Dar asked
I would like to discontinue Effexor 150 XR. If I miss just one dose I have severe withdrawal symptoms, so I cannot imagine weeks of that. I would like a pharmacist to advise the best route and then see my PCP. Thanks so much!
Answer
Tapering (i.e. slowly decreasing your dose) of antidepressant medications is often recommended in order to prevent withdrawal symptoms or a worsening of depression. This is especially true for Effexor XR (venlafaxine extended-release).
Many studies have evaluated and discussed the potential withdrawal symptoms from discontinuing Effexor XR too quickly. Unfortunately, it appears as though withdrawal symptoms are more likely with Effexor XR when compared to other antidepressant medication classes such as SSRIs (selective serotonin re-uptake inhibitors).
Below, we discuss the potential withdrawal symptoms of Effexor XR and tapering methods.
Safely Tapering Effexor XR
Potential Withdrawal Symptoms
Withdrawal symptoms are often noted with the acronym FINISH:
F: Flu-like symptoms
I: Insomnia
N: Nausea
I: Imbalance:
S: Sensory disturbances
H: Hyperarousal
Withdrawal symptoms don't occur in all individuals but if they do occur, they most often begin about one week after starting your taper and are generally worst by one to two weeks. In addition, the most commonly experienced withdrawal symptoms are generally mild and self-resolving in a few weeks.
Effexor XR Tapering Methods
There are multiple tapering methods that could be potentially used for individuals taking Effexor XR. There generally isn't a single approach recommend for all and evidence on the best tapering methods are lacking or purely anecdotal. The most important thing is to be educated on the potential withdrawal symptoms and stay in close communication with your doctor.
Nevertheless, the below tapering methods have been used successfully in many.
The prescribing information for Effexor XR doesn't give many specifics in terms of a tapering recommendation, but it does state the following:
"In clinical studies with Effexor XR, tapering was achieved by reducing the daily dose by 75 mg at one-week intervals. Individualization of tapering may be necessary."
The above tapering method is more in line with how most antidepressants are discontinued...slowly decreasing your dose over a few weeks. As mentioned above however, Effexor XR has been noted by many to be particularly difficult to discontinue and has a higher risk of withdrawal effects. Therefore, a more conservative approach may be prudent.
One study suggests the following, more conservative approach:
- Reduce your current dose by 25% every four to six weeks.
- Adjust your taper based on any side effects you are experiencing.
- Effexor XR is available in multiple strengths to help facilitate your taper if you are having particularly bad withdrawal symptoms.
The key takeaway is that the taping method employed will vary by individual and should be determine by you and your doctor.
If you do experience withdrawal symptoms that are intolerable when tapering your Effexor XR dose, your doctor may recommend resuming your previously tolerated dose and continue decreasing at a slower rate.
