                               Effexor (venlafaxine)
                            FREQUENTLY ASKED QUESTIONS
                            Version 3.0 / 19 August 1994
 
                                    Index.
 
1. What is Effexor
2. How does Effexor differ from other antidepressants?
3. What kinds of depression can be treated with Effexor?
4. What are the side-effects of Effexor?
5. Which side effects force people to stop taking Effexor?
6. Are there any special hazards for people with bipolar disorder?
7. Does Effexor interact with other medications?
8. Does Effexor interact with alcohol?
9. Is Effexor safe for a woman who is pregnant, about to become 
pregnant,
   or nursing an infant?
10. Is Effexor a satisfactory antidepressant for children and 
adolescents?
11. Is Effexor a satisfactory antidepressant for the elderly?
12. How is treatment with Effexor initiated?
13. What is the usual final dose of Effexor?
14. How long does it take Effexor to relieve depression.
15. Are there withdrawal effects if Effexor is suddenly discontinued?
16. Is Effexor toxic if an overdose is taken?
17. What precautions are necessary when switching between Effexor and 
a
    MAO inhibitor?
18. What does Effexor cost?
19. Additions and corrections.
======================================================================
=====
1. What is Effexor
 
        Venlafaxine (Effexor) is a new antidepressant with a novel 
chemical
   structure.  Venlafaxine has a structure that does not resemble 
those of
   any currently used antidepressants.  Effexor is not a tricyclic 
anti-
   depressant or an MAO inhibitor.
 
 
2. How does Effexor differ from other antidepressants?
 
        Effexor seems to have the relative freedom from side-effects 
   associated with the SSRIs [fluoxetine (Prozac), sertraline 
(Zoloft),
   paroxetine (Paxil), fluvoxamine (Luvox)] and the impact on both the
   serotonin and norepinephrine associated with the tricyclic 
antidepres-
   sants (amitriptyline (Elavil), imipramine (Tofranil) etc.).  It is
   hypothesized that the action of the Effexor molecule upon both 
   serotonin and norepinephrine will cause Effexor to be a successful
   antidepressant for some people who have not responded to treatment 
   with SSRIs.
 
        As Effexor and its active metabolite have relatively short 
half-lives9es, 4 hours and 11 hours respectively, Effexor should be 
administered
  in divided does, two or three times a day.
 
 
3. What kinds of depression can be treated with Effexor?
 
        While the pre-marketing studies were restricted to patients 
with a
   DSM-III-R diagnosis of Major Depressive Disorder (with or without
   melancholia), it is to be expected that Effexor will be prescribed 
for
   patients with Dysthymia, Major Depression, and Bipolar Disorder.
 
        While Effexor was only studied for periods of administration 
of up
   to 6-weeks, it is to expected that patients with long-standing 
depres-
   sions will take the drug for longer periods of time.
 
 
4. What are the side-effects of Effexor?
 
        The most common side-effects and the percentage of people 
reporting
   them during clinical trials are:
 
                                Nausea                  37%
                                Headache                25%
         
                       Sleepiness              23%
                                Dry mouth               22%
                                Dizziness               19%
                                Insomnia                18%
                                Constipation            15%
                                Nervousness             13%
                                Raised blood pressure   13% *
                                Fatigue                 12%
                                Sweating                12%
                                Decreased appetite      11%
                                Male sexual dysfunction 12%
                                Female sexual
                                          Dysfunction    2%
 
                        * While the manufacturer days that 
hypertension only
                          occurs in patients receiving over 300 
mg/day, there
                          been reports of moderately severe 
hypertension in
                          patients taking smaller doses.
 
5. Which side effects force people to stop taking Effexor?
 
        In the premarketing studies  19% (537 out of the 2897) of 
depressed
   patients ?taking Effexor discontinued the medication because of 
side-
   effects.  The side effects and the percentages of total patients 
who 
   dropped out for each are:
 
                                Nausea                  6%
                                Sleepiness              3%
                                Insomnia                3%
                                Dizziness               3%
                                Male sexual dysfunction 3% *
                                Headache                2%
                                Nervousness             2%
                                Anxiety                 2%
                                Dry mouth               2%
                                Fatigue                 2%
                                Sweating                2%
                                           * % of men
 
 
6. Are there any special hazards for people with bipolar disorder?
 
        As with other antidepressants, people with bipolar disorder 
who 
   are not being treated with a mood regulator such as lithium, 
valproate
   (Depakote), or carbamazepine (Tegretol), may be pushed into a manic 
   episode when treated with Effexor.
 
 
7. Does Effexor interact with other medications?
 
        Lithium - No interaction.
 
        Diazepam (Valium) - No interaction.
 
        Cimetidine (Tagamet) - Slight increase in blood level of 
        Effexor's active metabolite.  Not of clinical significance.
 
        Fluoxetine (Prozac) - Significant increase in the 
concentration
        of Effexor and its active metabolite.  Potential for increased 
        side-effects.
        
 
 
8. Does Effexor interact with alcohol?
 
        Although Effexor has not been found to increase the impairment 
of
   cognitive or motor skills caused by alcohol, the manufacturer warns 
   against drinking while taking Effexor.
 
 
9. Is Effexor safe for a woman who is pregnant, about to become 
pregnant, 
   or nursing an infant?
 
        There is no data to establish the safety of Effexor for the 
fetus 
   or nursing infant.
 
 
10. Is Effexor a satisfactory antidepressant for children and 
adolescents?
 
        Although here have been no published studies on the use of 
Effexor
    for the treatment of children and adolescents with depression, it 
is
    expected that the drug will be prescribed for depressed children 
and
    adolescents.
 
 
11. Is Effexor a satisfactory antidepressant for the elderly?
 
         No special problems were encountered when Effexor was 
prescribed 
    for elderly people with depression.
 
 
12. How is treatment with Effexor initiated?
 
    b    In adults, the usual starting dose of Effexor is 75 mg a day 
taken
   in two or three divided doses with food (to minimize nausea).  If 
higher
   doses are needed, the dose should not be increased more rapidly 
than 75
   mg every 4 days.
 
        When Effexor is given to elderly patients the starting doses 
are
   the same as for other adults.  As older people may be more 
sensitive to
   increases in dose they should be made slowly.
 
 
13. What is the usual final dose of Effexor?
 
        While doses up to 375 mg per day are approved by the FDA, some 
   severely depressed patients have been treated with higher doses.  
Most
   depressed people respond to doses under 300 mg per day.
 
 
14. How rapidly may a person with depression feel some relief from 
taking
    Effexor?
 
        While most people taking Effexor become aware of some 
lessening
   of depression within two to four weeks, there are some who 
experience
   relief within the first week and others who only experience relief
   after a couple of months of therapy.
 
 
 
15. Are there withdrawal effects if Effexor is suddenly discontinued?
 
        Because of the very short half-life, Effexor should be 
    discontinued gradually over at least 2-weeks.  If Effexor is 
suddenly
    discontinued, a withdrawal syndrome involving fatigue, nausea, 
    dizziness, headache, insomnia, and nervousness, may develop.
 
 
16.  Is Effexor toxic if an overdose is taken?
 
        Fourteen overdoses of Effexor have been reported.  In some 
cases
    Effexor was taken along with alcohol and/or other medications.  
All
    individuals who took an overdose recovered without sequelae.
 
 
17. What precautions are necessary when switching between Effexor and 
a
    MAO inhibitor?
 
        When switching from an MAO inhibitor to Effexor, there should 
be a
    14-day interval between the discontinuation of the MAOI and the 
    initiation of Effexor therapy.  When switching from Effexor to an 
MAOI
    a 7-day interval is adequate, because of Effexor's short half-
life.
 
 
18. What does Effexor cost?
 
        Effexor is supplied in tablets ranging from 25 to 100 mg in
    strength.  The 25 mg tablets cost pharmacies nearly as much as the 
    100 mg tablets ($0.71 vs. $0.83).  It is expected that all 
strengths 
    of Effexor will be sold for between $1.00 and $1.50 per tablet.
 
 
19. Additions and corrections to:.
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||                          Ivan Goldberg, MD                ~          
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|| ikg1@columbia.edu                                  
psydoc@netcom.com ||
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