your depression from returning. Your doctor should check your progress at regular visits during this time.   Continue to take Effexor even if you feel well. Do not stop taking Effexor without talking to your doctor, especially if you have taken large doses for a long time. Your doctor probably will want to decrease your dose gradually. This drug must be taken regularly for a few weeks before its full effect is felt.

Effexor should be taken with food or on a full stomach to lessen the chance of stomach upset. However, if your doctor tells you to take the medicine a certain way, take it exactly as directed.

If you are taking the extended-release capsule dosage form, swallow the capsule whole with fluid; do not break, crush, chew, or place the capsule in liquid.

Dosing

The dose of Effexor will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of Effexor. If your dose is different, do not change it unless your doctor tells you to do so.

The number of capsules or tablets that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on your special needs.

• For mental depression:
  • For oral extended-release capsule dosage form:
    • Adults — At first, 75 milligrams (mg) a day, taken in one dose in the morning or evening. Your doctor may increase your dose if needed. However, the dose is usually not more than 225 mg a day.
    • Children — Use and dose must be determined by your doctor.
  • For oral tablet dosage form:
    • Adults — At first, a total of 75 mg a day, taken in smaller doses two or three times during the day. Your doctor may increase your dose if needed. However, the dose is usually not more than 375 mg a day.
    • Children up to 18 years of age — Use and dose must be determined by your doctor.

• For anxiety:
  • For oral extended-release capsule dosage form:
    • Adults — At first, 75 mg a day, taken in one dose in the morning or evening. Your doctor may increase your dose if needed. However, the dose is usually not more than 225 mg per day.
    • Children — Use and dose must be determined by your doctor.

Side Effects:
Side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. However, check with your doctor if any of the following side effects continue or are bothersome:

• upset stomach
• drowsiness
• weakness or tiredness
• excitement or anxiety
• insomnia
• nightmares
• dry mouth
• skin more sensitive to sunlight than usual
• changes in appetite or weight
• headache

Tell your doctor if any of these symptoms are severe or do not go away:

• constipation
• difficulty urinating
• frequent urination
• blurred vision
• changes in sex drive or ability
• excessive sweating

If you experience any of the following symptoms, call your doctor immediately:

• jaw, neck, and back muscle spasms
• slow or difficult speech
• shuffling walk
• persistent fine tremor or inability to sit still
• fever
• difficulty breathing or swallowing
• severe skin rash
• yellowing of the skin or eyes
• irregular heartbeat

Precautions:

• tell your doctor and pharmacist if you are allergic to venlafaxine or any other drugs.
• in addition to the drugs listed in the IMPORTANT WARNING section, tell your doctor and pharmacist what other prescription and nonprescription drugs you are taking, especially anticoagulants [warfarin (Coumadin)]; cimetidine (Tagamet); indinavir (Crixivan); lithium (Eskalith, Lithobid), medication for high blood pressure; muscle relaxants; sedatives; sleeping pills; tranquilizers; and vitamins.
• tell your doctor if you have or have ever had difficulty urinating, elevated intraocular pressure, or liver, kidney, or heart disease.
• tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking venlafaxine, call your doctor immediately.
• if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking venlafaxine.
• you should know that this drug may make you drowsy. Do not drive a car or operate machinery until you know how this drug affects you.
• remember that alcohol can add to the drowsiness caused by this drug.

Drug Interactions:
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking venlafaxine, it is especially important that your health care professional know if you are taking the following:

• Buspirone (e.g., BuSpar) or
• Bromocriptine (e.g., Parlodel) or
• Certain tricyclic antidepressants (amitriptyline [e.g., Elavil], clomipramine [e.g., Anafranil], or imipramine [e.g., Tofranil]) or
• Dextromethorphan (cough medicine) or
• Levodopa (e.g., Sinemet) or
• Lithium (e.g., Eskalith) or
• Meperidine (e.g., Demerol) or
• Nefazodone (e.g., Serzone) or
• Pentazocine (e.g., Talwin) or
• Selective serotonin reuptake inhibitors (fluoxetine [e.g., Prozac], fluvoxamine [e.g., Luvox], paroxetine [e.g., Paxil], sertraline [e.g., Zoloft]) or
• Street drugs (LSD, MDMA [e.g., ecstasy], marijuana) or
• Sumatriptan (e.g., Imitrex) or
• Tramadol (e.g., Ultram) or
• Trazodone (e.g., Desyrel) or
• Tryptophan — Using these medicines with Effexor may increase the chance of developing a rare, but very serious, unwanted effect known as the serotonin syndrome; symptoms of this syndrome include confusion, diarrhea, fever, poor coordination, restlessness, shivering, sweating, talking or acting with excitement you cannot control, trembling or shaking, or twitching; if you experience these symptoms contact your doctor as soon as possible

• Moclobemide (e.g., Manerex) — Taking moclobemide and Effexor together or less than 3 days apart may increase the chance of developing serious unwanted effects, including the serotonin syndrome, and is not recommended

• Monoamine oxidase (MAO) inhibitor activity (isocarboxazid [e.g., Marplan], phenelzine [e.g., Nardil], procarbazine [e.g., Matulane], selegiline [e.g., Eldepryl], tranylcypromine [e.g., Parnate])— Do not take venlafaxine while you are taking or within 2 weeks of taking an MAO inhibitor; if you do, you may develop confusion, agitation, restlessness, stomach or intestinal symptoms, sudden high body temperature, extremely high blood pressure, and severe convulsions; at least 14 days should be allowed between stopping treatment with an MAO inhibitor and starting treatment with Effexor, and at least 7 days should be allowed between stopping treatment with Effexor and starting treatment with an MAO inhibitor.

Other medical problems — The presence of other medical problems may affect the use of Effexor. Make sure you tell your doctor if you have any other medical problems, especially:

• Brain disease or damage, or mental retardation or
• Seizures (history of) — The risk of seizures may be increased

• Heart disease or
• High or low blood pressure — Effexor may make these conditions worse

• Kidney disease or
• Liver disease — Higher blood levels of Effexor may occur, increasing the chance of side effects; your doctor may need to adjust your venlafaxine dose

• Mania (history of) — The risk of developing mania may be increased

• Weight loss — Effexor may cause weight loss; this weight loss is usually small, but if a large weight loss occurs, it may be harmful in some patients

Missed Dosage:
If you take several doses per day, take the missed dose as soon as you remember it and take any remaining doses for that day at evenly spaced intervals. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule.

If you take venlafaxine once a day at bedtime and do not remember to take it until the next morning, skip the missed dose. Do not take a double dose to make up for a missed one.

Notes:
If overdose is suspected, contact your local poison control center or emergency room immediately.

Storage:

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.