Venlafaxine, Oral

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KEY POINTS

• This medicine is taken by mouth to treat depression or anxiety. Take it exactly as directed.
• This medicine may increase suicidal thoughts or actions in some people.
• Keep all appointments for tests to see how this medicine affects you.
• This medicine may cause unwanted side effects. Tell your healthcare provider if you have any side effects that are serious, continue, or get worse.
• This medicine may cause life-threatening problems if you take this medicine with certain other medicines. Tell all healthcare providers who treat you about all the prescription medicines, nonprescription medicines, supplements, natural remedies, and vitamins that you take.

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What are other names for this medicine?

Type of medicine: selective serotonin and norepinephrine reuptake inhibitor (SNRI) antidepressant

Generic and brand names: venlafaxine, oral; Effexor XR

What is this medicine used for?

This medicine is taken by mouth to treat depression. This medicine is also used to treat generalized anxiety disorder (GAD). The extended-release tablets may also be used to treat social anxiety disorder and panic disorder.

This medicine may be used to treat other conditions as determined by your healthcare provider.

What should my healthcare provider know before I take this medicine?

Before taking this medicine, tell your healthcare provider if you have ever had:

• An allergic reaction to any medicine
• Bleeding problems
• Diabetes
• Glaucoma
• Heart disease or a heart attack
• High blood pressure
• High cholesterol
• Liver or kidney disease
• Problems with low levels of sodium in the blood
• Problems with mania or bipolar disorder
• Seizures
• Thyroid problems

Do not take this medicine if you have taken an MAO inhibitor in the last 2 weeks. Also, do not start taking an MAO inhibitor within 7 days after stopping this medicine. You could have serious side effects if you do. Talk with your healthcare provider about this.

Females of childbearing age: Tell your healthcare provider if you are pregnant or plan to become pregnant. It is not known whether this medicine will harm an unborn baby. Taking this medicine in the last 3 months of pregnancy can cause problems for the baby. Do not breast-feed while taking this medicine without your healthcare provider's approval.

How do I take it?

Read the Medication Guide that comes in the medicine package when you start taking this medicine and each time you get a refill.

Check the label on the medicine for directions about your specific dose. Take this medicine with food exactly as your healthcare provider prescribes. During this treatment, your healthcare provider may adjust your dosage depending on your response. Be sure you understand how much medicine to take and when to take it. Do not take more or take it longer than prescribed.

Do not stop taking this medicine without your healthcare provider's approval. You may need to reduce your dose slowly to avoid serious side effects.

Check with your healthcare provider before using this medicine in children under age 18.

If you are taking the extended release capsules or tablets, take them with food at the same time each day. Swallow the extended release tablets or capsules whole with a full glass of water. Do not divide, crush, or chew them or put them in water. If you cannot swallow the extended release capsule, tell your healthcare provider. Your healthcare provider may instruct you to carefully open the capsule and sprinkle the entire contents on a spoonful of applesauce. The mixture should be swallowed immediately without chewing and followed with a glass of water to ensure complete swallowing of the medicine pellets.

What if I miss a dose?

If you miss a dose, take it as soon as you remember unless it is almost time for the next scheduled dose. In that case, skip the missed dose and take the next one as directed. Do not take double doses. If you miss a dose of the extended release capsules (Effexor XR) one day, do not double the dose the next day. If you are not sure of what to do if you miss a dose, or if you miss more than one dose, contact your healthcare provider.

What if I overdose?

If you or anyone else has intentionally taken too much of this medicine, call 911 or go to the emergency room right away. If you pass out, have seizures, weakness or confusion, or have trouble breathing, call 911. If you think that you or anyone else may have taken too much of this medicine, call the poison control center. Do this even if there are no signs of discomfort or poisoning. The poison control center number is 800-222-1222.

Symptoms of an acute overdose may include: dizziness; drowsiness; nausea; vomiting; fast heartbeat; seizures; flushing; sweating; fever; muscle pain; tremor; uncontrolled movements of the face, hands or feet; coma.

What should I watch out for?

Antidepressant medicines may increase suicidal thoughts or actions in some children, teenagers, and young adults within the first few months of treatment or at times of dose changes. Talk with your provider about this.

Behavior changes may be caused by the medicine or by depression or another mental health problem. Contact your healthcare provider right away if you or your family notice any disturbing changes in your thoughts or behavior, such as:

• More outgoing or aggressive behavior than normal
• Confusion
• Hallucinations
• Worsening of depression
• Suicidal thoughts

This medicine may cause a life-threatening problem called serotonin syndrome if you take it with certain other medicines, such as antidepressants, migraine medicines, pain medicines, some cough medicines, and St. John’s wort. Make sure that your providers know ALL of the medicines that you take. Contact your healthcare provider right away if you have:

• Restlessness
• Hallucinations
• Loss of coordination
• Tremor
• Stiff muscles
• Fast heart beat
• Rapid changes in blood pressure
• Increased body temperature, sweating, or flushing
• Dizziness
• Nausea
• Vomiting
• Diarrhea

This medicine may trigger angle-closure glaucoma. Contact your provider right away if you have eye pain, vision changes, or redness and swelling in or around your eye.

This medicine may cause drowsiness, dizziness, or blurred vision. Do not drive or operate machinery unless you are fully alert and can see clearly. This medicine increases the effects of alcohol and other medicines. Do not drink alcohol or take other medicines, including nonprescription products or natural remedies, unless your healthcare provider approves.

You may need to have blood tests and blood pressure checks regularly to see how this medicine affects you. Keep all appointments for these tests.

When taken for a long time, this medicine may cause loss of appetite and weight loss. Talk with your healthcare provider about this.

Adults over the age of 65 may be at greater risk for side effects. Talk with your healthcare provider about this.

If you need emergency care, surgery, lab tests, or dental work, tell the healthcare provider or dentist you are taking this medicine.

What are the possible side effects?

Along with its needed effects, your medicine may cause some unwanted side effects. Some side effects may be very serious. Some side effects may go away as your body adjusts to the medicine. Tell your healthcare provider if you have any side effects that continue or get worse.

Life-threatening (Report these to your healthcare provider right away. If you cannot reach your healthcare provider right away, get emergency medical care or call 911 for help.): Allergic reaction (hives; itching; rash; trouble breathing; chest pain or tightness in your chest; swelling of your lips, tongue, and throat).

Serious (Report these to your healthcare provider right away.): Seizures, thoughts of suicide, worsening depression, panic attacks, severe confusion, severe dizziness or lightheadedness, fainting, fast or irregular heartbeat, unusual nervousness or restlessness, hallucinations, stiff muscles, tremors, fever, loss of coordination or unsteadiness, severe nausea or vomiting, severe diarrhea, severe or ongoing headache, chest pain, swelling in arms or legs, trouble breathing, cough, chest infection, unusual bruising or bleeding, unusual tiredness or weakness, severe or ongoing trouble sleeping, memory problems or trouble concentrating, trouble urinating or decreased urination, blurred vision or enlarged pupils.

Other: Nausea, gas, headache, drowsiness, mild dizziness, trouble sleeping, nervousness, constipation, loss of appetite, weight loss, sweating, rash, hives, dry mouth, change in sexual desire or ability, abnormal dreams, yawning, sensitivity to sun.

What products might interact with this medicine?

When you take this medicine with other medicines, it can change the way this or any of the other medicines work. Nonprescription medicines, vitamins, natural remedies, and certain foods may also interact. Using these products together might cause harmful side effects. Talk to your healthcare provider if you are taking:

• Alfuzosin (Uroxatral)
• Antianxiety medicines such as alprazolam (Xanax), buspirone, clorazepate (Gen-Xene, Tranxene), diazepam (Valium), lorazepam (Ativan), and oxazepam
• Antibiotics such as chloramphenicol, ciprofloxacin (Cipro), clarithromycin (Biaxin), erythromycin (E.E.S., Ery-Tab, Erythrocin), linezolid (Zyvox), moxifloxacin (Avelox), pentamidine (NebuPent, Pentam), rifabutin (Mycobutin), rifampin (Rifadin), rifapentine (Priftin), and telithromycin (Ketek)
• Antifungal medicines such as itraconazole (Sporanox), ketoconazole (Nizoral), posaconazole (Noxafil), terbinafine (Lamisil), and voriconazole (Vfend)
• Antihistamines such as brompheniramine, chlorpheniramine (Chlor-Trimeton), clemastine (Tavist), dexchlorpheniramine, and diphenhydramine (Benadryl)
• Antipsychotic medicines such as asenapine (Saphris), chlorpromazine, clozapine (Clozaril, FazaClo), fluphenazine, haloperidol (Haldol), iloperidone (Fanapt), paliperidone (Invega), perphenazine, pimozide (Orap), quetiapine (Seroquel), risperidone (Risperdal), thioridazine, thiothixene (Navane), trifluoperazine, and ziprasidone (Geodon)
• Antiseizure medicines such as carbamazepine (Carbatrol, Epitol, Equetro, Tegretol), oxcarbazepine (Trileptal), phenobarbital, phenytoin (Dilantin, Phenytek), and primidone (Mysoline)
• Apomorphine (Apokyn)
• Atomoxetine (Strattera)
• Bupropion (Aplenzin, Forfivo, Wellbutrin, Buproban, Zyban)
• Cancer medicines such as abiraterone (Zytiga), arsenic trioxide (Trisenox), crizotinib (Xalkori), enzalutamide (Xtandi), gefitinib (Iressa), lapatinib (Tykerb), nilotinib (Tasigna), sorafenib (Nexavar), sunitinib (Sutent), toremifene (Fareston), vandetanib (Caprelsa), and vemurafenib (Zelboraf)
• Cimetidine (Tagamet)
• Cinacalcet (Sensipar)
• Conivaptan (Vaprisol)
• Dexamethasone
• Dextromethorphan, an ingredient in many cough, cold, or allergy medicines such as Robitussin-DM
• Dextromethorphan/quinidine (Nuedexta)
• Diuretics (water pills) such as amiloride, bumetanide, chlorothiazide (Diuril), furosemide (Lasix), hydrochlorothiazide (Microzide), spironolactone (Aldactone), torsemide (Demadex), and triamterene (Dyrenium)
• Doxepin (Silenor)
• Entacapone (Comtan)
• Heart medicines such as amiodarone (Cordarone, Pacerone), disopyramide (Norpace), dronedarone (Multaq), flecainide, metoprolol (Lopressor, Toprol), nicardipine (Cardene), procainamide, propafenone (Rythmol), quinidine, and sotalol (Betapace, Sorine)
• HIV medicines such as atazanavir (Reyataz), darunavir (Prezista), delavirdine (Rescriptor), elvitegravir/cobicistat/emtricitabine/tenofovir (Stribild), fosamprenavir (Lexiva), indinavir (Crixivan), lopinavir/ritonavir (Kaletra), nelfinavir (Viracept), nevirapine (Viramune), ritonavir (Norvir), saquinavir (Invirase), and tipranavir (Aptivus)
• Lithium (Lithobid)
• Malaria medicines such as artemether/lumefantrine (Coartem), chloroquine, mefloquine, primaquine, and quinine
• MAO inhibitors such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam, Zelapar), and tranylcypromine (Parnate) (Do not take this medicine and an MAO inhibitor within 14 days of each other.)
• Medicines to treat or prevent blood clots such as apixaban (Eliquis), aspirin, clopidogrel (Plavix), dabigatran (Pradaxa), dalteparin (Fragmin), dipyridamole (Persantine), enoxaparin (Lovenox), heparin, prasugrel (Effient), rivaroxaban (Xarelto), ticagrelor (Brilinta), and warfarin (Coumadin)
• Mifepristone (Korlym, Mifeprex)
• Migraine medicines such as almotriptan (Axert), dihydroergotamine (D.H.E. 45, Migranal), eletriptan (Relpax), ergotamine (Ergomar), frovatriptan (Frova), naratriptan (Amerge), rizatriptan (Maxalt), sumatriptan (Alsuma, Imitrex, Sumavel), and zolmitriptan (Zomig)
• Milnacipran (Savella)
• Muscle relaxants such as baclofen (Gablofen, Lioresal), carisoprodol (Soma), cyclobenzaprine (Amrix), dantrolene (Dantrium), methocarbamol (Robaxin), and tizanidine (Zanaflex)
• Natural remedies such as alfalfa, anise, bilberry, cat's claw, garlic, ginger, ginkgo biloba, ginseng, glucosamine, gotu kola, kava, SAMe, St. John's wort, tryptophan, and valerian
• Nausea medicines such as aprepitant (Emend), dolasetron (Anzemet), ondansetron (Zofran), prochlorperazine (Compro), and promethazine
• Nonsteroidal anti-inflammatory medicines (NSAIDs) such as celecoxib (Celebrex), ibuprofen (Advil, Motrin), ketoprofen, and naproxen (Aleve, Anaprox, Naprelan)
• Other antidepressants such as amitriptyline, citalopram (Celexa), desipramine (Norpramin), duloxetine (Cymbalta), escitalopram (Lexapro), fluoxetine (Prozac), fluvoxamine (Luvox), imipramine (Tofranil), mirtazapine (Remeron), nefazodone, nortriptyline (Pamelor), sertraline (Zoloft), and trazodone
• Pain medicines such as buprenorphine (Buprenex, Butrans), codeine, fentanyl (Abstral, Actiq, Duragesic, Fentora, Sublimaze), hydrocodone/acetaminophen (Norco, Vicodin), hydromorphone (Dilaudid, Exalgo), meperidine (Demerol), methadone (Dolophine, Methadose), morphine (Kadian, MS Contin), oxycodone (OxyContin, Roxicodone), oxycodone/acetaminophen (Percocet, Roxicet), tapentadol (Nucynta), and tramadol (ConZip, Ultram)
• Paroxetine (Brisdelle, Paxil, Pexeva)
• Procarbazine (Matulane)
• Products that contain methylene blue (Hyophen, Prosed DS, Urophen, Uta)
• Sleeping pills such as butabarbital (Butisol), ramelteon (Rozerem), triazolam (Halcion), zaleplon (Sonata), and zolpidem (Ambien, Edluar, Intermezzo)
• Stimulants and diet pills such as dexmethylphenidate (Focalin), dextroamphetamine (Dexedrine), methamphetamine (Desoxyn), and methylphenidate (Concerta, Daytrana, Metadate, Ritalin)
• Tetrabenazine (Xenazine)

Do not drink alcohol while you are taking this medicine.

If you are not sure if your medicines might interact, ask your pharmacist or healthcare provider. Keep a list of all your medicines with you. List all the prescription medicines, nonprescription medicines, supplements, natural remedies, and vitamins that you take. Be sure that you tell all healthcare providers who treat you about all the products you are taking.

How should I store this medicine?

Store this medicine at room temperature. Keep the container tightly closed. Protect it from heat, high humidity, and bright light.

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This advisory includes selected information only and may not include all side effects of this medicine or interactions with other medicines. Ask your healthcare provider or pharmacist for more information or if you have any questions.

Ask your pharmacist for the best way to dispose of outdated medicine or medicine you have not used. Do not throw medicine in the trash.

Keep all medicines out of the reach of children.

Do not share medicines with other people.