what happens if you stop venlafaxine suddenly or miss a dose?

the label’s discontinuation warning (5.7) lists symptoms from dizziness, nausea, electric-shock sensations and insomnia to agitation and low mood, says they were more frequent at higher doses and after longer treatment, and reports post-marketing cases that were protracted and severe, including suicidal thoughts during dose reduction. it recommends gradual reduction, going back to the previous dose if a step is intolerable, and says some people need several months to taper. an independent review found withdrawal most often with venlafaxine among snris, even with gradual tapering. a taper plan is a conversation with a prescriber, not something to decide from a web page.

does venlafaxine raise blood pressure?

yes, dose-dependently. the label reports a diastolic rise of 15 mm hg or more to 105 or above in 1.4% of people on venlafaxine against 0.9% on placebo, a systolic rise of 20 or more to 180 or above in 1% against 0.3%, and sustained high diastolic pressure in 3% of depression-trial patients. it asks for a reading before starting and regularly during treatment, and for existing hypertension to be controlled first.

what are the most common venlafaxine side effects?

from the label’s pooled trials, 3,558 people on venlafaxine extended-release against 2,197 on placebo: nausea 30.0% vs 11.8%, insomnia 17.8% vs 9.5%, dizziness 15.8% vs 9.5%, sleepiness 15.3% vs 7.5%, dry mouth 14.8% vs 5.3%, weakness 12.6% vs 7.8%, sweating 11.4% vs 2.9%, loss of appetite 9.8% vs 2.6%, constipation 9.3% vs 3.4%. in men, abnormal ejaculation or orgasm was 9.9% vs 0.5% and impotence 5.3% vs 1.0%.

is venlafaxine stronger than an ssri?

slightly, on average, and it is also stopped more often. pooling 26 trials, venlafaxine gave higher remission (odds ratio 1.13) and response (1.17) than ssris but 41% more discontinuation for side effects. in the largest antidepressant comparison it was among the more effective drugs and among those most often dropped. in the star*d switch trial it did no better than sertraline or bupropion. whether a small average edge is worth the tolerability cost is a question for a prescriber who knows the person.

Medication approval journey

venlafaxine (Effexor XR)

Approved for Major depressive disorder in adults

page first published 2026-08-31 · last updated 2026-10-05

Also answers to “the double shot” — its codename in our videos and posts. The full codebook

FDA approvedSNRI antidepressantTaper risk: moderate

How this page reads

The page as written, with the clinical terms

Plain language uses the same facts, the same numbers and the same caveats. It does not leave anything out. Quotes from the FDA label are never reworded in either setting.

Before you stop or change your venlafaxine dose

Stopping abruptly causes withdrawal effects that can be severe

SNRIs — venlafaxine especially — are associated with some of the most difficult withdrawal of any antidepressant, partly because of their short half-life. Do not skip doses or stop abruptly. Any change should be a slow, prescriber-supervised taper.

what the venlafaxine warnings mean

label facts below are read from the venlafaxine hydrochloride extended-release capsules FDA label on DailyMed, set id 33b39416-7981-46fb-ba31-e933a6afcf8b, version 4, effective august 27, 2026. the section numbers in brackets are the label’s own. every source is linked at the end of this section. last checked 2026-10-05.

venlafaxine’s extended-release capsule was approved for depression in 1997, and about 3.4 million americans filled a prescription for venlafaxine in 2024 [meps]. it is an snri, acting on norepinephrine as well as serotonin, which is where two of its warnings that ssris do not carry come from: blood pressure, and a withdrawal syndrome the label itself calls protracted and severe in some cases. the label carries one boxed warning and twelve further warnings. this section says what each means in plain words, what the approval trials measured and for how long, which side effects the label counts and how often, and what independent research has found since, in both directions. every number is from the label or from a study in the library, and each source is linked at the end.

this is information to take to a prescriber. nothing here is a reason to start, stop or change a dose on your own; for this drug in particular, the label says stopping suddenly is the thing to avoid.

the boxed warning: suicidal thoughts and behaviors, by age

the boxed warning says antidepressants increased the risk of suicidal thoughts and behavior in children, adolescents and young adults in short-term studies, that everyone on the drug should be watched for worsening, and that venlafaxine extended-release is not approved for anyone under 18 [label, boxed warning and 5.1].

the numbers come from pooled placebo-controlled trials of antidepressants covering about 77,000 adults and 4,500 children. per 1,000 people treated, the difference against placebo was: under 18, 14 additional people with suicidal thoughts or behaviors; 18 to 24, 5 additional; 25 to 64, 1 fewer; 65 and older, 6 fewer [label 5.1, table 1]. the label adds that the absolute risk was highest in people treated for depression and that whether the risk extends beyond four months is unknown.

so the warning is specific: thoughts and behaviors, not deaths; the first months; and above age 24 the pooled trials showed no increase [label 5.1; age-ceiling row]. venlafaxine adds one more line in its withdrawal warning, below: suicidal thoughts and completed suicide have also been observed while the dose was being reduced [label 5.7].

the twelve other warnings, in plain words

the label’s warnings and precautions run from 5.2 to 5.13. none is boxed. blood pressure, lung inflammation and the two pediatric warnings for a drug not approved in children are venlafaxine’s own; the discontinuation warning is shared with the ssris but written more strongly here; the rest match the ssri labels.

serotonin syndrome [5.2]: too much serotonin signalling, which can be life-threatening. the risk rises with other serotonergic drugs (the label names triptans, tricyclics, fentanyl, lithium, tramadol, meperidine, methadone, buspirone, amphetamines and st john’s wort) and the combination with an maoi is contraindicated. it can happen on venlafaxine alone. signs are agitation or confusion, racing heart, sweating, fever, tremor, muscle jerking and overactive reflexes.
raised blood pressure [5.3]: the trials showed dose-related rises in systolic and diastolic pressure and cases of sustained hypertension. 1.4% of people on venlafaxine had a diastolic rise of 15 mm hg or more to 105 or above, against 0.9% on placebo; 1% had a systolic rise of 20 or more to 180 or above, against 0.3%. sustained high diastolic pressure occurred in 19 of 705 depression-trial patients (3%) at 75 to 375 mg a day [label 5.3, 6.1 table 11]. the label asks for a reading before starting and regularly after, for existing hypertension to be controlled first, and says too few people took more than 300 mg a day in trials to know the risk at those doses.
bleeding [5.4]: drugs that block serotonin reuptake make platelets less effective. aspirin, nsaids such as ibuprofen and naproxen, and blood thinners add to the risk, and snri use in the month before delivery has been linked to a less than twofold rise in postpartum bleeding.
angle-closure glaucoma [5.5]: the pupil dilation many antidepressants cause can trigger an attack in an eye with narrow drainage angles that has not been treated.
activation of mania or hypomania [5.6]: in someone with bipolar disorder an antidepressant can tip a depressive episode into a manic one. mania or hypomania was reported in 0.3% of depression-trial patients on venlafaxine and none on placebo [label 5.6, table 2]. the label tells prescribers to screen for a personal or family history first.
discontinuation syndrome [5.7]: this is the warning venlafaxine is known for, and the label is unusually direct. withdrawal symptoms were systematically studied and were more frequent at higher doses and after longer treatment. the list runs to agitation, anxiety, confusion, poor coordination and balance, diarrhea, dizziness, dry mouth, low mood, muscle twitching, fatigue, flu-like symptoms, headache, hypomania, insomnia, nausea, nightmares, electric-shock sensations, sleepiness, sweating, tremor, vertigo and vomiting. post-marketing reports include symptoms that were "protracted and severe", completed suicide, suicidal thoughts, aggression and violent behavior during dose reduction, and blurred vision and raised blood pressure after stopping. the label recommends gradual reduction, says that if a step brings intolerable symptoms the prescriber may consider returning to the previous dose and going slower, and that "in some patients, discontinuation may need to occur over a period of several months".
seizures [5.8]: cases have been reported; people with a seizure disorder were not studied, so the label says caution.
low sodium [5.9]: hyponatremia, usually from the hormone syndrome siadh, with cases below 110 mmol/l reported. early signs are headache, poor concentration, confusion, weakness and unsteadiness; severe cases have included seizures and death. older people, people on diuretics and anyone dehydrated may be at greater risk.
weight and height in children [5.10] and appetite in children [5.11]: venlafaxine extended-release is not approved for anyone under 18, and the label still reports what happened in pediatric trials: children lost weight (18% lost 3.5% or more of body weight over 8 weeks against 3.6% on placebo; 47% against 14% over 16 weeks), grew less than expected over six months, and lost appetite more often (10% against 3% over 8 weeks; 22% against 3% over 16 weeks).
lung inflammation [5.12]: interstitial lung disease and eosinophilic pneumonia have rarely been reported. new, worsening breathlessness, cough or chest discomfort on venlafaxine should be looked at promptly.
sexual dysfunction [5.13]: delayed or absent ejaculation, erectile dysfunction and reduced desire in men; reduced desire and delayed or absent orgasm in women. the label tells prescribers to ask before starting and to ask again during treatment, because people do not volunteer it.

what the trials measured, and for how long

the depression approval for the extended-release capsule rested on two placebo-controlled flexible-dose trials in adult outpatients, one of 8 weeks and one of 12 weeks, at 75 to 225 mg a day, with change on the 21-item hamilton depression scale as the outcome [label 14.1]. the label does not give enrollment per trial; 705 people took the extended-release capsule across the pre-marketing depression studies, and a further 2,897 took the immediate-release tablet [label 6.1]. a 4-week inpatient study of the immediate-release tablet at 150 to 375 mg a day is also described.

a longer trial took people who had responded to 8 weeks of open-label venlafaxine and randomised them to continue or switch to placebo for up to 26 weeks; relapse was lower on venlafaxine, and the label gives the result without percentages [label 14.1]. that design cannot separate relapse from withdrawal, and for a drug whose own label says withdrawal can be protracted and severe, that limit matters more than usual.

the arithmetic that matters: the efficacy trials were 8 and 12 weeks, the longest controlled measurement was 26 weeks, children were never approved, and about 3.4 million americans a year take it. how long people stay on it is on the longest-trial page linked below.

the most common side effects, with the label’s numbers

the label pools 3,558 people on the extended-release capsule against 2,197 on placebo from trials of up to 12 weeks across all four approved conditions, and reports the reactions at 5% or more and twice placebo: nausea 30.0% vs 11.8%, sleepiness 15.3% vs 7.5%, dry mouth 14.8% vs 5.3%, sweating 11.4% vs 2.9%, loss of appetite 9.8% vs 2.6%, constipation 9.3% vs 3.4% [label 6.1]. insomnia (17.8% vs 9.5%), dizziness (15.8% vs 9.5%) and weakness (12.6% vs 7.8%) were also common. nausea at 30% is the highest rate on any antidepressant page on this site. the full list is in the side-effects section lower on this page.

sexual side effects, by sex. in men (1,440 on venlafaxine, 923 on placebo): abnormal ejaculation or orgasm 9.9% vs 0.5%, impotence 5.3% vs 1.0%, anorgasmia 3.6% vs 0.1%. in women (2,118 vs 1,274): anorgasmia 2.0% vs 0.2% [label 6.1]. decreased libido was 5.1% overall. the label notes, as every ssri and snri label does, that people and clinicians are reluctant to raise these, so trial rates likely understate them.

two cautions the label attaches to all of these: rates from trials cannot be compared directly with rates for other drugs, and they may not match what happens in ordinary practice.

what independent research says, in both directions

in favour. in the largest comparison of antidepressants, 522 randomised trials with 116,477 adults, venlafaxine was among the more effective drugs in head-to-head trials (odds ratios 1.19 to 1.96) [cipriani-2018]. in generalised anxiety disorder, a network meta-analysis of 89 trials and 25,441 people found it lowered anxiety scores by about 2.7 hamilton anxiety points more than placebo and placed it among the drugs combining efficacy with reasonable acceptability [slee-2019]. pooling 26 trials and 5,858 people against ssris, venlafaxine gave slightly higher remission (odds ratio 1.13) and response (odds ratio 1.17) [de-silva-2012]. and in a 14-year health-system record, the triptan interaction every snri label lists produced two definite cases of serotonin syndrome in 30,928 person-years of combined use, about 0.6 per 10,000 years [orlova-2018].

against, or smaller than the badge suggests. the same large comparison put venlafaxine among the drugs most often stopped (dropout odds ratios 1.30 to 2.32) [cipriani-2018], and the ssri comparison found about 41% more discontinuation for adverse events (odds ratio 1.41) alongside its small efficacy edge [de-silva-2012]. in the nimh-funded star*d trial, 727 people whose depression had not remitted on citalopram were switched; extended-release venlafaxine produced remission in about 25%, no better than sertraline or bupropion [star-d-2006]. when sexual function was measured with a questionnaire across antidepressants, venlafaxine ranked second of ten, behind only sertraline [serretti-2009]. in may 2019 the european regulator’s safety committee ordered every maker of venlafaxine and nine related drugs to add a warning that sexual dysfunction can continue after the drug is stopped; how often is unknown, and that uncertainty cuts both ways [prac-2019].

on withdrawal, which is this drug’s defining question. a systematic review of 61 reports, including 22 double-blind randomised trials, found withdrawal symptoms after stopping any snri, most often with venlafaxine, typically starting within days and lasting weeks, and appearing even with gradual tapering [fava-2018]. the uk guideline nice ng215 says coming off can take months, that medicines should not be stopped abruptly except in exceptional circumstances, and that tapers should get smaller as the dose gets lower [nice-2022]; the royal college of psychiatrists conceded in 2019 that for some people withdrawal is severe and long-lasting, while stating that antidepressant use is not dependence in the addiction sense [rcpsych-2019]. serotonin toxicity, the other warning people are told to watch for, has a seven-sign definition built from 2,222 overdoses: inducible muscle jerking, agitation, sweating, tremor, overactive reflexes, and in severe cases rigidity and fever [hunter-2003].

questions to ask your prescriber about venlafaxine

each one comes from a warning or a study above. they are questions, not instructions; the answers depend on a history nobody here has.

given my age, which side of the boxed warning’s line am i on, and what exactly should i or the people around me watch for in the first two months?
the label asks for blood pressure before starting and regularly after, and the rise is dose-related. when was mine last checked on this dose?
the label says withdrawal can be protracted and severe and may need several months. if i ever want to stop, what would the taper look like, how small are the steps near the end, and how would we tell withdrawal from relapse?
the withdrawal review found symptoms typically start within days of stopping. what should i do if i miss a dose?
nausea was 30% in the trials. how long does it usually last, and what would make us change course?
the label says to ask about sexual function before starting and during treatment. can we do that now?
the largest trial of switching after a first antidepressant found about one in four remit on venlafaxine, sertraline or bupropion alike. why venlafaxine for me?

questions people ask

does venlafaxine have a black box warning?: yes. the fda label carries one boxed warning, on suicidal thoughts and behaviors in children, adolescents and young adults in short-term studies, and states that venlafaxine extended-release is not approved for anyone under 18. per 1,000 people treated, the pooled numbers are 14 additional cases under 18, 5 additional at 18 to 24, 1 fewer at 25 to 64 and 6 fewer at 65 and over.
what happens if you stop venlafaxine suddenly or miss a dose?: the label’s discontinuation warning (5.7) lists symptoms from dizziness, nausea, electric-shock sensations and insomnia to agitation and low mood, says they were more frequent at higher doses and after longer treatment, and reports post-marketing cases that were protracted and severe, including suicidal thoughts during dose reduction. it recommends gradual reduction, going back to the previous dose if a step is intolerable, and says some people need several months to taper. an independent review found withdrawal most often with venlafaxine among snris, even with gradual tapering. a taper plan is a conversation with a prescriber, not something to decide from a web page.
does venlafaxine raise blood pressure?: yes, dose-dependently. the label reports a diastolic rise of 15 mm hg or more to 105 or above in 1.4% of people on venlafaxine against 0.9% on placebo, a systolic rise of 20 or more to 180 or above in 1% against 0.3%, and sustained high diastolic pressure in 3% of depression-trial patients. it asks for a reading before starting and regularly during treatment, and for existing hypertension to be controlled first.
what are the most common venlafaxine side effects?: from the label’s pooled trials, 3,558 people on venlafaxine extended-release against 2,197 on placebo: nausea 30.0% vs 11.8%, insomnia 17.8% vs 9.5%, dizziness 15.8% vs 9.5%, sleepiness 15.3% vs 7.5%, dry mouth 14.8% vs 5.3%, weakness 12.6% vs 7.8%, sweating 11.4% vs 2.9%, loss of appetite 9.8% vs 2.6%, constipation 9.3% vs 3.4%. in men, abnormal ejaculation or orgasm was 9.9% vs 0.5% and impotence 5.3% vs 1.0%.
is venlafaxine stronger than an ssri?: slightly, on average, and it is also stopped more often. pooling 26 trials, venlafaxine gave higher remission (odds ratio 1.13) and response (1.17) than ssris but 41% more discontinuation for side effects. in the largest antidepressant comparison it was among the more effective drugs and among those most often dropped. in the star*d switch trial it did no better than sertraline or bupropion. whether a small average edge is worth the tolerability cost is a question for a prescriber who knows the person.

sources for this section

the library rows link to our one-page summary of each study, with the original paper, its funding and our evidence grade on that page.

How long the venlafaxine trials actually ran

The longest trial behind the venlafaxine approval ran 12 weeks.

The gap between how long the trials ran and how long people actually take these medications is the single most important thing on this page. It is not evidence that longer use is unsafe or ineffective. It is evidence that longer use was not what got tested.

People often stay on these drugs for far longer than the trials ran. The two main trials behind the approval ran 8 and 12 weeks.

That does not mean longer use is unsafe. It does not mean the drug stops working either. It means longer use was never the thing that got tested.

If you have been on it a long time, that is a fair thing to ask your prescriber about.

Boxed warning: suicidal thoughts and behaviors

The strongest warning the FDA puts on a label, often called a black box warning. It is reproduced below word for word, not summarised.

This is the strongest warning the FDA can put on a drug label. Some people call it a black box warning. We copied it word for word. We did not shorten it and we did not soften it.

The warning below is about suicidal thoughts. In short studies, antidepressants raised the risk of suicidal thoughts and behavior. That was in children and young adults. The label tells prescribers to watch every patient closely for this. It also tells them to watch for the illness getting worse.

The FDA’s own words follow, copied exactly.

WARNING: SUICIDAL THOUGHTS AND BEHAVIORS Antidepressants increased the risk of suicidal thoughts and behavior in pediatric and young adult patients in short-term studies. Closely monitor all antidepressant-treated patients for clinical worsening, and emergence of suicidal thoughts and behaviors [see Warnings and Precautions (5.1) ] . Venlafaxine hydrochloride extended-release capsules are not approved for use in pediatric patient s [see Use in Specific Populations (8.4) ] . WARNING: SUICIDAL THOUGHTS AND BEHAVIORS See full prescribing information for complete boxed warning. Increased risk of suicidal thoughts and behavior in pediatric patients and young adults taking antidepressants. Closely monitor all antidepressant-treated patients for clinical worsening and emergence of suicidal thoughts and behaviors ( 5.1 ). Venlafaxine hydrochloride extended-release capsules are not approved for use in pediatric patients ( 8.4 ).

FDA label effective August 27, 2026 — read the full label on DailyMed

What venlafaxine is FDA approved for, and the trials behind it

Approved for major depressive disorder in adults; indications for generalized anxiety disorder, social anxiety disorder, and panic disorder were added later in 1997, under application NDA 020699. Source: FDA Drugs@FDA.

The label does not report how many patients enrolled in each of the two pivotal MDD trials; the 705 figure is total extended-release exposure across all premarketing MDD studies. The label's efficacy tables give score changes but no per-arm enrollment for these trials.

The label credits the extended-release capsule's efficacy in major depressive disorder to two placebo-controlled, flexible-dose outpatient studies, one of 8 weeks and one of 12 weeks, at 75 to 225 mg per day. A 4-week inpatient study of the immediate-release tablets (150 to 375 mg per day) and two longer-term relapse-prevention studies are also described. Across the premarketing program, 705 patients received the extended-release capsules in MDD studies; a further 2,897 received the immediate-release tablets in MDD studies.

One gap first. The label does not say how many people enrolled in each of the two main depression trials.

The 705 figure is a total instead. It counts everyone who took the slow-release capsules before the drug went on sale. That is across every depression study. The label’s results tables give score changes. They give no group sizes for these trials.

The FDA approved venlafaxine in 1997. The approved use was major depression in adults. Three more uses came later. They are generalized anxiety disorder, social anxiety disorder, and panic disorder. The file number is NDA 020699. The source is Drugs@FDA, the FDA's own database.

The label credits the slow-release capsule to two outpatient studies. Both ran against a placebo. The dose could be adjusted in both. One ran 8 weeks. One ran 12 weeks. Doses ran from 75 to 225 mg a day.

It also describes a 4-week study of the fast-release tablets. Those people were staying in hospital. Doses there ran from 150 to 375 mg a day. Two longer studies on keeping people well are described too.

Before the drug went on sale, 705 people took the slow-release capsules in depression studies. Another 2,897 took the fast-release tablets in depression studies.

Trials: 2 placebo-controlled trials
Duration: 8 and 12 weeks
Participants: 705 patients on the extended-release capsules across MDD studies
Compared against: Placebo

The efficacy of venlafaxine hydrochloride extended-release capsules as a treatment for Major Depressive Disorder (MDD) was established in two placebo-controlled, short-term (8 weeks for study 1; 12 weeks for study 2), flexible-dose studies, with doses starting at 75 mg per day and ranging to 225 mg per day in adult outpatients meeting DSM-III-R or DSM-IV criteria for MDD.

Verbatim from the venlafaxine FDA label, Clinical Studies section, effective August 27, 2026 — read the full label on DailyMed.

Side effects of venlafaxine in the approval trials

Incidence among 3,558 patients on venlafaxine extended-release versus 2,197 on placebo, pooled from short-term placebo-controlled studies of up to 12 weeks across all four indications (MDD, GAD, social anxiety disorder, and panic disorder), not MDD alone. The label itself cautions that trial adverse-reaction rates may not reflect the rates observed in clinical practice.

Read the limits first. These numbers are pooled from short trials against a placebo of up to 12 weeks. They cover all four approved uses, not depression alone. 3,558 people took the slow-release form and 2,197 took a placebo.

The label warns that real life may not match trial rates.

Nausea (30.0% vs 11.8% on placebo)
Insomnia (17.8% vs 9.5%)
Dizziness (15.8% vs 9.5%)
Somnolence (15.3% vs 7.5%)
Dry mouth (14.8% vs 5.3%)
Asthenia (12.6% vs 7.8%)
Sweating (11.4% vs 2.9%)
Abnormal ejaculation, men (9.9% vs 0.5%)
Anorexia (9.8% vs 2.6%)
Constipation (9.3% vs 3.4%)

The most commonly observed adverse reactions in the clinical study database in venlafaxine hydrochloride extended-release capsules treated patients in MDD, GAD, SAD, and PD (incidence ≥5% and at least twice the rate of placebo) were: nausea (30.0%), somnolence (15.3%), dry mouth (14.8%), sweating (11.4%), abnormal ejaculation (9.9%), anorexia (9.8%), constipation (9.3%), impotence (5.3%), and decreased libido (5.1%).

From the venlafaxine FDA label, Adverse Reactions section, effective August 27, 2026 — DailyMed.

More from the venlafaxine label: drug abuse and dependence

Not a controlled substance
Venlafaxine is not scheduled under the Controlled Substances Act. The label notes there was no indication of drug-seeking behavior in the clinical studies, while adding that premarketing experience cannot predict how a CNS-active drug will be misused once marketed.
FDA label, Drug Abuse and Dependence section.
Stopping can produce a discontinuation syndrome
Abrupt discontinuation or dose reduction has been associated with new symptoms — dizziness, sensory disturbances including shock-like electrical sensations, agitation, insomnia, and others — more frequent at higher doses and after longer treatment. The label reports postmarketing cases that were protracted and severe, recommends gradual dose reduction rather than abrupt cessation, and says some patients may need to taper over several months.
FDA label, Warnings and Precautions section.

How many Americans take venlafaxine

Survey-based federal estimates, published with a lag of about two years. They count prescriptions filled, not outcomes.

These are federal survey numbers. They come out about two years late. They count prescriptions filled. They do not tell you if the drug helped.

16,273,306
prescriptions in the United States (2024), refills included: 3,429,959
people filling them (2024), ± 589,058 (95%)

From 2014 to 2024 the estimate moved down 6%, but that is within the survey’s margin of error, so we do not call it a rise or a fall. Whatever you decide about venlafaxine, you are deciding alongside about 3,429,959 other people in 2024.

Prescriptions by year: 2014 17,385,389 · 2015 17,109,915 · 2016 15,283,794 · 2017 16,080,521 · 2018 16,121,150 · 2019 17,713,653 · 2020 15,022,424 · 2021 15,122,967 · 2022 13,881,023 · 2023 13,234,840 · 2024 16,273,306.

Prescriptions are not clearly up or down since 2014. About 3.4 million people in the United States took it in 2024.

Correction (29 September 2026). An earlier version of this section took its numbers from ClinCalc DrugStats, a third-party site that republishes this survey; we now compute them from AHRQ’s public-use files ourselves. It said prescriptions were down 6% since 2014; that change is within the survey’s margin of error, so we no longer state a direction.

Source: AHRQ Medical Expenditure Panel Survey (MEPS), Prescribed Medicines public-use files, 2014 (HC-168A) through 2024 (HC-254A), computed by veisund. People with at least one purchase where the Multum generic name (RXDRGNAM) equals the drug, weighted by the year’s person weight; purchases include refills. Standard errors by Taylor linearization on VARSTR/VARPSU. AHRQ’s reliability rule: a year is not shown when fewer than 60 survey respondents reported the drug or the relative standard error is over 50%. AHRQ cautions that its 2018 questionnaire redesign and the 2020–2022 pandemic years make year-to-year comparisons less certain.

What people report to the FDA about venlafaxine

Read this before the numbers.

Anyone can file an adverse event report — patients, doctors, manufacturers — and nobody verifies that the drug caused what was reported. There is no denominator: tens of millions of prescriptions generate reports at an unknowable rate, and reporting rises with news coverage, not necessarily with harm. Counts below are report volumes, not rates, and cannot be compared between drugs. The FDA itself says not to use this data to make medical decisions — we show it because you deserve to see what is in the public record, with its limits stated plainly.

Read this before the numbers.

Anyone can send a report to the FDA. Patients can. Doctors can. Drug makers can. Nobody checks that the drug caused what the report describes.

There is also no bottom number. Tens of millions of prescriptions turn into reports at a rate nobody knows. Reports go up when a drug is in the news, and that is not the same as more harm.

So these are counts of reports. They are not rates. You cannot use them to compare one drug with another. The FDA itself says not to use this data to make medical choices.

We show it because it is on the public record, and you should get to see it with its limits named.

131,573
reports mentioning venlafaxine, all time: 97,754
filed as serious (a report-level flag covering every drug and outcome in the report) filed as serious. That flag covers the whole report, and one report can name more than one drug and more than one outcome.

Most-reported reactions

Drug ineffective9,998
Nausea9,124
Fatigue8,208
Headache7,507
Dizziness6,594
Depression6,359
Anxiety6,176
Off label use6,108
Pain5,572
Diarrhoea5,302

“Drug ineffective” ranking this high is worth noticing: a report of not being helped counts as an adverse event too, and people file them in large numbers.

It is worth noticing how high “drug ineffective” ranks. A report that the drug did not help counts as an adverse event too. People file a lot of them.

Source: FDA Adverse Event Reporting System (FAERS), via openFDA, openFDA dataset refreshed 2026-07-30 (the refresh date of the query endpoint, not the date reports run through).

Drug interactions listed on the venlafaxine label

The FDA label’s interactions section, verbatim. A pharmacist checking your actual medication list beats any published list — including this one.

Below is the part of the FDA label that lists other drugs. It is copied word for word.

No list on the web can see what else you take. A pharmacist can. Ask one to check your full list.

Read the label’s interactions section

7 DRUG INTERACTIONS

7.1 Drugs Having Clinically Important Interactions with Venlafaxine Hydrochloride Extended-Release Capsules Table 15: Clinically Important Drug Interactions with Venlafaxine Hydrochloride Extended-Release Capsules Monoamine Oxidase Inhibitors (MAOI) Clinical Impact The concomitant use of SNRIs, including venlafaxine hydrochloride extended-release capsules, with MAOIs increases the risk of serotonin syndrome. Intervention Concomitant use of venlafaxine hydrochloride extended-release capsules is contraindicated in patients taking MAOIs, including MAOIs such as linezolid or intravenous methylene blue [see Dosage and Administration (2.11) , Contraindications (4) and Warnings and Precautions (5.2) ]. Other Serotonergic Drugs Clinical Impact Concomitant use of venlafaxine hydrochloride extended-release capsules with other serotonergic drugs (including other SNRIs, SSRIs, triptans, tricyclic antidepressants, opioids, lithium, buspirone, amphetamines, tryptophan, and St. John's Wort) increases the risk of serotonin syndrome. Intervention Monitor for symptoms of serotonin syndrome when venlafaxine hydrochloride extended-release capsules is used concomitantly with other drugs that may affect the serotonergic neurotransmitter systems. If serotonin syndrome occurs, consider discontinuation of venlafaxine hydrochloride extended-release capsules and/or concomitant serotonergic drugs [see Dosage and Administration (2.11) and Warnings and Precautions (5.2) ]. Drugs that Interfere with Hemostasis Clinical Impact Concomitant use of venlafaxine hydrochloride extended-release capsules with an antiplatelet or anticoagulant drug may potentiate the risk of bleeding. This may be due to the effect of venlafaxine hydrochloride extended-release capsules on the release of serotonin by platelets. Intervention Closely monitor for bleeding for patients receiving an antiplatelet or anticoagulant drug when venlafaxine hydrochloride extended-release capsules are initiated or discontinued [see Warnings and Precautions (5.4) ] . Effect of CYP3A Inhibitors Clinical Impact Concomitant use of a CYP3A inhibitor increases the C max and AUC of venlafaxine and O-desmethylvenlafaxine (ODV) [see Clinical Pharmacology (12.3) ] , which may increase the risk of toxicity of venlafaxine hydrochloride extended-release capsules. Intervention Consider reducing the dose of venlafaxine hydrochloride extended-release capsules. CYP2D6 Substrates Clinical Impact Concomitant use of venlafaxine hydrochloride extended-release capsules increases C max and AUC of a CYP2D6 substrate, which may increase the risk of toxicity of the CYP2D6 substrate [see Clinical Pharmacology (12.3) ] . Intervention Consider reduction in dose of concomitant CYP2D6 substrates.

7.2 Other Drug Interactions with Venlafaxine Hydrochloride Extended-Release Capsules Central Nervous System (CNS)-Active Drugs The risk of using venlafaxine concomitantly with other CNS-active drugs (including alcohol) has not been systematically evaluated. Consequently, caution is advised when venlafaxine hydrochloride extended-release capsules are taken concomitantly in combination with other CNS-active drugs. Weight Loss Agents Concomitant use of venlafaxine hydrochloride extended-release capsules and weight loss agents is not recommended. The safety and efficacy of venlafaxine therapy in combination with weight loss agents, including phentermine, have not been established. Venlafaxine hydrochloride extended-release capsules are not indicated for weight loss alone or in combination with other products. Laboratory Test Interference False-positive urine immunoassay screening tests for phencyclidine (PCP) and amphetamine have been reported in patients taking venlafaxine due to lack of specificity of the screening tests. False-positive test results may be expected for several days following discontinuation of venlafaxine therapy. Confirmatory tests, such as gas chromatography/mass spectrometry, will distinguish venlafaxine from PCP and amphetamine.

FDA label for venlafaxine, effective August 27, 2026 — DailyMed.

Label history: when this label changes, it is recorded in What changed.

Who pays for venlafaxine

Two claims datasets and one survey, covering different populations with different instruments — they cannot be reconciled by arithmetic, and where their sum crowds the all-payer estimate, that is a finding about the estimates rather than a percentage.

Medicare Part D · claims · 2024Medicaid · claims floor · 2024All-payer · survey · 2024Commercially insured adults · not publishedChildren · no per-drug data

Medicare Part D: Read the under-65 group correctly before the numbers: Medicare before 65 means the disabled and dual-eligible population — among the sickest, highest-need people in the program — and reading their utilization as typical adult use would be a category error. The beneficiary total sums brand-level rows, so treat it as an upper bound on distinct people. 1,163,195 beneficiaries filled 6,169,621 claims in 2024 — 916,481 aged 65 and over, and 246,714 under 65.
Medicaid: At least 2,967,610 prescriptions in 2024 — a floor, because 377 of 1,753 national data rows are suppressed for privacy and contribute zero. Medicaid covers more children than any insurer in the country and publishes no age split — how much of this number is pediatric use is not knowable from public data.
All payers (survey estimate): A survey estimate from 202 respondents, which we computed from AHRQ’s MEPS 2024 Prescribed Medicines file (people with at least one purchase, weighted; purchases include refills), puts the whole country at 16,273,306 purchases and 3,429,959 people in 2024. Subtracting the public programs from it would produce a number for everyone else — and we do not print that number, because subtracting a survey from claims counts manufactures precision that does not exist.
The population nobody counts: The commercially insured working-age adult — statistically, the likeliest person to be reading this page — is the one population with no public per-drug count anywhere. Private claims data exists and is sold, but nothing a patient can check is published. For children the record is thinner still: no public source counts pediatric use of venlafaxine specifically; the closest the public record comes is condition-level treatment rates for children, which we have traced for one condition in how childhood ADHD got counted.

Sources: Medicare Part D Prescribers — by Geography and Drug, data.cms.gov, National rows, data year 2024 (published with ~17-month lag). Medicaid State Drug Utilization Data 2024, data.medicaid.gov, national aggregate rows. Retrieved 2026-09-01.

Who has been paying for venlafaxine, 2019–2024

Medicare Part D

Claims, all ages — the one payer with a public per-drug series.

20192024

5,963,483 → 6,169,621 claims

Medicare under 65

Beneficiaries, not ordinary working-age adults: Medicare before 65 means the disabled and dual-eligible population. A gap is a suppressed split, not zero.

20192024

312,913 → 246,714 beneficiaries

Medicaid

A floor each year — small-cell rows are suppressed federally and excluded from the sum.

20192024

3,310,552 → 2,967,610 prescriptions (floor)

Commercially insured adults

No public dataset publishes per-drug commercial claims for any year — the absence is the finding, and it is rendered, not interpolated. The population this library most wants to inform is the one with no public per-drug series, in any year — insurers and PBMs hold that data privately. What the federal surveys do measure — how many adults take these medications at all — is on the adult-usage page.

Sources: Medicare Part D Prescribers by Geography and Drug (data.cms.gov, national rows, per data year); Medicaid State Drug Utilization Data (data.medicaid.gov, national rows). Claims, fills and beneficiaries are different units — compare each series only with itself.

The venlafaxine approval, step by step

Step 1
What the approval was actually based on
Which studies did the FDA rely on, how long did they run, and who was in them?
The efficacy of Effexor XR (venlafaxine hydrochloride) extended-release capsules as a treatment for Major Depressive Disorder (MDD) was established in two placebo-controlled, short-term (8 weeks for study 1; 12 weeks for study 2), flexible-dose studies, with doses starting at 75 mg per day and ranging to 225 mg per day in adult outpatients meeting DSM-III-R or DSM-IV criteria for MDD.
FDA-approved labelling, 14 CLINICAL STUDIES 14.1 Major Depressive Disorder — read the label on DailyMed
Our reading
Two trials, eight and twelve weeks, in adult outpatients. This entry is anchored on NDA020699, the extended-release capsule almost everyone is prescribed, rather than on the 1993 immediate-release tablet — a distinction worth stating because the two applications do not carry the same section 14 and it is easy to quote one under the other. Venlafaxine also has a dose-dependent blood-pressure effect and, like paroxetine, a short half-life and a hard discontinuation, neither of which was an efficacy endpoint in an eight-week trial.
Step 2
The approval
When was it approved, under what application, and by whose review?
Approved
October 20, 1997
Application
NDA020699
Review
STANDARD
Original sponsor
Wyeth (now Viatris)
Holds it now
Upjohn
Label submissions since
80
Source: openFDA Drugs@FDA, original application ORIG-1
Step 3
What was added after it was on the market
Which warnings arrived only after millions of people were already taking it?
- PRAC recommendations on signals adopted at the 13-16 May 2019 PRAC meeting, section 1.3: SNRIs and SSRIs - persistent…
  22 years after approval
  On 16 May 2019 the EU drug regulator's safety committee ordered every manufacturer of citalopram, escitalopram, fluvoxamine, fluoxetine, paroxetine, sertraline, duloxetine, venlafaxine, desvenlafaxine, and milnacipran to add this warning within two months: "There have been reports of long-lasting sexual dysfunction where the symptoms have continued despite discontinuation of SSRIs/SNRI." The patient leaflet wording is "In some cases, these symptoms have continued after stopping treatment." This is a regulator acting on case reports and pharmacovigilance data, not a prevalence study — how often it happens is still unknown, and that uncertainty cuts both ways.
  Worth asking
  European regulators require a label warning that sexual side effects can persist after stopping an SSRI or SNRI — how would you and I tell that apart from the depression itself if it happened to me?
  PRAC recommendations on signals adopted at the 13-16 May 2019 PRAC meeting, section 1.3: SNRIs and SSRIs - persistent sexual dysfunction after drug withdrawal (EMA/PRAC/265212/2019). — Pharmacovigilance Risk Assessment Committee (PRAC), European Medicines Agency. Rapporteur: Gross-Martirosyan L. (2019)
- The antidepressant suicidality warning has an age ceiling most people never hear about
  Antidepressants carry a boxed warning about suicidal thoughts and behaviour in children, adolescents and young adults. It came from pooling 24 short-term placebo-controlled trials of nine antidepressants in more than 4,400 young patients: suicidality was reported in about 4% on drug against 2% on placebo. There were no completed suicides in those trials.
  The part that usually gets lost is the age boundary, which is in the label itself. The studies did not show an increased risk above age 24, and in patients 65 and older the risk went in the other direction — it was reduced. The warning is real and it is specific, not a blanket statement about everyone who takes one.
  Worth asking
  Given my age, which side of that line am I on, what specifically should I or the people around me watch for in the first two months, and who do I call if it happens.
  PROZAC (fluoxetine) prescribing information — Boxed Warning: Suicidal Thoughts and Behaviors — U.S. Food and Drug Administration (approved labelling)
Step 4
What independent research has found since
What has been learned by people who were not selling it?
- Triptans with SSRIs or SNRIs: 14 years of records found two definite cases of serotonin syndrome in 30,928 person-years
  21 years after approval
  The labels list triptans among the drugs that raise serotonin syndrome risk with antidepressants. This is the study that measured the combination and found the risk close to zero.
  Significant findings
  Orlova, Rizzoli and Loder (JAMA Neurology, 2018) searched electronic health records of the Partners system in greater Boston for patients diagnosed with anything compatible with serotonin syndrome who had also been co-prescribed a triptan and an SSRI or SNRI, from January 2001 to December 2014. "A total of 19 017 (±3) patients were coprescribed triptans and antidepressants during the study, with a total of 30 928 person-years of exposure."
  "Serotonin syndrome was suspected in 17 patients. Only 2 patients were classified as having definite serotonin syndrome (incidence rate, 0.6 cases per 10 000 person-years of exposure; 95% CI, 0.0-1.5). Five patients were classified as having possible serotonin syndrome (incidence rate with these 5 cases added to the 2 definite cases, 2.3 cases per 10 000 person-years of exposure; 95% CI, 0.6-3.9)."
  The advisory did not change practice: "The proportion of patients with triptan prescriptions who were coprescribed an SSRI or SNRI antidepressant was relatively stable during the study, ranging from 21% to 29%." The conclusion, verbatim: "The risk of serotonin syndrome associated with concomitant use of triptans and SSRIs or SNRIs was low. Coprescription of these drugs is common and did not decrease after the 2006 FDA advisory. Our results cast doubt on the validity of the FDA advisory and suggest that it should be reconsidered."
  Worth asking
  This is the row that keeps the rest of the wave honest. A listed interaction is a warning that a mechanism exists, not a measurement of how often it hurts anyone; here, when someone measured, the answer was about one definite case per 15,000 years of combined use. If you have migraines and depression, the combination is common, and the question for the prescriber is what symptoms would prompt a call, not whether the two can be prescribed together at all.
  Association of Coprescription of Triptan Antimigraine Drugs and Selective Serotonin Reuptake Inhibitor or Selective Norepinephrine Reuptake Inhibitor Antidepressants With Serotonin Syndrome — Orlova Y, Rizzoli P, Loder E (2018)
- Half of people on an SSRI or SNRI reported weaker mushroom effects, lasting up to three months after stopping
  26 years after approval
  People taking mushrooms while on an antidepressant report a specific thing: it does less. This survey measured how often, and for how long after stopping.
  Significant findings
  Gukasyan and colleagues (Journal of Psychopharmacology, 2023) ran an online retrospective survey of people who had used psilocybin mushrooms with an antidepressant or within two years of stopping one, comparing the strength of effects with the same dose before the antidepressant or with companions not on one.
  "In reports (n = 611) of taking mushrooms with an antidepressant, probabilities [95% CI] of weaker than expected drug effects were 0.47 [0.41-0.54] (selective serotonergic reuptake inhibitors, SSRIs), 0.55 [0.44-0.67] (serotonin norepinephrine reuptake inhibitors, SNRIs) and 0.29 [0.2-0.39] (bupropion)."
  After stopping: "Following SSRI/SNRI discontinuation (n = 1,542 reports), the probability of reduced drug effects was not significantly different from the earliest post-discontinuation timepoint (within 1 week) until 3-6 months, probability = 0.3 [0.20-0.46], p = 0.001." Removing fluoxetine, which lingers in the body, did not change that. "SSRI/SNRIs appear to weaken psilocybin drug effects relative to a non-serotonergic antidepressant. This dampening effect may last as long as 3 months following antidepressant discontinuation."
  Worth asking
  A survey of people who chose to answer cannot give a true rate, and "weaker than expected" is a memory. What it does show is the shape: serotonergic antidepressants blunt psilocybin, bupropion much less, and the blunting outlasts the drug by weeks to months. The Becker 2022 row beside this one is the controlled trial, which found the good effects intact and the bad ones reduced after two weeks of escitalopram. The two are not in conflict; they measured different things over different durations. What neither supports is stopping an antidepressant to make mushrooms work, which trades a known risk for an unmeasured one.
  Attenuation of psilocybin mushroom effects during and after SSRI/SNRI antidepressant use — Gukasyan N, Griffiths RR, Yaden DB, Antoine DG, Nayak SM (2023)
- Serotonin toxicity is diagnosed by seven signs, and the rules were built from 2,222 overdoses
  6 years after approval
  Half the labels in this wave warn about serotonin syndrome. This is the paper that defined how a clinician recognises it.
  Significant findings
  Dunkley and colleagues (QJM, 2003) studied "all patients admitted to the Hunter Area Toxicology Service (HATS) following an overdose of a serotonergic drug from January 1987 to November 2002 (n = 2222)." A learning set of 473 SSRI-alone overdoses was used to find which clinical features predicted a toxicologist's diagnosis of serotonin toxicity.
  "Numerous clinical features were associated with serotonin toxicity, but only clonus (inducible, spontaneous or ocular), agitation, diaphoresis, tremor and hyperreflexia were needed for accurate prediction of serotonin toxicity as diagnosed by a clinical toxicologist. Although the learning dataset did not include patients with life-threatening serotonin toxicity, hypertonicity and maximum temperature > 38 degrees C were universal in such patients; these features were therefore added."
  The result: "These new criteria were simpler, more sensitive (84% vs. 75%) and more specific (97% vs. 96%) than Sternbach's criteria."
  Worth asking
  The everyday value of this paper is the symptom list in plain words: muscle twitching or jerking that a doctor can trigger by flexing your ankle, restlessness, sweating, tremor, overactive reflexes, and in severe cases stiffness and fever. Nausea or a headache after starting a second serotonergic drug is not on the list. If you have been told to watch for serotonin syndrome, these seven signs are what to watch for, and they are a reason to seek care the same day.
  The Hunter Serotonin Toxicity Criteria: simple and accurate diagnostic decision rules for serotonin toxicity — Dunkley EJ, Isbister GK, Sibbritt D, Dawson AH, Whyte IM (2003)
- Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major…
  21 years after approval
  Across 522 randomized trials (116,477 participants), every antidepressant including venlafaxine beat placebo for acute depression, and in head-to-head trials venlafaxine was among the more effective drugs (odds ratios 1.19-1.96) but also had among the highest dropout rates (odds ratios 1.30-2.32).
  Worth asking
  Worth asking your prescriber how venlafaxine's slightly stronger effect stacks up against its higher dropout rate for you, and what the plan is if side effects make it hard to stay on.
  Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis — Cipriani A, et al. (2018)
- Pharmacological treatments for generalised anxiety disorder: a systematic review and network meta-analysis
  22 years after approval
  In a network meta-analysis of 89 randomized trials (25,441 patients) in generalized anxiety disorder, venlafaxine lowered anxiety scores by about 2.7 Hamilton Anxiety points more than placebo (mean difference -2.69, 95% credible interval -3.50 to -1.89) and was among the drugs combining efficacy with relatively good acceptability.
  Worth asking
  Worth asking your prescriber whether venlafaxine is being chosen for your anxiety as well as mood, since it is one of the few drugs with strong trial evidence in generalized anxiety disorder.
  Pharmacological treatments for generalised anxiety disorder: a systematic review and network meta-analysis — Slee A, et al. (2019)
- Withdrawal from these medications can take months, and NICE says so
  25 years after approval
  NICE guideline NG215 covers safe prescribing and managed withdrawal for five groups of medication: opioids, benzodiazepines, gabapentinoids, Z-drugs and antidepressants. It is the closest thing there is to an official answer on how coming off actually goes.
  It states that withdrawal can be difficult and may take several months or more, that symptoms vary widely in type and severity, that they affect both physical and mental health, and that they can be delayed in onset and can persist. Two recommendations are worth quoting to a prescriber. Do not stop a medicine abruptly except in exceptional medical circumstances. And taper using a slow, stepwise reduction proportionate to the current dose, so the decrements get smaller as the dose gets lower — not a fixed cut each time.
  That last detail is the one most commonly missed. Gabapentinoids are the exception in the guideline and are reduced by a fixed amount at each step.
  Worth asking
  Can we write the taper down, what size are the steps near the end, and how long do I hold at each step before the next reduction.
  Medicines associated with dependence or withdrawal symptoms: safe prescribing and withdrawal management for adults (NG215) — National Institute for Health and Care Excellence (2022)
- Bupropion-SR, sertraline, or venlafaxine-XR after failure of SSRIs for depression
  9 years after approval
  In the NIMH-funded STAR*D trial, 727 patients whose depression had not remitted on citalopram were randomized to a switch; extended-release venlafaxine produced remission in about 25% (24.8% on HRSD-17), which was not statistically better than sertraline or bupropion-SR.
  Worth asking
  Worth asking your prescriber, if a first antidepressant did not work, why venlafaxine over another switch option — the largest trial found roughly one in four remit on any of the three switches tested.
  Bupropion-SR, sertraline, or venlafaxine-XR after failure of SSRIs for depression — Rush AJ, et al. (2006)
- In 2019 the Royal College of Psychiatrists changed its position on withdrawal
  22 years after approval
  For years people reporting long, severe antidepressant withdrawal were told it lasted a week or two. In May 2019 the Royal College of Psychiatrists published a position statement conceding the point: while withdrawal symptoms are often mild and self-limiting, there is substantial variation, and for some patients symptoms last much longer and are more severe.
  It went further and asked for changes — that guidelines and patient information recognise the potential for severe and long-lasting withdrawal, that pharmacologically-informed tapering guidance be developed, that discontinuation be tapered at a rate the patient can tolerate over potentially several months, and that clinicians actively work to tell withdrawal apart from relapse.
  One thing it explicitly does not say, and it is worth being accurate about: the College states that from a clinical perspective antidepressant use is not associated with dependence in the addiction sense. Withdrawal and dependence are not the same claim.
  Worth asking
  If I feel bad three weeks after a dose reduction, how will we decide whether that is withdrawal or my depression returning, and what do we do differently in each case.
  Position statement on antidepressants and depression (PS04/19) — Royal College of Psychiatrists (2019)
- Efficacy and tolerability of venlafaxine versus specific serotonin reuptake inhibitors in treatment of major…
  15 years after approval
  Pooling 26 randomized trials (5,858 participants), venlafaxine gave slightly higher remission (odds ratio 1.13, 95% CI 1.0-1.28) and response (odds ratio 1.17, 95% CI 1.03-1.34) than SSRIs, but about 41% more discontinuation for adverse events (odds ratio 1.41, 95% CI 1.10-1.79).
  Worth asking
  Worth asking your prescriber whether venlafaxine's small edge over SSRIs matters in your case, given it is also somewhat more likely to be stopped for side effects.
  Efficacy and tolerability of venlafaxine versus specific serotonin reuptake inhibitors in treatment of major depressive disorder: a meta-analysis of published studies — de Silva VA, Hanwella R (2012)
- Treatment-emergent sexual dysfunction related to antidepressants: a meta-analysis.
  12 years after approval
  When sexual function is actually asked about with a questionnaire rather than waited for as a spontaneous complaint, treatment-emergent sexual dysfunction ranged from 25.8% to 80.3% of patients across antidepressants, all significantly above placebo. In descending order of impact the drugs were sertraline, venlafaxine, citalopram, paroxetine, fluoxetine, imipramine, phenelzine, duloxetine, escitalopram, and fluvoxamine. Agomelatine, amineptine, bupropion, moclobemide, mirtazapine, and nefazodone showed no significant difference from placebo.
  Worth asking
  Where does the antidepressant I'm on sit on the sexual side-effect ranking, and is there a drug with a lower rate that would still treat my condition?
  Treatment-emergent sexual dysfunction related to antidepressants: a meta-analysis. — Serretti A, Chiesa A. (2009)
- Withdrawal Symptoms after Serotonin-Noradrenaline Reuptake Inhibitor Discontinuation: Systematic Review
  21 years after approval
  A systematic review of 61 reports (including 22 double-blind randomized trials) found withdrawal symptoms after stopping any SNRI, occurring most often with venlafaxine, typically starting within days and lasting weeks — and appearing even with gradual tapering.
  Worth asking
  Worth asking your prescriber, before starting or stopping venlafaxine, what the tapering plan would look like and how to tell withdrawal symptoms apart from a returning depression or anxiety.
  Withdrawal Symptoms after Serotonin-Noradrenaline Reuptake Inhibitor Discontinuation: Systematic Review — Fava GA, et al. (2018)
Step 5
What still is not known
Which questions you might reasonably have has nobody answered yet?
- Twelve weeks is the longest of the two pivotal trials. How long have you been taking it?
- Blood pressure rises with dose. Is yours being checked at the dose you are on?
- Missing doses produces withdrawal symptoms within about a day. That is a property of the drug, not a failure of yours.

The venlafaxine legal and safety record

Settled and adjudicated matters only, from primary sources — including the litigation that was decided for the manufacturer, and the cases this drug is verifiably not part of.

Read the venlafaxine legal and safety record

Deciding about venlafaxine?

Side-effect rates from venlafaxine's own label — drug vs placebo, with every caveat the label attaches
How long every medication's approval trials ran — venlafaxine beside every other drug in the library, from the same FDA record
12 questions to ask before starting a psychiatric medication — each with the study behind it
Already on it? The 10-question annual review — including the honest case for staying
How long every drug here was tested before approval — one chart, all medications

Open venlafaxine (Effexor XR) in veisund

The app has the full approval journey, the resources behind it, and people working through the same questions.

Browse the evidence library

venlafaxine (Effexor XR)

Before you stop or change your venlafaxine dose

what the venlafaxine warnings mean

the boxed warning: suicidal thoughts and behaviors, by age

the twelve other warnings, in plain words

what the trials measured, and for how long

the most common side effects, with the label’s numbers

what independent research says, in both directions

questions to ask your prescriber about venlafaxine

questions people ask

sources for this section

How long the venlafaxine trials actually ran

Boxed warning: suicidal thoughts and behaviors

What venlafaxine is FDA approved for, and the trials behind it

Side effects of venlafaxine in the approval trials

More from the venlafaxine label: drug abuse and dependence

Not a controlled substance

Stopping can produce a discontinuation syndrome

How many Americans take venlafaxine

What people report to the FDA about venlafaxine

Most-reported reactions

Drug interactions listed on the venlafaxine label

Who pays for venlafaxine

Who has been paying for venlafaxine, 2019–2024

The venlafaxine approval, step by step

What the approval was actually based on

The approval

What was added after it was on the market

What independent research has found since

What still is not known

The venlafaxine legal and safety record

Deciding about venlafaxine?

Open venlafaxine (Effexor XR) in veisund