Dosing: Adult

Depression: Oral:

Immediate-release tablets: Initial: 75 mg/day, administered in 2 or 3 divided doses; may increase in ≤75 mg/day increments at intervals of ≥4 days as tolerated (maximum daily dose: 225-375 mg)

Extended-release capsules or tablets: Initial: 37.5-75 mg once daily; in patients who are initiated at 37.5 mg once daily, may increase to 75 mg once daily after 4-7 days; dose may then be increased by ≤75 mg/day increments at intervals of ≥4 days as tolerated (maximum daily dose: 225 mg)

Generalized anxiety disorder: Oral: Extended-release capsules: Initial: 37.5-75 mg once daily; in patients who are initiated at 37.5 mg once daily, may increase to 75 mg once daily after 4-7 days; may then be increased by ≤75 mg/day increments at intervals of ≥4 days as tolerated (maximum daily dose: 225 mg)

Panic disorder: Oral: Extended-release capsules: Initial: 37.5 mg once daily for 1 week; may increase to 75 mg once daily after 7 days, may then be increased by ≤75 mg/day increments at intervals of ≥7 days (maximum daily dose: 225 mg).

Social anxiety disorder: Oral: Extended-release capsules or tablets: 75 mg once daily (maximum daily dose: 75 mg); no evidence that doses >75 mg/day offer any additional benefit

Obsessive-compulsive disorder (unlabeled use): Oral: Titrate to usual dosage range of 150-300 mg/day; however, doses up to 375 mg/day have been used; response may be seen in 4 weeks (Phelps, 2005)

Neuropathic pain (unlabeled use): Oral: Dosages evaluated varied considerably based on etiology of chronic pain, but efficacy has been shown for many conditions in the range of 75-225 mg/day; onset of relief may occur in 1-2 weeks, or take up to 6 weeks for full benefit (Grothe, 2004).

Diabetic neuropathy (unlabeled use): Oral: 75-225 mg/day (Bril, 2011)

Hot flashes (unlabeled use): Oral: Doses of 37.5-75 mg/day have demonstrated significant improvement of vasomotor symptoms after 4-8 weeks of treatment; in one study, doses >75 mg/day offered no additional benefit (Evans, 2005; Loprinzi, 2000); however, higher doses (225 mg/day) may be beneficial in patients with perimenopausal depression.

Attention-deficit disorder (unlabeled use): Oral: Initial: Doses vary between 18.75 to 75 mg/day; may increase after 4 weeks to 150 mg/day; if tolerated, doses up to 225 mg/day have been used (Maidment, 2003)

Post-traumatic stress disorder (PTSD) (unlabeled use): Oral: Extended release formulation: 37.5-300 mg/day (Bandelow, 2008; Benedek, 2009)

Note: When discontinuing this medication after more than 1 week of treatment, it is generally recommended that the dose be tapered. If venlafaxine is used for 6 weeks or longer, the dose should be tapered over 2 weeks when discontinuing its use.

Dosing: Pediatric

Attention-deficit/hyperactivity disorder (unlabeled use; Olvera, 1996): Children and Adolescents: Oral: Initial: 12.5 mg/day

Children <40 kg: Increase by 12.5 mg/week to maximum of 50 mg/day in 2 divided doses

Children ≥40 kg: Increase by 25 mg/week to maximum of 75 mg/day in 3 divided doses.

Mean dose: 60 mg or 1.4 mg/kg administered in 2-3 divided doses

Dosing: Geriatric

Refer to adult dosing. No specific recommendations for elderly, but may be best to start lower at 25-50 mg twice daily and increase as tolerated by 25 mg/dose. Extended-release formulation: 37.5 mg once daily, increase by 37.5 mg every 4-7 days as tolerated

Alzheimer’s dementia-related depression (unlabeled use; Rabins, 2007):

Immediate-release tablets: Initial: 25 mg/day; may increase at weekly intervals to maximum of 375 mg/day in divided doses

Extended-release capsules: Initial: 37.5 mg/day; may increase at weekly intervals to maximum of 225 mg/day

Dosing: Renal Impairment

GFR: 10-70 mL/minute: Reduce total daily dose by 25% to 50%

Hemodialysis: Reduce total daily dose by 50%

Dosing: Hepatic Impairment

Mild-to-moderate hepatic impairment: Reduce total daily dose by 50%; further reductions may be necessary in some patients