how long does it take effexor to work
During its premarketing assessment, multiple doses of Effexor XR were also administered to 1381 patients in Phase 3 GAD studies and 277 patients in Phase 3 Social Anxiety Disorder studies. Additional data are required to confirm this finding.
Cardiovascular side effects have frequently included vasodilatation, hypertension, palpitation, postural hypotension, and tachycardia.
Cardiovascular side effects reported in premarketing Phase 3 trials have included angina pectoris, arrhythmia, bradycardia, extrasystoles, hypotension, peripheral vascular disorder (mainly cold feet and/or cold hands), syncope, thrombophlebitis, aortic aneurysm, arteritis, first-degree atrioventricular block, bigeminy, bundle branch block, capillary fragility, cerebral ischemia, coronary artery disease, congestive heart failure, heart arrest, hematoma, cardiovascular disorder (mitral valve and circulatory disturbance), mucocutaneous hemorrhage, myocardial infarct, pallor, and sinus arrhythmia. The reported incidence of each of these effects ranges between 10% and 20% of treated patients. Tachycardia and QTc prolongation appear to occur in a dose-dependent manner.
In one case report, venlafaxine (75 mg 3 times/day) may have contributed to an elevation in defibrillation threshold in a patient with nonischemic cardiomyopathy and an implantable cardioverter- defibrillator. Although these events occurred during treatment with venlafaxine, causality has not been determined.
Musculoskeletal
Musculoskeletal side effects have included rhabdomyolysis.
Musculoskeletal side effects reported in premarketing Phase 3 trials have included arthralgia, arthritis, arthrosis, bone spurs, bursitis, leg cramps, myasthenia, tenosynovitis, bone pain, pathological fracture, muscle cramp, muscle spasms, musculoskeletal stiffness, myopathy, osteoporosis, osteosclerosis, how long does it take effexor to work fasciitis, rheumatoid arthritis, and tendon rupture. Experience with the immediate-release venlafaxine showed that sustained how long does it take effexor to work was dose-related, increasing from 3% to 7% at 100 to 300 mg/day to 13% at doses above 300 mg/day. The reduction in REM sleep is greatest early in treatment, but gradually returns towards baseline during long-term therapy; however, ROL remains long. Although these events occurred during treatment with venlafaxine, causality has not been determined.
Musculoskeletal
Musculoskeletal side effects have included rhabdomyolysis.
Musculoskeletal side effects reported in premarketing Phase 3 trials have included arthralgia, arthritis, arthrosis, bone spurs, bursitis, leg cramps, myasthenia, tenosynovitis, bone pain, pathological fracture, muscle cramp, muscle spasms, musculoskeletal stiffness, myopathy, osteoporosis, osteosclerosis, plantar fasciitis, how long does it take effexor to work arthritis, and tendon rupture. There have been postmarketing reports of toxic epidermal necrolysis.
One case of venlafaxine-induced Stevens-Johnson syndrome has been reported. It is important to emphasize that, although the events reported occurred during treatment with venlafaxine, they were not necessarily caused by it.
Events are further categorized by body system and listed in order of decreasing frequency using the following definitions: frequent adverse events are defined as those occurring on one or more occasions in at least 1/100 patients; infrequent adverse events are those occurring in 1/100 to 1/1000 patients; rare events are those occurring in fewer how long does it take effexor to work 1/1000 patients.
Body as a whole—Frequent: accidental injury, chest pain substernal, how long does it take effexor to work pain; Infrequent: face edema, intentional injury, malaise, moniliasis, neck rigidity, pelvic pain, photosensitivity reaction, suicide attempt, withdrawal syndrome; Rare: appendicitis, bacteremia, carcinoma, cellulitis.
Cardiovascular system—Frequent: migraine; Infrequent: angina pectoris, arrhythmia, extrasystoles, hypotension, peripheral vascular disorder (mainly cold feet and/or cold hands), syncope, thrombophlebitis; Rare: aortic aneurysm, arteritis, first-degree atrioventricular block, bigeminy, bradycardia, bundle branch block, capillary fragility, cardiovascular disorder (mitral valve and circulatory disturbance), cerebral ischemia, coronary artery disease, congestive heart failure, heart arrest, mucocutaneous hemorrhage, myocardial infarct, pallor.
Digestive system—Frequent: eructation; Infrequent: bruxism, colitis, dysphagia, tongue edema, esophagitis, gastritis, gastroenteritis, gastrointestinal ulcer, gingivitis, glossitis, rectal hemorrhage, hemorrhoids, melena, oral moniliasis, stomatitis, mouth ulceration; Rare: cheilitis, cholecystitis, cholelithiasis, duodenitis, esophageal spasm, hematemesis, gastrointestinal hemorrhage, gum hemorrhage, hepatitis, ileitis, jaundice, intestinal obstruction, parotitis, periodontitis, proctitis, increased salivation, soft stools, tongue discoloration.
Endocrine system—Rare: goiter, hyperthyroidism, hypothyroidism, thyroid nodule, thyroiditis.
Hemic and lymphatic system—Frequent: ecchymosis; Infrequent: anemia, leukocytosis, leukopenia, lymphadenopathy, thrombocythemia, thrombocytopenia; Rare: basophilia, bleeding time increased, cyanosis, eosinophilia, lymphocytosis, multiple myeloma, purpura.
Metabolic and nutritional—Frequent: edema, weight gain; Infrequent: alkaline phosphatase increased, dehydration, hypercholesteremia, hyperglycemia, hyperlipemia, hypokalemia, SGOT (AST) increased, SGPT (ALT) increased, thirst; Rare: alcohol intolerance, bilirubinemia, BUN increased, creatinine increased, diabetes mellitus, glycosuria, gout, healing abnormal, hemochromatosis, hypercalcinuria, hyperkalemia, hyperphosphatemia, hyperuricemia, hypocholesteremia, hypoglycemia, hyponatremia, hypophosphatemia, hypoproteinemia, how long does it take effexor to work system—Infrequent: arthritis, arthrosis, bone pain, bone spurs, bursitis, leg cramps, myasthenia, tenosynovitis; Rare: pathological fracture, how long does it take effexor to work osteoporosis, osteosclerosis, plantar fasciitis, rheumatoid arthritis, tendon rupture.
Nervous system—Frequent: trismus, vertigo; Infrequent: akathisia, apathy, ataxia, circumoral paresthesia, CNS stimulation, emotional lability, euphoria, hallucinations, hostility, hyperesthesia, hyperkinesia, hypotonia, incoordination, libido increased, manic reaction, myoclonus, neuralgia, neuropathy, psychosis, seizure, abnormal how long does it take effexor to work stupor; Rare: akinesia, alcohol abuse, aphasia, bradykinesia, buccoglossal syndrome, cerebrovascular accident, loss of consciousness, delusions, dementia, dystonia, facial paralysis, feeling drunk, abnormal gait, Guillain-Barre Syndrome, hyperchlorhydria, hypokinesia, impulse control difficulties, neuritis, nystagmus, paranoid reaction, paresis, psychotic depression, reflexes decreased, how long does it take effexor to work increased, suicidal ideation, torticollis.
Respiratory system—Frequent: bronchitis, dyspnea; Infrequent: asthma, chest congestion, epistaxis, hyperventilation, laryngismus, laryngitis, pneumonia, voice alteration; Rare: atelectasis, hemoptysis, hypoventilation, hypoxia, larynx edema, pleurisy, pulmonary embolus, sleep apnea.
Skin and appendages—Infrequent: acne, alopecia, brittle nails, contact dermatitis, dry skin, eczema, skin hypertrophy, maculopapular rash, psoriasis, urticaria; Rare: erythema nodosum, exfoliative dermatitis, lichenoid dermatitis, hair discoloration, skin discoloration, furunculosis, hirsutism, leukoderma, petechial rash, pustular rash, vesiculobullous rash, seborrhea, skin atrophy, skin striae.
Special senses—Frequent: abnormality of accommodation, abnormal vision; Infrequent: cataract, conjunctivitis, corneal how long does it take effexor to work diplopia, dry eyes, eye pain, hyperacusis, otitis media, parosmia, photophobia, taste loss, visual field defect; Rare: blepharitis, chromatopsia, conjunctival edema, deafness, exophthalmos, glaucoma, retinal hemorrhage, subconjunctival hemorrhage, keratitis, labyrinthitis, miosis, papilledema, decreased pupillary reflex, otitis externa, scleritis, uveitis.
Urogenital system—Frequent: metrorrhagia*, prostatic disorder (prostatitis and enlarged prostate)*, vaginitis*; Infrequent: albuminuria, amenorrhea*, cystitis, dysuria, hematuria, leukorrhea*, menorrhagia*, nocturia, bladder pain, breast pain, polyuria, pyuria, urinary incontinence, urinary urgency, vaginal hemorrhage*; Rare: abortion*, anuria, balanitis*, how long does it take effexor to work discharge, breast engorgement, breast enlargement, endometriosis*, fibrocystic breast, calcium crystalluria, cervicitis*, ovarian cyst*, prolonged erection*, gynecomastia (male)*, hypomenorrhea*, kidney calculus, kidney pain, kidney function how long does it take effexor to work female lactation*, mastitis, menopause*, oliguria, orchitis*, pyelonephritis, salpingitis*, urolithiasis, uterine hemorrhage*, uterine spasm*, vaginal dryness*.
* Based on the number of men and women as appropriate.
Postmarketing Reports
Voluntary reports of other adverse events temporally how long does it take effexor to work with the use of venlafaxine that have been received since market introduction and that may have no causal relationship with the use of venlafaxine include the following: agranulocytosis, anaphylaxis, angioedema, aplastic anemia, catatonia, congenital anomalies, impaired coordination and balance, CPK increased, deep vein thrombophlebitis, delirium, EKG abnormalities such as QT prolongation; cardiac arrhythmias including atrial fibrillation, supraventricular tachycardia, ventricular extrasystole, and rare reports of ventricular fibrillation and ventricular tachycardia, including torsade de pointes; toxic epidermal necrolysis/Stevens-Johnson Syndrome, erythema multiforme, extrapyramidal symptoms (including dyskinesia and tardive dyskinesia), angle-closure glaucoma, hemorrhage (including eye and gastrointestinal bleeding), hepatic events (including GGT elevation; abnormalities of unspecified liver function tests; liver damage, necrosis, or failure; and fatty liver), interstitial lung disease, involuntary movements, LDH increased, neutropenia, night sweats, pancreatitis, pancytopenia, panic, prolactin increased, renal failure, rhabdomyolysis, shock-like electrical sensations or tinnitus (in some cases, subsequent to the discontinuation of venlafaxine or tapering of dose), and syndrome of inappropriate antidiuretic hormone secretion (usually in the elderly).
There have been reports of elevated clozapine levels that were temporally associated with adverse events, including seizures, following the addition of venlafaxine. The manufacturer recommends that therapy be discontinued in patients who develop seizures.
The how long does it take effexor to work of venlafaxine on pain how long does it take effexor to work may indicate a potential analgesic effect for clinical neuropathic pain.
Nearly all selective serotonin reuptake inhibitors, mixed serotonin/norepinephrine reuptake inhibitors, and tricyclic antidepressants cause sleep abnormalities to some extent. The proposed mechanism for the development of hyponatremia involves the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) via release of antidiuretic hormone.
Use of venlafaxine has been associated with small but statistically significant increases in total cholesterol, high- density lipoprotein cholesterol and low- density lipoprotein cholesterol.
Renal
Renal side effects reported in premarketing Phase 3 trials have included kidney calculus, kidney pain, abnormal kidney function, and pyelonephritis. If the how long does it take effexor to work term for an event was so general as to be uninformative, it was replaced with a more informative term. There are not sufficient data with the use of venlafaxine extended-release at doses above 300 mg/day how long does it take effexor to work determine the incidence of sustained increases in blood pressure at these high doses.
One study has reported average systolic blood pressure increases of 1.7 to 3.4 mm Hg and how long does it take effexor to work diastolic pressure increases of 0.4 to 2.6 mm Hg. In all cases, hair re- growth occurred within 2 to 4 weeks following discontinuation of venlafaxine.
Dermatologic side effects have included sweating in up to approximately 14% of treated patients. Tests for potential dose relationships for these events (Cochran-Armitage Test, with a criterion of exact 2-sided p-value ≤ 0.05) suggested a dose-dependency for several adverse events in this list, including chills, hypertension, anorexia, nausea, agitation, dizziness, somnolence, tremor, yawning, sweating, and abnormal ejaculation.
TABLE 3 Treatment-Emergent Adverse Experience Incidence in a Dose Comparison Trial
Effexor (mg/day)
Body System/ Preferred Term
Placebo (n=92)
75 (n=89)
225 (n=89)
375 (n=88)
Body as a Whole
Abdominal pain
3.3%
3.4%
2.2%
8.0%
Asthenia
3.3%
16.9%
14.6%
14.8%
Chills
1.1%
2.2%
5.6%
6.8%
Infection
2.2%
2.2%
5.6%
2.3%
Cardiovascular System
Hypertension
1.1%
1.1%
2.2%
4.5%
Vasodilatation
0.0%
4.5%
5.6%
2.3%
Digestive System
Anorexia
2.2%
14.6%
13.5%
17.0%
Dyspepsia
2.2%
6.7%
6.7%
4.5%
Nausea
14.1%
32.6%
38.2%
58.0%
Vomiting
1.1%
7.9%
3.4%
6.8%
Nervous System
Agitation
0.0%
1.1%
2.2%
4.5%
Anxiety
4.3%
11.2%
4.5%
2.3%
Dizziness
4.3%
19.1%
22.5%
23.9%
Insomnia
9.8%
22.5%
20.2%
13.6%
Libido decreased
1.1%
2.2%
1.1%
5.7%
Nervousness
4.3%
21.3%
13.5%
12.5%
Somnolence
4.3%
16.9%
18.0%
26.1%
Tremor
0.0%
1.1%
2.2%
10.2%
Respiratory System
Yawn
0.0%
4.5%
5.6%
8.0%
Skin and Appendages
Sweating
5.4%
6.7%
12.4%
19.3%
Special Senses
Abnormality of accommodation
0.0%
9.1%
7.9%
5.6%
Urogenital System
Abnormal ejaculation/orgasm
0.0%
4.5%
2.2%
12.5%
Impotence
0.0%
5.8%
2.1%
3.6%
(Number of men)
(n=63)
(n=52)
(n=48)
(n=56)
Adaptation to Certain Adverse Events
Over a 6-week period, there was evidence of adaptation to some adverse events with continued therapy (eg, dizziness and nausea), but less to other effects (eg, abnormal ejaculation and dry mouth).
Vital Sign Changes
Effexor (venlafaxine hydrochloride) treatment (averaged over all dose groups) in clinical trials was associated with a mean increase in pulse rate of approximately 3 beats per minute, compared to no change for placebo. Although these events occurred during treatment with venlafaxine, causality has not been determined.
There have been postmarketing reports of angioedema.
Genitourinary
One case of unexpected orgasm and subsequent ejaculation with no erection as well as orgasmic episodes with no ejaculation or erection has also been reported. This increase was duration dependent over the study how long does it take effexor to work and tended to be greater with higher doses. ough increased, and dysmenorrhea3.
— Incidence less than 1%.
2 Incidence based on number of male patients.
3 Incidence based on number of female patients.
Body as a Whole
Headache
25%
24%
Asthenia
12%
6%
Infection
6%
5%
Chills
3%
—
Chest pain
2%
1%
Trauma
2%
1%
Cardiovascular
Vasodilatation
4%
3%
Increased blood pressure/hypertension
2%
—
Tachycardia
2%
—
Postural hypotension
1%
—
Dermatological
Sweating
12%
3%
Rash
3%
2%
Pruritus
1%
—
Gastrointestinal
Nausea
37%
11%
Constipation
15%
7%
Anorexia
11%
2%
Diarrhea
8%
7%
Vomiting
6%
2%
Dyspepsia
5%
4%
Flatulence
3%
2%
Metabolic
Weight loss
1%
—
Nervous System
Somnolence
23%
9%
Dry mouth
22%
11%
Dizziness
19%
7%
Insomnia
18%
10%
Nervousness
13%
6%
Anxiety
6%
3%
Tremor
5%
1%
Abnormal dreams
4%
3%
Hypertonia
3%
2%
Paresthesia
3%
2%
Libido decreased
2%
—
Agitation
2%
—
Confusion
2%
1%
Thinking abnormal
2%
1%
Depersonalization
1%
—
Depression
1%
—
Urinary retention
1%
—
Twitching
1%
—
Respiration
Yawn
3%
—
Special Senses
Blurred vision
6%
2%
Taste perversion
2%
—
Tinnitus
2%
—
Mydriasis
2%
—
Urogenital System
Abnormal ejaculation/ orgasm
12%2
—2
Impotence
6%2
—2
Urinary frequency
3%
2%
Urination impaired
2%
—
Orgasm disturbance
2%3
—3
Dose Dependency of Adverse Events
A comparison of adverse event rates in a fixed-dose study comparing Effexor (venlafaxine how long does it take effexor to work 75, 225, and 375 mg/day with placebo revealed a dose dependency for some of the more common adverse events associated with Effexor use, as shown in the table that follows. Some of these drugs (i.e., bupropion, mirtazapine, nefazodone, trazodone, trimipramine) appear to have a modest or minimal effect on REM sleep.
Cardiovascular
There are reports of sustained hypertension (some requiring immediate treatment). The onset of venlafaxine- associated interstitial pneumonitis has ranged from 1 to 18 months after initial exposure to the drug and symptomatic improvement occurred after discontinuation of venlafaxine and treatment with corticosteroids.
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More Effexor resources
Effexor Detailed Consumer Information (PDR)
Effexor Prescribing Information (FDA)
Effexor Consumer Overview
Effexor Advanced Consumer (Micromedex) - Includes Dosage Information
Effexor MedFacts Consumer Leaflet (Wolters Kluwer)
Venlafaxine Prescribing Information (FDA)
Effexor XR Prescribing Information (FDA)
Effexor XR Extended-Release Capsules MedFacts Consumer Leaflet (Wolters Kluwer). ough increased, and dysmenorrhea3.
— Incidence less than 1%.
2 Incidence based on number of male patients.
3 Incidence based on number of female patients.
Body as a Whole
Headache
25%
24%
Asthenia
12%
6%
Infection
6%
5%
Chills
3%
—
Chest pain
2%
1%
Trauma
2%
1%
Cardiovascular
Vasodilatation
4%
3%
Increased blood pressure/hypertension
2%
—
Tachycardia
2%
—
Postural hypotension
1%
—
Dermatological
Sweating
12%
3%
Rash
3%
2%
Pruritus
1%
—
Gastrointestinal
Nausea
37%
11%
Constipation
15%
7%
Anorexia
11%
2%
Diarrhea
8%
7%
Vomiting
6%
2%
Dyspepsia
5%
4%
Flatulence
3%
2%
Metabolic
Weight loss
1%
—
Nervous System
Somnolence
23%
9%
Dry mouth
22%
11%
Dizziness
19%
7%
Insomnia
18%
10%
Nervousness
13%
6%
Anxiety
6%
3%
Tremor
5%
1%
Abnormal dreams
4%
3%
Hypertonia
3%
2%
Paresthesia
3%
2%
Libido decreased
2%
—
Agitation
2%
—
Confusion
2%
1%
Thinking abnormal
2%
1%
Depersonalization
1%
—
Depression
1%
—
Urinary retention
1%
—
Twitching
1%
—
Respiration
Yawn
3%
—
Special Senses
Blurred vision
6%
2%
Taste perversion
2%
—
Tinnitus
2%
—
Mydriasis
2%
—
Urogenital System
Abnormal ejaculation/ orgasm
12%2
—2
Impotence
6%2
—2
Urinary frequency
3%
2%
Urination impaired
2%
—
Orgasm disturbance
2%3
—3
Dose Dependency of Adverse Events
A comparison of adverse event rates in a fixed-dose study comparing Effexor (venlafaxine hydrochloride) 75, 225, and 375 mg/day with placebo revealed a dose dependency for some of the more common adverse events associated with Effexor use, as shown in the table that follows. These antidepressants have marked dose-dependent effects on rapid eye movement (REM) sleep, causing reductions in the overall amount of REM sleep over the night and delays the first entry into REM sleep (increased REM sleep onset latency (ROL)), both in healthy subjects and depressed patients. The antidepressants that increase serotonin function appear to have the greatest effect on REM sleep.
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