February 1, 2023

Effexor, generally prescribed as the generic venlafaxine, received FDA approval as a novel treatment for major depression, generalized anxiety disorder and panic. It now finds off label application as treatment for diabetic neuropathy and other pain syndromes, PTSD, menopausal hot flashes and prevention of migraine headache.

Hello i’m dr. ken lander thanks for watching let’s talk about effexor or then the vaccine it’s a structurally novel antidepressant the immediate release form was approved by the food and drug administration 1993 and went off patent 2008 the extended release form came on the market 1997 went generic in 2010 the importance of going generic means that it became reasonably

Priced structurally and pharmacologically effexor is related to tramadol dram called the painkiller it’s not related to the traditional antidepressants like the selective serotonin reuptake inhibitors prozac celexa zoloft or the tricyclics antidepressants or even the mao inhibitors it is a serotonin norepinephrine receptor inhibitor and it’s approved for use in

Major depressive disorder depression generalized anxiety disorder anxiety social anxiety disorder and panic it’s used very frequently but off-label without fda approval for treatment of diabetic neuropathy or for prevention of migraine headaches although in some people that can cause flares of migraine headaches it’s used for treatment of menopausal hot flashes and

Attention deficit hyperactivity disorder adhd or sometimes ad d used for treatment of obsessive-compulsive disorder and chronic pain syndromes but again without appropriate studies and without fd authorization well it was originally considered a second-line antidepressant because of all of the side effects associated with the drug but now because of all the direct

To consumer marketing most people would consider it a first-line drug but if we look at the tolerability we found that this drug is not ranked near the top of the drugs that are well tolerated in this matter of fact if we look at all the antidepressants effects their ranks near the top of the list of drugs that people discontinue because of this defense as far

As being effective for an antidepressant well all of the drugs seem to work about the same they have different side effect profiles some people seem to respond better to one versus the other some people like coke some people like pepsi well we can’t tell beforehand which one is going to click with an individual patient typically the drug has started at relatively

Low dose 75 milligrams per day gradually increased up to maybe about 225 milligrams on most of the scales of depression the drug seems to work seems to work better at least than placebo but it could take up to about 12 weeks to work and then when it works its reduced the symptoms it hasn’t necessarily eliminated the depression fortunately we can individualize the

Therapy when we talk about the immediate release form it comes as a 25 milligram 37 and a half 50 75 and 100 milligram capsule if we look at the extended release form comes in thirty seven and a half 75 and 150 milligrams well if we start with the drug let’s say the immediate release form the total daily dose is 75 milligrams but it has to be divided into two or

Three different doses so you take one morning midday night one morning nighttime take a with food that’s fine and you can increase the dose or it can be increased every you week or so as necessary until you get a benefit a significant benefit increase from 75 go to 150 milligrams sometimes people have to go to two hundred twenty-five milligrams but that’s about the

Top of the amount except in extraordinarily severely depressed people then the dose of up to 350 milligrams might be necessary under very careful observation if a person is going to take the extended-release form it’s much more convenient a person would start that at 75 milligrams typically just one dose one time per day some people because they’re elderly might

Start at the lower dose 37 1/2 milligrams and that can be increased again up to 225 milligrams single dose you take it with food could be taken in the morning could be taken an evening but at the same time each day and with all of the pills you don’t chew them and you don’t crush them you swallow them whole now if you’re changing from the immediate release to

The extended release form just add up the total dose and take it as one pill of the extended release if you happen to suffer from either mild to moderate liver or kidney disease then the dose might have to be reduced by about 50% if you have severe liver kidney disease this probably isn’t the correct drug for you now when people first see their physicians because

Of depression it’s important to differentiate major depressive disorder as a disease versus depression as the initial symptom of bipolar disorder we used to call it manic depressive disorder if a person has manic depressive disorder that affects our probably isn’t a good drug to take and somewhere around 6 million people suffer from manic depressive disorder so

It’s important to make the distinction if a person has a family history of bipolar disorder or there’s a family history of suicide then you have to be extraordinarily careful it seems that when we compare effexor to the ssris this drug the effexor might be more likely to precipitate or lead to a manic attack and there’s some question whether it’s associated with an

Increased risk of suicide and talk about suicide as with all of the antidepressants they all carry a black box warning and the black box warning by the food and drug administration says hey if you’re taking the drug especially if you’re less than age 24 you have an increased increased risk of suicide so you need careful monitoring especially when you start taking

The drug or if the dose is going to be changed and especially people who are taking the drug who develop some kind of peculiar symptoms so people who all of sudden become anxious or agitated or seemed to complain of panic attacks or have insomnia or hostility or aggressiveness or impulsivity well those people need to be considered for other kinds of therapy now

Once you take the drug the effexor it’s going to be metabolized in the system to its major metabolic by-product that’s called au des methyl venlafaxine we call od v it has the same effect it’s exactly the same effect inside the body as the major product called effexor it doesn’t have any affinity for the muscarinic sites or the histamine excites so that’s good so

That potentially reduces some of the side effects if you take a dose of less than 150 milligrams a day seems to work mostly on serotonin if you take it between 150 and 300 milligrams then it’s going to work on both the serotonin and norepinephrine receptors if you take even a higher dose it might actually involve the dopamine transport now most of the drug that

You take my mouth is going to be absorbed by the intestine the gastrointestinal tract it’s going to be metabolized in the liver to that o desmith or venlafaxine and the importance of odesk methyl venlafaxine is that drug is marketed that chemical is marketed as pristiq seems to be another anti depressant drug it’s going to be metabolized as i say in the liver

And then it’s going to be excreted in the urine the half-life is gonna be about five hours for the effexor and for the od v is gonna be about eleven hours and since that’s relatively short that means that if you forget even one dose you might have some withdrawal symptoms as far as pregnancy is concerned it’s not well studied but it’s clear that you should take

It only if it’s needed if you take it in the first trimester it’s been associated with the potential for miscarriages and brain abnormalities and cleft palate and certain heart defects and if it’s taken late in the third trimester then the newborn might have significant potential for side effects that cause respiratory distress and cyanosis and apnea and seizures

And temperature instability and difficulty feeding and constant crying and irritability and jitteriness we don’t know whether it’s a toxic reaction or a discontinuation reaction actually lactation breastfeeding again not appropriate pediatric dose well that’s sort of iffy common side effects of medicine include loss of appetite vomiting constipation dry mouth and

Dizziness and sweating and certain sexual problems like abnormal ejaculation or impotence can cause tiredness and insomnia and tremor shaking and yawning and interestingly can cause an interstitial lung disease so if you’re taking the drug in you develop a cough or chest discomfort or shortness of breath immediately to the doctor and it can cause a slight increase

In the heart rate so it probably is not appropriate for people who’ve had a recent heart attack or people who are suffering from unstable angina and it may increase the blood pressure in some people it increases the blood pressure by 10 or 15 points that’s relatively small number however enough so that when you start the drug you should have your blood pressure

Monitored and then periodically thereafter and it can cause a dilated pupil and that means that if you have an increased intraocular pressure and you’re at risk for narrow angle glaucoma you might have a potential problem it also can be associated with weight loss it can make you lose more than 5% of your body weight now that’s in about one in 16 people it’s more

Than with other antidepressants and it’s certainly not to be taken as a weight loss drug we don’t even know how it interacts with other weight loss drugs the drug also if it’s given to juveniles people under age 17 my decrease the linear growth it can be associated with a reduced seizure threshold so people who have epilepsy might be more likely to have epileptic

Seizures it can cause abnormal bleeding so especially if you’re taking it with aspirin or non-steroidal anti-inflammatory drugs or you’re taking it with a blood thinner have to be careful because you could develop nosebleeds or bleeding into the skin or bleeding in the intestine that could be fatal effects aren’t effexor extended-release have been associated with

A significant number of side effects according to the food and drug administration they’re adverse event reporting system by the end of 2018 serious cases and/or death about 13,000 cases death just a little shy of 800 cases now whether that’s cause and effect can’t be determined we just know there is that association if you stop taking the drug you’re likely to

Have a moderate to severe recurrence of symptoms more so than with the other antidepressants possibly that’s due to the short half-life of the abruptly discontinue the drug you could suffer from agitation and confusion and difficulty concentrating you could have impaired balance some people develop diarrhea or dry mouth or dysphoric mood sometimes symptoms can be

Mistaken for recurrence of depression person who suffers from fatigue and headache and vomiting nausea nightmares you can have what we call brain zaps we have peculiar sensory symptoms this can occur even if you are late in taking your next dose by 8 to 12 hours so if you normally take the medicine in the morning you better continue taking the drug in the morning

Set your clock so that you’ll remember to take it or in the evening again the same sort of thing don’t neglect taking the pill and don’t take it within two weeks of taking an mao inhibitor the two drugs don’t like each other if you take the two too close together you may well suffer from muscle problems sweating headache nausea dizziness the body temperature can

Go up some people have had seizures or even died and there’s another kind of a syndrome that we see with these kind of drugs and it’s called the serotonin syndrome the serotonin syndrome potentially life-threatening especially if it’s used if the effexor is used with other kind of drugs that interact with serotonin metabolism but the drug can cause the serotonin

Syndrome all by itself but especially if you take it with another antidepressant or a trip tend that would be used for treatment of migraine headaches or st. john’s wort or amphetamines or even the tramadol or fentanyl the symptoms of the serotonin syndrome can come on very quickly agitation hallucinations and coma irregularity of the heart beat fast heartbeat

Labile blood pressure goes up and down body becomes excessively warm reflexes are increased person becomes in coordinated as nausea and vomiting and diarrhea also you have to be careful taking this drug with alcohol and rarely it can cause a false positive test for either pcp or cocaine or amphetamine since the drug seems to work fair on depression people who are

Taking the drug need to be periodically re-evaluated to determine if they should continue taking the drug now as with all of the antidepressants this one’s been mired in a significant number of lawsuits lawsuits that are ongoing at the present time but the good news is that the price of the drug has come way down so if you’re taking generic effexor 75 milligrams

And you’re gonna take two a day the cash price would be somewhere between 100 125 dollars but if you get a coupon that you can get online for no cost say it good rx the price can be as low as $3 to as high as $48 $48 of walgreens if you’re taking the extended-release form well if you’re taking 150 milligrams and you’re taking that one time a day the cash price is

Between 60 and 100 $26 again walgreens is $126 costco much cheaper if you have a coupon the cost would be anywhere between $6 and $35 again the $35 is at the walgreens but if you buy the brand-name drug if you want the effexor extended-release form rather than the genera venlafaxine then the cost will be about $500 so when it comes to antidepressants this is just

Another one there’s nothing special about it doesn’t have any good unique features but it does have some unfortunate negative features and unfortunately there are an awful lot of people who are being treated with antidepressants who probably shouldn’t be and the more we learn about the antidepressants the more we know that most people have mild depression or mild

To moderate depression and the drugs might not work all that much better than placebo so anyway there’s something for you to talk with your doctor about thanks for watching i’m dr. ken landau you you

Transcribed from video
Effexor By wellnowdoctor