Effexor XR is a brand-name prescription drug. It’s approved for use in adults with any of the following conditions:
- major depressive disorder (MDD), often referred to as depression
- generalized anxiety disorder (GAD)
- social anxiety disorder
- panic disorder, with or without agoraphobia (fear of being in places where you could be trapped or helpless)
Effexor XR contains the drug venlafaxine in its extended-release (XR) form. An extended-release form of a drug slowly releases the active ingredient over a prolonged period of time.
Effexor XR belongs to a class of drugs called serotonin-norepinephrine reuptake inhibitors (SNRIs).
It comes as a capsule that’s taken by mouth once a day.
Effectiveness
Effexor XR has been found to be effective at treating MDD, GAD, social anxiety disorder, and panic disorder. For details, see the “Effexor XR uses” section below.
Effexor XR can cause mild or serious side effects. The following lists contain some of the key side effects that may occur while taking Effexor XR. These lists do not include all possible side effects.
For more information on the possible side effects of Effexor XR, talk with your doctor or pharmacist. They can give you tips on how to deal with any side effects that may be bothersome.
Note: The Food and Drug Association (FDA) tracks side effects of drugs they have approved. If you would like to report to the FDA a side effect you’ve had with Effexor XR, you can do so through MedWatch.
More common side effects
The more common side effects of Effexor XR can include:
- dry mouth
- sleepiness
- loss of appetite
- erectile dysfunction
- abnormal ejaculation
- decreased libido (sex drive)
- weakness
- dizziness
Other common side effects, explained in more detail below in “Side effect details,” include:
- nausea
- constipation
- sweating
- insomnia (trouble sleeping)
Most of these side effects may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk with your doctor or pharmacist.
Serious side effects
Serious side effects from Effexor XR aren’t common, but they can occur. Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life threatening or if you think you’re having a medical emergency.
Serious side effects and their symptoms can include the following:
- Seizures.
- Serotonin syndrome (high levels of serotonin, a chemical in your brain). Symptoms can include:
- anxiety
- shakiness
- fever
- diarrhea
- fast heartbeat
- seizures
- High blood pressure. Symptoms can include:
- headache
- nausea
- blurred vision
- shortness of breath
- Abnormal bleeding. Symptoms can include:
- bruising easily and often
- nosebleeds
- coughing up blood
- producing vomit that looks like coffee grounds
- blood in your stool
- black or tarry stool
- Hyponatremia (low sodium levels). Symptoms can include:
- headache
- trouble focusing
- weakness
- feeling unsteady
- fainting
- seizures
- Lung disease and pneumonia. Symptoms can include:
- shortness of breath
- cough
- pain in your chest
- fever
- Withdrawal symptoms (if you stop taking the drug suddenly). See the “Effexor XR withdrawal” section for more details.
- Increased risk of suicidal thoughts and behaviors in children and young adults.* See “Side effect details” below to learn more.
* Effexor XR has a
Side effect details
You may wonder how often certain side effects occur with this drug. Here’s some detail on some of the side effects this drug may cause.
Allergic reaction
As with most drugs, some people can have an allergic reaction after taking Effexor XR. Symptoms of a mild allergic reaction can include:
A more severe allergic reaction is rare but possible. Symptoms of a severe allergic reaction can include:
- swelling under your skin, typically in your eyelids, lips, hands, or feet
- swelling of your tongue, mouth, or throat
- trouble breathing
Call your doctor right away if you have a severe allergic reaction to Effexor XR. Call 911 if your symptoms feel life threatening or if you think you’re having a medical emergency.
Weight gain or weight loss
Weight gain and weight loss have occurred in clinical trials of Effexor XR. However, it’s not known how common this side effect is.
Talk with your doctor if you’re concerned about weight gain or loss while taking Effexor XR.
Nausea
Nausea is a common side effect of Effexor XR. In clinical trials, 30% of people who took Effexor XR had nausea, compared to 11.8% of people who took a placebo (a treatment with no active drug). Of people who took Effexor XR, 4.3% stopped treatment because of nausea. Less than 1% of people who took a placebo stopped treatment because of nausea.
If you have nausea while taking Effexor XR, talk with your doctor about ways to minimize this side effect.
Insomnia
Insomnia (trouble sleeping) is a common side effect of Effexor XR. In clinical trials, 17.8% of people who took Effexor XR had insomnia, compared to 9.5% of people who took a placebo. Of people who took Effexor XR, 2.1% stopped treatment because of insomnia. Less than 1% of people who took a placebo stopped treatment because of insomnia.
If you have trouble sleeping while taking Effexor XR, talk with your doctor. They can recommend ways to reduce this side effect.
Headache
Headache is a possible side effect of Effexor XR. In clinical trials, 1.5% of people who took Effexor XR stopped treatment because of headaches. In comparison, 0.8% of people who took a placebo stopped treatment because of headaches.
Your headaches may also be a symptom of hyponatremia (low sodium levels), which is another side effect of Effexor XR.
Talk with your doctor if you have headaches while taking Effexor XR. They can determine if your headaches are caused by low sodium levels. If so, they may recommend that you stop taking Effexor XR.
If your headaches are not caused by low sodium levels, your doctor can recommend safe pain relievers for you.
Sweating and night sweats
Sweating and night sweats are common side effects of Effexor XR. In clinical trials, 11.4% of people who took Effexor XR had sweating or night sweats. In comparison, 2.9% of people who took a placebo had this side effect. Sweating and night sweats lead to 1% of people who took Effexor XR to stop treatment, compared to 0.2% of people who took a placebo.
If you have problematic sweating while taking Effexor XR, talk with your doctor about ways to manage this side effect.
Constipation
Constipation is a common side effect of Effexor XR. In clinical trials, 9.3% of people who took Effexor XR had constipation, compared to 3.4% of people who took a placebo.
If you have constipation while taking Effexor XR, talk with your doctor about ways to manage it.
Suicidal thoughts and behaviors in young people
There is an increased risk of suicidal thoughts and behavior in young people (up to 24 years old) who take antidepressants, including Effexor XR. This increased risk is seen in young people who have major depressive disorder or other psychiatric conditions. Effexor XR has a
An analysis of 24 studies looked at suicide rates in adults ages 18 to 24 years old. It found that in this age range, there’s an increase of five suicide cases for every 1,000 people taking an antidepressant, compared to a placebo. Studies have found this increased risk in short-term use and across all antidepressants. It’s not known if the risk is also seen with long-term use of antidepressants.
Young people starting Effexor XR should be monitored closely for worsening depression, unusual behavior, and suicidal thoughts and behavior.
Note: Effexor XR is not approved for use in children (younger than 18 years old).
Suicide prevention
If you know someone at immediate risk of self-harm, suicide, or hurting another person:
- Ask the tough question: “Are you considering suicide?”
- Listen to the person without judgment.
- Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
- Stay with the person until professional help arrives.
- Try to remove any weapons, medications, or other potentially harmful objects if it’s safe to do so.
If you or someone you know is having thoughts of suicide, a prevention hotline can help. The 988 Suicide and Crisis Lifeline is available 24 hours a day at 988. During a crisis, people who are hard of hearing can use their preferred relay service or dial 711 then 988.
Side effects in children
Effexor XR is not approved for use in children (under 18 years old).
Effexor XR can cause an increased risk of suicidal thoughts and behaviors in children (see “Effexor XR side effects” above). There are also other side effect concerns if children take this drug.
Weight loss in children
In clinical trials lasting 8 to 16 weeks, many children who took Effexor XR had a lack of appetite. This may have contributed to weight loss seen in children within the study.
In the studies, 18% to 47% of children who took Effexor XR lost at least 3.5% of their total body weight. The average weight loss for all children who took Effexor XR was about 1 lb. to 1.7 lb. (0.45 kg to 0.75 kg).
In comparison, of the children who took a placebo (a treatment with no active drug), 3.6% to 14% lost at least 3.5% of their total body weight. However, children who took a placebo in these studies actually had an average weight gain of about 1.7 pounds (0.76 kg).
Longer trials lasting up to 6 months showed that children taking Effexor XR did not gain as much weight as other children in the same age group, especially in children under the age of 12 years old.
Slowed growth in children
In clinical trials, children who took Effexor XR grew in height more slowly than typical children in their age group. This difference in growth was more dramatic for children under the age of 12 years old than for those ages 12 years and older.
The Food and Drug Administration (FDA) approves prescription drugs such as Effexor XR to treat certain conditions. Effexor XR may also be used off-label for other conditions. Off-label use is when a drug that’s approved to treat one condition is used to treat a different condition.
Effexor XR for major depressive disorder
Effexor XR is FDA-approved to treat major depressive disorder (MDD) in adults, often referred to as depression. MDD is a condition that’s thought to be caused by a chemical imbalance in your brain. It can also be linked to life events, such as losing your job or the loss of a loved one.
Symptoms of MDD can include:
- loss of interest in things you used to enjoy
- feeling sad
- trouble thinking or focusing
- trouble sleeping or wanting to sleep more than usual
- feeling emotionally numb
Your doctor may diagnose you with MDD if you have these or other related symptoms nearly every day for at least 2 weeks.
To learn more about MDD, you can refer to our depression hub.
Effectiveness for MDD
Effexor XR has been found to be effective in treating MDD.
In clinical trials, its effectiveness was measured using the Hamilton Rating Scale for Depression (HAM-D). The HAM-D scale measures how severe a person’s depression is. There is a maximum of 52 points on the scale. Scores of 17 to 23 indicate moderate depression. Scores of 24 and higher indicate severe depression.
A decrease in HAM-D scores indicates an improvement in depression symptoms.
In clinical trials, people took either a placebo (a treatment with no active drug) or Effexor XR. The doses of Effexor XR ranged from 75 mg to 225 mg per day.
- At the end of an 8-week study, HAM-D scores decreased (improved) by 4.45 more points in the Effexor XR group than in the placebo group.
- At the end of a 12-week study, HAM-D scores decreased (improved) by 6.40 more points in the Effexor XR group than in the placebo group.
Effexor XR for generalized anxiety disorder
Effexor XR is FDA-approved to treat generalized anxiety disorder (GAD) in adults. GAD is a condition characterized by ongoing fear or worry. The anxiety is not related to any certain event.
Symptoms of GAD can include:
- fast heart rate
- dry mouth
- nausea
- trouble focusing
- muscle tension
To learn more about GAD, you can refer to our anxiety hub.
Effectiveness for GAD
Effexor XR has been found to be effective in treating GAD. In clinical trials, the effectiveness of Effexor XR in treating GAD was measured using the Hamilton Anxiety Rating Scale (HAM-A). The HAM-A scale measures how severe a person’s GAD is.
The maximum score on the HAM-A scale is 56. A HAM-A score of 25 to 30 is considered moderate to severe GAD. A score above 30 is considered severe GAD. A decrease in HAM-A scores is related to an improvement in GAD symptoms.
In clinical trials, people took either a placebo or Effexor XR. The doses of Effexor XR ranged from 37.5 mg to 225 mg per day.
In two 8-week clinical trials, HAM-A scores decreased (improved) by up to 2.6 more points for people who took Effexor XR compared to those who took a placebo. In these two studies, people took between 37.5 mg and 225 mg of Effexor daily.
In two clinical trials that each lasted 6 months, HAM-A scores decreased (improved) by 2.8 to 5.5 more points for people who took Effexor compared to those who took a placebo. In these two studies, people took between 37.5 mg and 225 mg of Effexor daily.
Effexor XR for social anxiety disorder
Effexor XR is FDA-approved to treat social anxiety disorder in adults. Social anxiety disorder is a type of anxiety felt during interactions with other people. Symptoms can include fear of being judged by others, sweating, shakiness, fast heart rate, and avoiding social situations. To learn more about social anxiety disorder, you can refer to our anxiety hub.
Effexor XR has been found to be effective for treating social anxiety disorder. The effectiveness of Effexor XR in treating this condition was measured using the Liebowitz Social Anxiety Scale (LSAS).
The LSAS is a scale that measures how severe a person’s fear of social situations is. There is maximum score of 144 points, with higher scores meaning worse social anxiety disorder. A decrease in LSAS scores is related to an improvement in symptoms of social anxiety disorder.
Effectiveness for social anxiety disorder
In clinical trials, people with social anxiety disorder took either Effexor XR or a placebo. The studies lasted for 3 and 6 months. Doses of Effexor XR ranged from 75 mg to 225 mg once a day.
At the end of the studies, LSAS scores decreased (improved) by 10.7 to 16.9 more points for people who took Effexor XR than for those who took placebo. This means Effexor XR controlled their symptoms more effectively than a placebo.
Effexor XR for panic disorder
Effexor XR is FDA-approved to treat panic disorder in adults. It’s approved to treat panic disorder with or without agoraphobia (fear of being in places where you could be trapped or helpless).
Panic disorder is a type of anxiety in which you have repeated and unexpected panic attacks (feelings of very bad anxiety). Panic attacks can last anywhere from 5 to 30 minutes.
To learn more about this condition, you can refer to our mental health hub.
Effectiveness for panic disorder
Effexor XR has been found to be effective in treating panic disorder with or without agoraphobia. In clinical trials, people with panic disorder took either Effexor XR or a placebo for 3 months. The dosage range of Effexor XR was 75 mg to 225 mg once a day.
These studies found that people who took Effexor XR were about 2.2 to 3 times more likely to be free of full-symptom panic attacks while taking treatment compared to people who took a placebo. A full-symptom panic attack is one that involves all of the usual symptoms, including rapid heart rate, shakiness, nausea, and fear of losing control.
Effexor XR and children
Effexor XR is not approved for use in people under 18 years old.
In fact, the FDA has required the manufacturers of Effexor XR to include a
The Effexor XR boxed warning describes an increased risk of suicidal thoughts and behaviors in young people who take Effexor XR. The increased risk is seen in children under 18 years old and in adults ages 24 years old and younger. (All antidepressants carry this warning, not just Effexor XR.)
Off-label uses for Effexor XR
In addition to the uses listed above, Effexor XR may be used off-label. Off-label drug use is when a drug that’s approved for one use is used for a different one that’s not approved.
Effexor XR for OCD
Effexor XR is not approved by the FDA to treat obsessive-compulsive disorder (OCD). However, Effexor XR may be prescribed off-label for this condition.
The American Psychiatric Association suggests that venlafaxine (the active drug in Effexor XR) may be an option for people who didn’t find other antidepressants to be effective enough for them.
Talk with your doctor if you’re interested in taking Effexor XR to treat OCD.
Effexor XR for migraine
Effexor XR is not FDA-approved to prevent or treat migraine headaches. However, it may be prescribed off-label for this purpose.
The American Academy of Family Physicians recommends venlafaxine (the active drug in Effexor XR) as a second-choice option for preventing migraine headaches.
Talk with your doctor if you’re interested in taking Effexor XR for migraine.
Effexor XR for pain
Effexor XR is not FDA-approved to treat pain, but it may be prescribed off-label for this purpose.
A review of 13 clinical studies found that venlafaxine (the active drug in Effexor XR) may be useful for treating neuropathic pain (pain caused by nerve damage) in people who can’t take other recommended treatments.
Talk with your doctor if you’re interested in taking Effexor XR to treat pain.
Effexor XR for menopausal symptoms and hot flashes
Effexor XR is not FDA-approved to treat menopausal symptoms and hot flashes. However, it may be prescribed off-label for this purpose.
Treatment guidelines from the Endocrine Society recommend the use of antidepressants such as venlafaxine (the active drug in Effexor XR) to treat vasomotor symptoms (hot flashes, night sweats, and flushing). Venlafaxine is recommended as a treatment option for people who can’t take or choose not to take hormone therapy.
The American Academy of Family Physicians also states that venlafaxine is an effective option for females* with menopausal symptoms who can’t take or choose not to take hormone therapy.
* Sex and gender exist on spectrums. Use of the term “female” in this article refers to sex assigned at birth.
Effexor XR for post-traumatic stress disorder
Effexor XR is not FDA-approved to treat post-traumatic stress disorder (PTSD). However, it may be prescribed off-label for this purpose.
The Department of Veterans Affairs recommends venlafaxine (the active drug in Effexor XR) as a first-choice treatment option for people with PTSD. Venlafaxine is recommended for people with PTSD who choose not to seek psychotherapy or don’t have access to psychotherapy.
Treatment guidelines from the American Psychological Association also include venlafaxine as a treatment option for people with PTSD.
Effexor XR is available as a brand-name and generic medication. The generic form is a venlafaxine extended-release capsule.
Effexor XR contains the active drug ingredient venlafaxine.
The Effexor XR dosage your doctor prescribes will depend on several factors. These include:
- the type and severity of the condition you’re using Effexor XR to treat
- other medical conditions you may have
Typically, your doctor will start you on a low dosage. Then they’ll adjust it over time to reach the amount that’s right for you. Your doctor will ultimately prescribe the smallest dosage that provides the desired effect.
The following information describes dosages that are commonly used or recommended. However, be sure to take the dosage your doctor prescribes for you. Your doctor will determine the best dosage to fit your needs.
Drug forms and strengths (37.5 mg, 75 mg, and 150 mg)
Effexor XR contains the drug venlafaxine in its extended-release (XR) form.
Effexor XR comes as a capsule that’s taken by mouth. You take it with food.
It comes in three strengths: 37.5 milligrams (mg), 75 mg, and 150 mg.
Dosage for major depressive disorder
The usual starting dosage of Effexor XR for major depressive disorder (MDD, often referred to as depression) is 37.5 to 75 mg once daily. The maximum dosage for MDD is 225 mg once daily.
However, daily dosages of 300 mg or higher may be needed to treat MDD in some people. This would be considered an off-label (nonapproved) use.
Dosage for generalized anxiety disorder
The usual starting dosage of Effexor XR for generalized anxiety disorder (GAD) is 75 mg once daily. The maximum dosage of Effexor XR for GAD is 225 mg once daily.
Dosage for social anxiety disorder
The standard dosage of Effexor XR for social anxiety disorder is 75 mg once daily.
Dosage for panic disorder
The usual starting dosage of Effexor XR for panic disorder is 37.5 mg once daily. After 7 days, the dosage can be increased if needed. The maximum dosage for panic disorder is 225 mg once daily.
What if I miss a dose?
If you miss a dose of Effexor XR, take it as soon as you remember. However, if it’s almost time for your next dose, skip the missed dose and take your next dose at its regular time. Never take two doses at once. This will raise your risk of serious side effects.
To help make sure you don’t miss a dose, try setting a reminder on your phone. A medication timer may be useful, too.
Will I need to use this drug long term?
Effexor XR is meant to be used as a long-term treatment. If you and your doctor determine that Effexor XR is safe and effective for you, you’ll likely take it long term.
Abruptly stopping treatment with Effexor XR can cause withdrawal symptoms. These symptoms can include:
- anxiety
- feeling agitated
- confusion
- flu-like symptoms
- insomnia (trouble sleeping)
- shakiness
- diarrhea
- nausea
- vomiting
- aggression or violent behavior*
- suicidal thoughts*
- vision changes*
- increased blood pressure*
To avoid withdrawal symptoms, your doctor will have you taper (gradually decrease) your dosage of Effexor XR over several weeks. See “Common questions about Effexor XR” for more details about how to safely stop taking Effexor XR.
* This side effect was not reported during Effexor XR’s clinical trials, but has occurred since the drug was approved.
If you drink alcohol, you should not drink it while taking Effexor XR. This is because both Effexor XR and alcohol can cause sleepiness and trouble concentrating when taken separately. Drinking alcohol while taking Effexor XR could make these side effects worse.
Other drugs are available that can treat your condition. Some may be a better fit for you than others. If you’re interested in finding an alternative to Effexor XR, talk with your doctor. They can tell you about other medications that may work well for you.
Note: Some of the drugs listed here are used off-label to treat these specific conditions. Off-label use is when a drug that’s approved to treat one condition is used to treat a different condition.
Alternatives for major depressive disorder
Examples of other drugs that may be used to treat major depressive disorder include:
- citalopram (Celexa)
- escitalopram (Lexapro)
- sertraline (Zoloft)
- fluoxetine (Prozac)
- bupropion (Wellbutrin SR, Aplenzin)
- desvenlafaxine (Pristiq)
- duloxetine (Cymbalta)
- mirtazapine (Remeron)
- amitriptyline
- desipramine (Norpramin)
- nortriptyline (Pamelor)
Alternatives for generalized anxiety disorder
Examples of other drugs that may be used to treat generalized anxiety disorder include:
- duloxetine (Cymbalta)
- fluoxetine (Prozac)
- paroxetine (Paxil)
- sertraline (Zoloft)
- escitalopram (Lexapro)
- buspirone
- hydroxyzine (Vistaril)
- amitriptyline
- quetiapine (Seroquel)
- imipramine (Tofranil)
- pregabalin (Lyrica)
Alternatives for social anxiety disorder
Examples of other drugs that may be used to treat social anxiety disorder include:
- sertraline (Zoloft)
- escitalopram (Lexapro)
- paroxetine (Paxil)
- fluvoxamine (Luvox)
- clonazepam (Klonopin)
- pregabalin (Lyrica)
Alternatives for panic disorder
Examples of other drugs that may be used to treat panic disorder include:
You may wonder how Effexor XR compares with Effexor. Effexor is discontinued and no longer available for use.
A key difference between these drugs is that they have different forms. Effexor was an immediate-release tablet, and Effexor XR is an extended-release (XR) capsule.
An immediate-release form of a drug (sometimes referred to as “short-acting”) releases the active ingredient all at once after you take it. An extended-release form slowly releases the active ingredient over a prolonged period of time.
Effexor and Effexor XR contain the same active drug, venlafaxine. Both drugs are approved by the Food and Drug Administration (FDA) to treat major depressive disorder (MDD) in adults. MDD is often referred to as depression.
In addition, Effexor XR is FDA-approved for use in adults with:
- social anxiety disorder
- generalized anxiety disorder
- panic disorder, with or without agoraphobia (fear of being in places where you could be trapped or helpless)
These drugs tend to cause very similar side effects. And both have a
Although Effexor is no longer available, a generic form of immediate-release venlafaxine (the active drug in Effexor XR) is available. Your doctor can provide more information about how these drugs compare and which is right for your condition.
You may wonder how Effexor XR compares to other medications that are prescribed for similar uses. Here we look at how Effexor XR and Lexapro are alike and different.
Uses
Effexor XR and Lexapro are both approved by the Food and Drug Administration (FDA) to treat major depressive disorder (MDD) in adults. MDD is often referred to as depression. Lexapro is also FDA-approved to treat MDD in children ages 12 to 17 years old.
Both drugs are also FDA-approved to treat generalized anxiety disorder (GAD) in adults.
In addition, Effexor XR is FDA-approved for use in adults with:
- social anxiety disorder
- panic disorder, with or without agoraphobia (fear of being in places where you could be trapped or helpless)
Drug forms and administration
Effexor XR contains the drug venlafaxine (extended-release form). Lexapro contains the drug escitalopram.
Effexor XR comes as a capsule that’s taken by mouth once a day. It’s taken with food.
Lexapro comes as a tablet and a solution. Both forms are taken by mouth once a day. Lexapro can be taken with or without food.
Side effects and risks
Effexor XR and Lexapro have many similar side effects and a few that differ. Below are examples of these side effects.
More common side effects
These lists contain examples of more common side effects that can occur with Lexapro or with both drugs (when taken individually).
- Can occur with Lexapro:
- fatigue (lack of energy)
- Can occur with both Effexor XR and Lexapro:
- nausea
- sweating
- sleepiness
- erectile dysfunction
- abnormal ejaculation
- decreased libido (sex drive)
- insomnia (trouble sleeping)
- not being able to have an orgasm
- weakness
- dizziness
- constipation
- dry mouth
- loss of appetite
Serious side effects
These lists contain examples of serious side effects that can occur with Effexor XR or with both drugs (when taken individually).
- Can occur with Effexor XR:
- high blood pressure
- lung disease and pneumonia
- Can occur with both Effexor XR and Lexapro:
- serotonin syndrome (high levels of serotonin, a chemical in your brain)
- abnormal bleeding
- seizures
- hyponatremia (low sodium levels)
- suicidal thoughts and behaviors in children and young adults*
* Effexor XR and Lexapro both have a
Effectiveness
Effexor XR and Lexapro have different FDA-approved uses, but they’re both used in adults with:
- major depressive disorder (MDD), often referred to as depression
- generalized anxiety disorder (GAD)
The use of Effexor XR and Lexapro in treating MDD or GAD have been compared in analyses of multiple clinical studies. In one analysis, Effexor XR and Lexapro were found to be similarly effective in the treatment of MDD. When Effexor XR is used to treat GAD, another analysis found it to be similarly effective to Lexapro.
Costs
Effexor XR and Lexapro are both brand-name drugs. There are generics available for both drugs. The generic forms of both drugs will cost less. (Brand-name medications usually cost more than generics.)
The actual price you’ll pay for either drug depends on your insurance plan, your location, and the pharmacy you use.
Effexor XR and Pristiq are prescribed for similar uses. Below are details of how these medications are alike and different.
Uses
Effexor XR and Pristiq are both approved by the Food and Drug Administration (FDA) to treat major depressive disorder (MDD) in adults. MDD is often referred to as depression.
Effexor XR is also FDA-approved for use in adults with:
- generalized anxiety disorder (GAD)
- social anxiety disorder
- panic disorder, with or without agoraphobia (fear of being in places where you could be trapped or helpless)
Drug forms and administration
Effexor XR contains the drug venlafaxine. Pristiq contains the drug desvenlafaxine. They are both extended-release forms of the active drugs.
Effexor XR comes as a capsule that’s taken by mouth once a day. It should be taken with food.
Pristiq comes as a tablet that’s taken by mouth once a day. It can be taken with or without food.
Side effects and risks
Effexor XR and Pristiq both contain antidepressants. Therefore, these medications can cause very similar side effects. Below are examples of these side effects.
More common side effects
These lists contain examples of more common side effects that can occur with Effexor XR, with Pristiq, or with both drugs (when taken individually).
- Can occur with Pristiq:
- anxiety
- Can occur with both Effexor XR and Pristiq:
- nausea
- constipation
- dry mouth
- sweating
- sleepiness
- loss of appetite
- erectile dysfunction
- abnormal ejaculation
- decreased libido (sex drive)
- weakness
- dizziness
- insomnia (trouble sleeping)
- not being able to have an orgasm
Serious side effects
These lists contain examples of serious side effects that can occur with Effexor XR and Pristiq (when taken individually).
Can occur with both Effexor XR and Pristiq:
- serotonin syndrome (high levels of serotonin, a chemical in your brain)
- high blood pressure
- abnormal bleeding
- seizures
- hyponatremia (low sodium levels)
- lung disease and pneumonia
- suicidal thoughts and behaviors in children and young adults*
* Effexor XR and Pristiq both have a
Effectiveness
Effexor XR and Pristiq have different FDA-approved uses, but they’re both used to treat major depressive disorder (MDD) in adults.
The use of Effexor XR and Pristiq in treating MDD has been directly compared in clinical studies. An analysis of these studies found that the two drugs are similarly effective in treating MDD.
Costs
Effexor XR and Pristiq are both brand-name drugs. There are currently generic forms of each drug. The generic forms of both drugs will cost less. (Brand-name medications usually cost more than generics.)
The actual price you’ll pay for either drug depends on your insurance plan, your location, and the pharmacy you use.
Effexor XR can interact with several other medications and cause false results for certain lab tests. It can also interact with certain supplements.
Different interactions can cause different effects. For instance, some interactions can interfere with how well a drug works. Other interactions can increase side effects or make them more severe.
Effexor XR and other medications
Below is a list of medications that can interact with Effexor XR. This list does not contain all drugs that may interact with Effexor XR.
Before taking Effexor XR, talk with your doctor and pharmacist. Tell them about all prescription, over-the-counter, and other drugs you take. Also tell them about any vitamins, herbs, and supplements you use. Sharing this information can help you avoid potential interactions.
If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.
Effexor XR and Adderall XR
Taking Effexor XR with Adderall XR (amphetamine salts) or other stimulant medications can increase your risk for serious side effects. The combination of Effexor XR with stimulants increases your risk of serotonin syndrome.
Serotonin syndrome is a serious reaction that happens when too much serotonin (a chemical messenger) builds up in your body. Symptoms of serotonin syndrome can include anxiety, shakiness, fever, diarrhea, fast heartbeat, and seizures.
If you need to take Effexor XR with Adderall XR or other stimulants, your doctor will monitor you closely for symptoms of serotonin syndrome.
If you experience any symptoms of serotonin syndrome, tell your doctor right away. They may recommend that you stop taking one or both of the medications until your symptoms are treated.
Call 911 if your symptoms feel life threatening or if you think you’re having a medical emergency.
Effexor XR and certain antidepressants
Taking Effexor XR with certain antidepressants can increase your risk for serious side effects, including serotonin syndrome (high levels of serotonin, a chemical in your brain).
Examples of antidepressants that can increase your risk for serotonin syndrome if taken with Effexor XR include:
- sertraline (Zoloft)
- paroxetine (Paxil)
- citalopram (Celexa)
- escitalopram (Lexapro)
- fluoxetine (Prozac)
- desvenlafaxine (Pristiq)
- duloxetine (Cymbalta)
- levomilnacipran (Fetzima)
If you need to take Effexor XR with one of the antidepressants listed above, your doctor will monitor you closely for symptoms of serotonin syndrome.
If you experience any symptoms of serotonin syndrome, tell your doctor right away. They may recommend that you stop taking one or both of the medications until your symptoms are treated.
Call 911 if your symptoms feel life threatening or if you think you’re having a medical emergency.
You should not take Effexor XR with a certain type of antidepressant called monoamine oxidase inhibitors (MAOIs). The risk for serotonin syndrome is very high if Effexor XR is taken with an MAOI. Examples of MAOIs include:
- selegiline (Emsam, Zelapar)
- phenelzine (Nardil)
- tranylcypromine (Parnate)
- isocarboxazid (Marplan)
Switching from an MAOI to Effexor XR
You should not take Effexor XR for at least 2 weeks after your last dose of an MAOI antidepressant. This is because the effects of an MAOI can last up to a couple of weeks after your last dose.
Switching from Effexor XR to an MAOI
You should not take an MAOI for at least 1 week after your last dose of Effexor XR. This is because the effects of Effexor XR can last for several days after your last dose.
Effexor XR and certain migraine drugs
Taking Effexor XR with certain migraine drugs, called triptans, can increase the risk for serious side effects. The combination of Effexor XR and a triptan can increase your risk for serotonin syndrome (high levels of serotonin, a chemical in your brain).
Examples of triptans include:
- sumatriptan (Imitrex, Onzetra Xsail, Tosymra, Zembrace Symtouch)
- naratriptan (Amerge)
- almotriptan
- frovatriptan (Frova)
- eletriptan (Relpax)
- rizatriptan (Maxalt, Maxalt-MLT)
- zolmitriptran (Zomig, Zomig-ZMT)
If you need to take Effexor XR with a triptan, your doctor will monitor you closely for symptoms of serotonin syndrome. Symptoms can include anxiety, shakiness, fever, diarrhea, fast heart rate, and seizures.
If you experience any symptoms of serotonin syndrome, tell your doctor right away. They may recommend that you stop taking one or both of the medications until your symptoms are treated.
Call 911 if your symptoms feel life threatening or if you think you’re having a medical emergency.
Effexor XR and certain pain relievers
Taking Effexor XR with certain pain relievers can increase your risk of serious side effects.
Effexor XR and over-the-counter pain relievers
Taking Effexor XR with certain over-the-counter pain relievers can increase your risk for serious bleeding, especially bleeding in your stomach. Examples of over-the-counter pain relievers that can increase the risk for bleeding if taken with Effexor XR include:
- aspirin
- ibuprofen
- naproxen
If you need to take one of these medications with Effexor XR, watch closely for symptoms of internal bleeding. Symptoms can include bruising easily and often, coughing up blood, vomiting what looks like coffee grounds, or having stools that are black, bloody, or tarry.
If you notice symptoms of internal bleeding, tell your doctor right away. They may have you stop taking one or both medications until your bleeding is treated.
Call 911 if your symptoms feel life threatening or if you think you’re having a medical emergency.
Effexor XR and tramadol and fentanyl
Taking Effexor XR with either tramadol (ConZip) or fentanyl (Abstral, Actiq, Duragesic, Subsys) can increase your risk for serotonin syndrome (high levels of serotonin, a chemical in your brain).
If you need to take pain medication with Effexor XR, your doctor will likely recommend a different pain medication than tramadol or fentanyl.
If you need to take Effexor XR with tramadol or fentanyl, they will monitor you closely for symptoms of serotonin syndrome. Symptoms can include anxiety, shakiness, fever, diarrhea, fast heart rate, and seizures.
If you experience any symptoms of serotonin syndrome, tell your doctor right away. They may recommend that you stop treatment with one or both of the medications until your symptoms are treated.
Call 911 if your symptoms feel life threatening or if you think you’re having a medical emergency.
Effexor XR and Zyvox
Taking Effexor with an antibiotic called linezolid (Zyvox) can increase your risk for serotonin syndrome (high levels of serotonin, a chemical in your brain).
You should not take Effexor XR if you are taking linezolid. If you need to take Effexor XR, your doctor will likely wait until your linezolid treatment is over before starting Effexor XR.
Effexor XR and warfarin or other anticoagulants
Taking Effexor XR with warfarin (Jantoven) or other anticoagulants (blood thinners) can increase your risk for serious bleeding. Examples of other anticoagulants include:
If you need to take warfarin or another anticoagulant with Effexor XR, watch closely for symptoms of internal bleeding. Symptoms can include bruising easily and often, coughing up blood, vomiting what looks like coffee grounds, or having stools that are black, bloody, or tarry.
If you notice symptoms of bleeding, tell your doctor right away. They may have you stop taking one or both medications until your bleeding is treated.
Call 911 if your symptoms feel life threatening or if you think you’re having a medical emergency.
Effexor XR and herbs and supplements
Below is a list of herbs and supplements that can interact with Effexor XR.
Effexor XR and St. John’s wort
St. John’s wort is an herbal supplement that’s often used to improve moods. Taking Effexor XR with St. John’s wort can increase your risk for serotonin syndrome (high levels of serotonin, a chemical in your brain).
If you need to take Effexor XR with St. John’s wort, your doctor will monitor you closely for symptoms of serotonin syndrome. Symptoms can include anxiety, shakiness, fever, diarrhea, fast heart rate, and seizures.
If you experience any symptoms of serotonin syndrome, tell your doctor right away. They may recommend that you stop taking one or both of the medications until your symptoms are treated.
Call 911 if your symptoms feel life threatening or if you think you’re having a medical emergency.
Effexor XR and tryptophan
Tryptophan (also called 5-HTP) is a supplement used to improve moods and sleep quality. Taking Effexor XR with tryptophan can increase your risk for serotonin syndrome (high levels of serotonin, a chemical in your brain).
If you need to take Effexor XR with tryptophan, your doctor will monitor you closely for symptoms of serotonin syndrome. Symptoms can include anxiety, shakiness, fever, diarrhea, fast heart rate, and seizures.
If you experience any symptoms of serotonin syndrome, tell your doctor right away. They may recommend that you stop treatment with one or both of the medications, until your symptoms are treated.
Call 911 if your symptoms feel life threatening or if you think you’re having a medical emergency.
Effexor XR and lab tests
Effexor XR can cause false-positive results for certain drug tests, such as tests for phencyclidine (PCP) or amphetamine/methamphetamine. This means that your drug test can show a positive result for PCP or amphetamines even though you did not use either of these drugs.
However, in case of a false-positive result, a second test can be done to rule out the use of PCP and amphetamines.
False-positive results can happen for several days after your last dose of Effexor XR. If you take Effexor XR and need to take a drug test, be sure to tell the test administrator about all medications you take. They will use this information when interpreting your test results.
Here are answers to some frequently asked questions about Effexor XR.
Is the immediate-release form of Effexor available?
No, the immediate-release form of brand-name Effexor is no longer on the market. (An immediate-release form of a drug releases the drug into your system as soon as your body absorbs it.) However, a generic form of immediate-release venlafaxine (the active drug in Effexor XR) is available.
If you’re interested in taking an immediate release form of venlafaxine, talk with your doctor. You can also see the “Effexor XR vs. Effexor” section for more information about the discontinued drug Effexor.
Is Effexor XR a controlled substance?
No. Effexor XR isn’t a controlled substance (a drug that can cause psychological or physical dependence and has the potential for misuse).
Is Effexor XR a stimulant?
No, Effexor XR isn’t a stimulant. (Stimulants speed up the level of activity in your body’s systems, including your brain, to help make you more alert.) However, it does have several side effects that may make it seem like a stimulant to some people.
For example, some people have insomnia (trouble sleeping), headache, increased blood pressure, and loss of appetite while taking Effexor XR. (See the “Effexor XR side effects” section above for more details.)
If you’re concerned about whether Effexor XR is causing stimulant-like side effects for you, talk with your doctor. They can recommend ways to relieve these side effects.
If I stop taking Effexor XR, do I need to taper off of the drug?
Yes. A taper, or gradual decrease of your dose, is recommended when stopping Effexor XR. This is because stopping Effexor XR suddenly can cause side effects. Some of these side effects include feeling agitated, lack of energy, flu-like symptoms, trouble sleeping, and others.
If you and your doctor decide that stopping Effexor XR is right for you, they will likely recommend a gradual decrease of 75 mg per week.
For example, if you were taking 150 mg of Effexor XR per day, then your doctor may recommend that you decrease your dose to 75 mg per day for at least a week. After that week, they may recommend that you stop taking Effexor XR. However, each person’s taper will be different.
If you want to stop taking Effexor XR, talk with your doctor. They can discuss with you the safest way to do it. Do not stop taking Effexor XR unless your doctor recommends that you do so.
Can I switch to Effexor XR if I’m using a short-acting form of venlafaxine?
You may be able to switch from a short-acting form of venlafaxine to Effexor XR if your doctor recommends that you do. (A short-acting form of a drug releases the active ingredient quickly for a faster effect. This is also referred to as immediate release. An extended-release form of a drug, such as the drug in Effexor XR, is released slowly for a more lasting effect.)
The short-acting form of venlafaxine comes as a tablet. If your doctor advises you to switch to Effexor XR, they may recommend a different dosage than you were taking of the short-acting form of venlafaxine. Do not switch to the short-acting form without your doctor’s guidance.
It’s not known if it’s safe to use Effexor XR while pregnant. There haven’t been any studies in humans to test its safety during pregnancy. Animal trials did show harm to the fetus when pregnant females* were given Effexor XR. However, animal studies don’t always predict what will happen in humans.
There have been reports of complications in newborns who were exposed to Effexor XR before birth. These symptoms were most commonly seen in newborns who were exposed to Effexor XR during the third trimester (the last few months before birth). The complications are generally considered withdrawal symptoms because the baby is no longer receiving Effexor XR after birth.
Complications and withdrawal symptoms included the need for tube feeding or breathing support, and an extended stay in the hospital. Other problems included constant crying, poor feeding, tense or shaky muscles, and vomiting.
These complications and symptoms can be treated by healthcare professionals. They typically go away within a few days or weeks.
Talk with your doctor if you are pregnant or considering becoming pregnant and want to take an antidepressant. They can discuss the safest options with you.
If you take Effexor XR while pregnant, you could consider joining the pregnancy registry for antidepressants. Pregnancy registries track the health of babies and pregnant people exposed to certain medications. You can learn more about the registry on its website, or by calling 866-961-2388. Your doctor can also provide more information.
* Sex and gender exist on spectrums. Use of the term “female” in this article refers to sex assigned at birth.
It’s not known if Effexor XR is safe to take during pregnancy. If you’re sexually active and you or your partner can become pregnant, talk with your doctor about your birth control needs while using Effexor XR.
Effexor XR does pass into breast milk. It’s not known to cause side effects in children who are breastfed. However, there’s not enough data to know for sure whether Effexor XR could cause problems in a child who is breastfed.
If you’re considering taking Effexor XR while breastfeeding, talk with your doctor about the risks and benefits.
Effexor XR contains the active drug venlafaxine. It’s the extended-release form of the drug. (An extended-release form of a drug slowly releases the active ingredient over a prolonged period of time.)
Effexor XR belongs to a class of drugs called serotonin-norepinephrine reuptake inhibitors (SNRIs). Drugs in the SNRI class treat depression and other related conditions by affecting the activity of serotonin and norepinephrine. These are two neurotransmitters (chemical messengers) that play a role in regulating your mood.
An imbalance of serotonin and norepinephrine levels can lead to conditions like depression, anxiety, and panic disorder.
Effexor XR and other SNRIs don’t allow serotonin and norepinephrine to be reabsorbed into nervous system cells in the brain. This allows the two neurotransmitters to stay active longer, which helps balance communication between nervous system cells in your brain.
Restoring the balance of serotonin and norepinephrine is thought to improve symptoms of depression, anxiety, and panic disorder.
How long does it take to work?
It may take several weeks before you begin to see your symptoms improve. This is because it takes time for the neurotransmitter levels in your brain to become stable. Talk with your doctor about how long you should wait to know whether or not Effexor XR is working for you.
As with all medications, the cost of Effexor XR can vary. The actual price you’ll pay depends on your insurance plan, your location, and the pharmacy you use.
Your insurance company may require you to get prior authorization before they approve coverage for Effexor XR. This means that your doctor will need to send a request to your insurance company asking them to cover the drug. The insurance company will review the request and let you and your doctor know if your plan will cover Effexor XR.
If you’re not sure if you’ll need to get prior authorization for Effexor XR, contact your insurance company.
Financial and insurance assistance
If you need financial support to pay for Effexor XR, or if you need help understanding your insurance coverage, help is available.
Pfizer, Inc., the manufacturer of Effexor XR, offers a copay savings program, which may help lower the cost of Effexor XR. For more information and to find out if you’re eligible for support, call 855-488-0750 or visit the program website.
You should take Effexor XR according to your doctor’s or healthcare professional’s instructions.
When to take
Effexor XR is taken once a day. You can take it in the morning or evening, but try to take it at the same time each day.
To help make sure you don’t miss a dose, try setting a reminder on your phone. A medication timer may be useful, too.
Taking Effexor XR with food
Effexor XR should be taken with food.
Can Effexor XR be crushed, split, or chewed?
No, Effexor XR should not be crushed, split, or chewed.
However, if you have trouble swallowing Effexor XR capsules, you can open the capsule and sprinkle the contents onto applesauce. You can mix it together or leave the contents on top. Be sure to empty the entire contents of the capsule.
Swallow the applesauce with Effexor XR contents without chewing. Drink a full glass of water after you swallow the applesauce. This will help make sure that you get your full dose of Effexor XR.
This drug comes with several warnings.
FDA warning: Increased risk of suicidal thoughts and behavior in young people
This drug has a
Effexor XR has been linked to an increased risk of suicidal thoughts and behavior in children and young adults who are 24 years old and younger. This increased risk has been found for all antidepressants, not just Effexor XR.
Caregivers of young people who take Effexor XR should closely watch for signs of worsening depression and suicidal thoughts and behavior. Effexor XR is not approved for use in children.
For more information, refer to the “Effexor XR side effects” section above.
Other precautions
Before taking Effexor XR, talk with your doctor about your health history. Effexor XR may not be right for you if you have certain medical conditions or other factors affecting your health. These include:
- Bipolar disorder or mania. Effexor XR should not be used to treat bipolar disorder, including manic episodes, because it can worsen these conditions. Before starting Effexor XR, your doctor will screen you for risk of bipolar disorder. If you have a family history of bipolar disorder or are unsure if you have bipolar disorder, talk with your doctor. They will determine if Effexor XR is safe for you.
- Use of medications that affect bleeding, including certain pain medications and blood thinners. Effexor XR can increase your risk of abnormal bleeding. Taking another medication that also increases this risk can make it more likely that you’ll experience abnormal bleeding. These medications include certain over-the-counter pain relievers such as aspirin, ibuprofen, and naproxen. They also include anticoagulants (also called “blood thinners”) such as warfarin (Jantoven). For more examples of these drugs, see the “Effexor XR interactions” section above. Be sure to tell your doctor about all of the medications you take before you start Effexor XR treatment.
- Unmanaged high blood pressure. Effexor XR can cause an increase in blood pressure. If you have high blood pressure that is not managed with treatment or lifestyle changes, you should not take Effexor XR. Your doctor will likely recommend managing your high blood pressure (getting it to a healthy level) before starting Effexor XR.
- Seizures. Effexor XR may increase the risk of seizures for some people. If you have a history of seizures, talk with your doctor to determine if Effexor XR is safe for you.
- History of allergic reaction. You should not take Effexor XR if you have had an allergic reaction to Effexor XR or any of its ingredients in the past. If you’re unsure if you’ve have an allergic reaction to Effexor XR, talk with your doctor.
- Unmanaged angle-closure glaucoma. Effexor XR can increase pressure in your eyes. You should not take Effexor XR if you have unmanaged angle-closure glaucoma. If you are unsure of whether you have unmanaged angle-closure glaucoma, talk with your doctor.
- Use in children. Effexor XR is not approved for use in children. Antidepressant use in children is related to an increased risk of suicidal thoughts and behaviors.
- Pregnancy. It’s not known if Effexor XR is safe to use during pregnancy. For more information, see the “Effexor XR and pregnancy” section above.
- Breastfeeding. Breastfeeding while taking Effexor XR can cause side effects in nursing children. For more information, see the “Effexor XR and breastfeeding” section above.
Note: For more information about the potential negative effects of Effexor XR, see the “Effexor XR side effects” section above.
Using more than the recommended dosage of Effexor XR can lead to serious side effects.
Overdose symptoms
Symptoms of an overdose can include:
- sleepiness
- dizziness
- nausea
- feeling numb in your hands and feet
What to do in case of overdose
If you think you’ve taken too much of this drug, call your doctor. You can also call America’s Poison Centers at 800-222-1222 or use their online tool. But if your symptoms are severe, call 911 or go to the nearest emergency room right away.
When you get Effexor XR from the pharmacy, the pharmacist will add an expiration date to the label on the bottle. This date is typically 1 year from the date they dispensed the medication.
The expiration date helps guarantee the medication is effective during this time. The
Storage
How long a medication remains good can depend on many factors, including how and where you store the medication.
Effexor XR tablets should be stored at room temperature (68°F to 77°F/20°C to 25°C) in a tightly sealed container. Avoid storing this medication in areas where it could get damp or wet, such as bathrooms.
Disposal
If you no longer need to take Effexor XR and have leftover medication, it’s important to dispose of it safely. This helps prevent others, including children and pets, from taking the drug by accident. It also helps keep the drug from harming the environment.
The
The following information is provided for clinicians and other healthcare professionals.
Indications
Effexor XR (venlafaxine extended release) is approved by the Food and Drug Administration (FDA) for use in adults with any of the following conditions:
- major depressive disorder
- generalized anxiety disorder
- social anxiety disorder (also known as social phobia)
- panic disorder with or without agoraphobia
Mechanism of action
Effexor XR is a serotonin-norepinephrine reuptake inhibitor (SNRI). It improves symptoms of depression, anxiety, and panic disorder by blocking the reabsorption of serotonin and norepinephrine. However, the exact mechanism for how the prolonged activity of serotonin and norepinephrine improves symptomology is not known.
Pharmacokinetics and metabolism
Oral bioavailability of Effexor XR is approximately 45%, with minimal binding to plasma proteins. It reaches steady-state concentration within 3 days of use.
Effexor is metabolized to an active metabolite, ODV, by CYP2D6. Effexor and ODV have half-lives of 5 hours and 11 hours, respectively.
Elimination occurs primarily via renal excretion (~87% of the dose).
Contraindications
Effexor XR use is contraindicated for patients who have a history of hypersensitivity reaction to venlafaxine or any of the product’s inactive ingredients.
Effexor XR is also contraindicated for patients who are currently taking, or have taken within 14 days, a monoamine oxidase inhibitor (MAOI), including linezolid and intravenous methylene blue.
Storage
Effexor XR tablets should be stored at room temperature (68°F to 77°F/20°C to 25°C).
Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.
