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Immediate release 25-50 mg/day PO divided q8-12hr initially; may be increased as tolerated by ≤25 mg/day no faster than every 4 days Moderate: Up to 225 mg/day PO divided q8-12hr Severe: Up to 375 mg/day PO divided q8-12hr Extended release 37.5 mg PO once daily initially; may be increased by 37.5 mg/day every 4-7 days; not to exceed 225 mg/day Headache (25-38%) Nausea (21-58%) Insomnia (15-24%) Asthenia (16-20%) Dizziness (11-24%) Ejaculation disorder (2-19%) Somnolence (12-26%) Dry mouth (12-22%) Diaphoresis (7-19%) Anorexia (15-17%) Nervousness (17-26%) Anorgasmia (5-13%) Weht loss (1-6%) Abnormal vision (4-6%) Hypertension (2-5%) Impotence (4-6%) Paresthesia (2-3%) Tremor (1-10%) Vasodilation (2-6%) Vomiting (3-8%) Weht gain (2%) Flatulence (3-4%) Pruritus (1%) Yawning (3-8%) Dyspepsia (5-7%) Twitching (1-3%) Mydriasis (2%) 65 years Not FDA approved for children; in children and young adults; benefits of taking antidepressants must be wehed against risks Patients should be monitored closely for changes in behavior, clinical worsening, and suicidal tendencies; this should be done during initial 1-2 months of therapy and dosage adjustments Patient’s family should communicate any abrupt behavioral changes to healthcare provider Worsening behavior and suicidal tendencies that are not part of presenting symptoms may necessitate discontinuance of therapy Not FDA approved for treatment of bipolar depression Risk of mydriasis; may trger angle closure attack in patients with angle closure glaucoma with anatomiy narrow angles without a patent iridectomy Use caution in bipolar mania, history of seizures, and cardiovascular disease May precipitate mania or hypomania episodes in patients with bipolar disorder; avoid monotherapy in bipolar disorder; screen patients presenting with depressive symptoms for bipolar disorder Use caution in hepatic or renal impairment Neonates exposed to serotonin-norepinephrine reuptake inhibitors (SNRIs) or selective serotonin reuptake inhibitors (SSRIs) late in 3rd trimester of pregnancy have developed complications necessitating prolonged hospitalization, respiratory support, and tube feeding Clinical worsening and suicidal ideation may occur despite medication in adolescents and young adults (18-24 years) When discontinuing, taper dosage to avoid flulike symptoms May cause increase in nervousness, anxiety, or insomnia May impair ability to operate heavy machinery; depresses CNS Bone fractures reported with antidepressant therapy; consider possibility if patient experiences bone pain May cause snificant increase in serum cholesterol Dose-dependent anorectic effects and weht loss reported in children and adult patients Dose-related increase in systolic and diastolic pressure reported Eosinophilic pneumonia and interstitial lung disease reported SAIDH and hyponatremia reported SSRIs Potentially life-threatening serotonin syndrome with SSRIs and SNRIs when used in combination with other serotonergic agents including TCAs, buspirone tryptophan, fentanyl, tramadol, lithium, and triptans; symptoms include tremor, myoclonus, diaphoresis, nausea, vomiting, flushing, dizziness, hyperthermia with features resembling neuroleptic malnant syndrome, seizures, ridity, autonomic instability with possible rapid fluctuations of vital sns, and mental status changes that include extreme agitation progressing to delirium and coma Venlafaxine in patient being treated with linezolid or IV methylene blue increases risk of serotonin syndrome; if linezolid or IV methylene blue must be administered, discontinue venlafaxine immediately and monitor for central nervous system (CNS) toxicity; therapy may be resumed 24 hours after last linezolid or methylene blue dose or after 2 weeks of monitoring, whichever comes first SSRIs and SNRIs may impair platelet aggregation and increase the risk of bleeding events, ranging from ecchymoses, hematomas, epistaxis, petechiae, and GI hemorrhage to life-threatening hemorrhage; concomitant use of aspirin, NSAIDs, warfarin, other anticoagulants, or other drugs known to affect platelet function may add to this risk Control hypertension before initiating treatment; monitor blood pressure regularly during treatment Risks of sustained hypertension, hyponatremia, and impeded heht and weht in children Drug-laboratory test interactions: False-positive urine immunoassay screening tests for phencyclidine (PCP) and amphetamine have been observed during venlafaxine therapy because of lack of specificity of the screening tests May cause or exacerbate sexual dysfunction "Bicyclic" antidepressant; drug is structurally unrelated to SSRIs, MAOIs, and tricyclic antidepressants (TCAs), but it and its metabolite are potent inhibitors of serotonin and norepinephrine reuptake and weak inhibitors of dopamine reuptake; it does not have MAOI activity or activity for H1 histaminergic, muscarinic cholinergic, or alpha2-adrenergic receptors The above information is provided for general informational and educational purposes only. 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