Venlafaxine: Difference between revisions

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| elimination_half-life = 5±2 h (parent compound for immediate release preparations), 15±6 h (parent compound for extended release preparations), 11±2 h (active metabolite)<ref name=TGA/><ref name="Effexor FDA label" />

 

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Venlafaxine is used primarily for the treatment of [[major depressive disorder|depression]], [[general anxiety disorder]], [[social phobia]], [[panic disorder]], and [[vasomotor symptoms]].<ref name=AHFS>{{cite web |title=venlafaxine-hydrochloride |url=https://www.drugs.com/monograph/venlafaxine-hydrochloride.html |work=The American Society of Health-System Pharmacists |access-date=3 April 2011 |archive-date=27 November 2020 |archive-url=https://web.archive.org/web/20201127001402/https://www.drugs.com/monograph/venlafaxine-hydrochloride.html |url-status=live }}</ref>

 

Due to its action on both the [[Serotonin|serotoninergic]] and [[adrenergic]] systems, venlafaxine is also used as a treatment to reduce episodes of [[cataplexy]], a form of muscle weakness, in patients with the [[sleep disorder]] [[narcolepsy]].<ref>{{cite web |title=Medications |publisher=Stanford University School of Medicine, Center for Narcolepsy |date=7 February 2003 |url=http://med.stanford.edu/school/Psychiatry/narcolepsy/medications.html |access-date=3 September 2007 |archive-url=https://web.archive.org/web/20070821090305/http://med.stanford.edu/school/Psychiatry/narcolepsy/medications.html |archive-date=21 August 2007 |url-status=dead }}</ref> Some open-label and three double-blind studies have suggested the efficacy of venlafaxine in the treatment of [[attention deficit-hyperactivity disorder]] (ADHD).<ref>{{cite journal | vauthors = Ghanizadeh A, Freeman RD, Berk M | title = Efficacy and adverse effects of venlafaxine in children and adolescents with ADHD: a systematic review of non-controlled and controlled trials | journal = Reviews on Recent Clinical Trials | volume = 8 | issue = 1 | pages = 2–8 | date = March 2013 | pmid = 23157376 | doi = 10.2174/1574887111308010002 }}</ref> Clinical trials have found possible efficacy in those with [[post-traumatic stress disorder]] (PTSD).<ref>{{cite journal | vauthors = Pae CU, Lim HK, Ajwani N, Lee C, Patkar AA | title = Extended-release formulation of venlafaxine in the treatment of post-traumatic stress disorder | journal = Expert Review of Neurotherapeutics | volume = 7 | issue = 6 | pages = 603–615 | date = June 2007 | pmid = 17563244 | doi = 10.1586/14737175.7.6.603 | s2cid = 25215502 }}</ref> Case reports, open trials and blinded comparisons with established medications have suggested the efficacy of venlafaxine in the treatment of [[obsessive–compulsive disorder]].<ref>{{cite journal | vauthors = Phelps NJ, Cates ME | title = The role of venlafaxine in the treatment of obsessive-compulsive disorder | journal = The Annals of Pharmacotherapy | volume = 39 | issue = 1 | pages = 136–140 | date = January 2005 | pmid = 15585743 | doi = 10.1345/aph.1E362 | s2cid = 30973410 }}</ref>

 

A comparative meta-analysis of 21 major antidepressants found that venlafaxine, [[agomelatine]], [[amitriptyline]], [[escitalopram]], [[mirtazapine]], [[paroxetine]], and [[vortioxetine]] were more effective than other antidepressants, although the quality of many comparisons was assessed as low or very low.<ref name=pmid19185342>{{cite journal | vauthors = Cipriani A, Furukawa TA, Salanti G, Geddes JR, Higgins JP, Churchill R, Watanabe N, Nakagawa A, Omori IM, McGuire H, Tansella M, Barbui C | title = Comparative efficacy and acceptability of 12 new-generation antidepressants: a multiple-treatments meta-analysis | journal = Lancet | volume = 373 | issue = 9665 | pages = 746–758 | date = February 2009 | pmid = 19185342 | doi = 10.1016/S0140-6736(09)60046-5 | s2cid = 35858125 }}</ref><ref>{{cite journal | vauthors = Cipriani A, Furukawa TA, Salanti G, Chaimani A, Atkinson LZ, Ogawa Y, Leucht S, Ruhe HG, Turner EH, Higgins JP, Egger M, Takeshima N, Hayasaka Y, Imai H, Shinohara K, Tajika A, Ioannidis JP, Geddes JR | title = 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 | journal = Lancet | volume = 391 | issue = 10128 | pages = 1357–1366 | date = April 2018 | pmid = 29477251 | pmc = 5889788 | doi = 10.1016/S0140-6736(17)32802-7 }}</ref>

 

Studies have shown that the extended release is superior to the immediate release form of venlafaxine.<ref name="Thase Asami Wajsbrot Dorries 2017 pp. 317–326"/>

 

 

 

{{see also|List of adverse effects of venlafaxine}}

 

Venlafaxine can increase eye pressure, so those with [[glaucoma]] may require more frequent eye checks.<ref name="Effexor FDA label" />

 

 

The US [[Food and Drug Administration]] (FDA) requires all antidepressants, including venlafaxine, to carry a [[black box warning]] with a generic warning about a possible suicide risk.{{citation needed|date=May 2021}}

 

A study conducted in Finland followed more than 15,000 patients for 3.4 years. Venlafaxine increased suicide risk by 60% (statistically significant), as compared to no treatment. At the same time, [[fluoxetine]] (Prozac) halved the suicide risk.<ref name="pmid17146010">{{cite journal | vauthors = Tiihonen J, Lönnqvist J, Wahlbeck K, Klaukka T, Tanskanen A, Haukka J | title = Antidepressants and the risk of suicide, attempted suicide, and overall mortality in a nationwide cohort | journal = Archives of General Psychiatry | volume = 63 | issue = 12 | pages = 1358–1367 | date = December 2006 | pmid = 17146010 | doi = 10.1001/archpsyc.63.12.1358 | doi-access = free }}</ref>

 

 

An analysis of clinical trials by the FDA statisticians showed the incidence of suicidal behaviour among the adults on venlafaxine to be not significantly different from fluoxetine or [[placebo]].<ref name=FDA>{{cite web |url=https://www.fda.gov/ohrms/dockets/ac/06/briefing/2006-4272b1-01-FDA.pdf |title=Overview for December 13 Meeting of Psychopharmacologic Drugs Advisory Committee |access-date=20 June 2007 |date=16 November 2006 |publisher=Food and Drug Administration: Center for Drug Evaluation and Research |archive-url=https://web.archive.org/web/20070316092329/https://www.fda.gov/ohrms/dockets/ac/06/briefing/2006-4272b1-01-FDA.pdf |archive-date=16 March 2007 |url-status=live}}</ref>

Venlafaxine is contraindicated in children, adolescents and young adults. In children and adolescents with depression, venlafaxine increases the risk of suicidal thoughts or attempts.<ref name=":0" /><ref name=":1" /><ref name=":2" /><ref name=":3" /><ref name=":4" /><ref name=":5" />

 

The development of a potentially life-threatening [[serotonin syndrome]] (also classified as "serotonin toxicity")<ref name="Dunkley">{{cite journal | vauthors = Dunkley EJ, Isbister GK, Sibbritt D, Dawson AH, Whyte IM | title = The Hunter Serotonin Toxicity Criteria: simple and accurate diagnostic decision rules for serotonin toxicity | journal = QJM | volume = 96 | issue = 9 | pages = 635–642 | date = September 2003 | pmid = 12925718 | doi = 10.1093/qjmed/hcg109 | doi-access = free }}</ref> may occur with venlafaxine treatment, particularly with concomitant use of serotonergic drugs, including but not limited to [[SSRI]]s and [[Serotonin-norepinephrine reuptake inhibitor|SNRI]]s, many hallucinogens such as [[tryptamine]]s and [[phenethylamine]]s (e.g., [[LSD]]/[[Lysergic acid amide|LSA]], [[Dimethyltryptamine|DMT]], [[MDMA]], [[mescaline]]), [[dextromethorphan]] (DXM), [[tramadol]], [[tapentadol]], [[pethidine]] (meperidine) and [[triptan]]s and with drugs that impair metabolism of serotonin (including [[MAOI]]s).{{Citation needed|date=January 2021}} Serotonin syndrome symptoms may include mental status changes (e.g. agitation, hallucinations, coma), autonomic instability (e.g. tachycardia, labile blood pressure, hyperthermia), neuromuscular aberrations (e.g. hyperreflexia, incoordination), or gastrointestinal symptoms (e.g. nausea, vomiting, diarrhea). Venlafaxine-induced serotonin syndrome has also been reported when venlafaxine has been taken in isolation in overdose.<ref name="Kolecki">{{cite journal | vauthors = Kolecki P | title = Isolated venlafaxine-induced serotonin syndrome | journal = The Journal of Emergency Medicine | volume = 15 | issue = 4 | pages = 491–493 | date = July–August 1997 | pmid = 9279702 | doi = 10.1016/S0736-4679(97)00078-4 }}</ref> An abortive serotonin syndrome state, in which some but not all of the symptoms of the full serotonin syndrome are present, has been reported with venlafaxine at mid-range dosages (150&nbsp;mg per day).<ref>{{cite web |url=http://www.priory.com/psych/venhall.htm |title=Hallucinations as a side effect of venlafaxine treatment |access-date=17 June 2008 |vauthors=Ebert D, etal |publisher=Psychiatry On-line |archive-date=21 May 2008 |archive-url=https://web.archive.org/web/20080521183032/http://www.priory.com/psych/venhall.htm |url-status=live }}</ref> A case of a patient with serotonin syndrome induced by low-dose venlafaxine (37.5&nbsp;mg per day) has also been reported.<ref name="pmid12549949">{{cite journal | vauthors = Pan JJ, Shen WW | title = Serotonin syndrome induced by low-dose venlafaxine | journal = The Annals of Pharmacotherapy | volume = 37 | issue = 2 | pages = 209–211 | date = February 2003 | pmid = 12549949 | doi = 10.1345/aph.1C021 }}</ref>

 

There are few well-controlled studies of venlafaxine in pregnant women. A study released in May 2010 by the Canadian Medical Association Journal suggests use of venlafaxine doubles the risk of [[miscarriage]].<ref>{{cite journal | vauthors = Broy P, Bérard A | title = Gestational exposure to antidepressants and the risk of spontaneous abortion: a review | journal = Current Drug Delivery | volume = 7 | issue = 1 | pages = 76–92 | date = January 2010 | pmid = 19863482 | doi = 10.2174/156720110790396508 | s2cid = 28153571 }}</ref><ref>{{cite journal | vauthors = Nakhai-Pour HR, Broy P, Bérard A | title = Use of antidepressants during pregnancy and the risk of spontaneous abortion | journal = CMAJ | volume = 182 | issue = 10 | pages = 1031–1037 | date = July 2010 | pmid = 20513781 | pmc = 2900326 | doi = 10.1503/cmaj.091208 }}</ref> Consequently, venlafaxine should only be used during pregnancy if clearly needed.<ref name="Effexor FDA label" /> A large case-control study done as part of the National Birth Defects Prevention Study and published in 2012 found a significant association of venlafaxine use during pregnancy and several birth defects including anencephaly, cleft palate, septal heart defects and coarctation of the aorta.<ref name="pmid23281074">{{cite journal | vauthors = Polen KN, Rasmussen SA, Riehle-Colarusso T, Reefhuis J | title = Association between reported venlafaxine use in early pregnancy and birth defects, national birth defects prevention study, 1997-2007 | journal = Birth Defects Research. Part A, Clinical and Molecular Teratology | volume = 97 | issue = 1 | pages = 28–35 | date = January 2013 | pmid = 23281074 | pmc = 4484721 | doi = 10.1002/bdra.23096 }}</ref> Prospective studies have not shown any statistically significant [[congenital malformation]]s.<ref>{{cite journal | vauthors = Gentile S | title = The safety of newer antidepressants in pregnancy and breastfeeding | journal = Drug Safety | volume = 28 | issue = 2 | pages = 137–152 | year = 2005 | pmid = 15691224 | doi = 10.2165/00002018-200528020-00005 | s2cid = 24798891 }}</ref> There have, however, been some reports of self-limiting effects on newborn infants.<ref>{{cite journal | vauthors = de Moor RA, Mourad L, ter Haar J, Egberts AC | title = [Withdrawal symptoms in a neonate following exposure to venlafaxine during pregnancy] | journal = Nederlands Tijdschrift voor Geneeskunde | volume = 147 | issue = 28 | pages = 1370–1372 | date = July 2003 | pmid = 12892015 }}</ref> As with other [[serotonin reuptake inhibitor]]s (SRIs), these effects are generally short-lived, lasting only 3 to 5 days,<ref>{{cite journal | vauthors = Ferreira E, Carceller AM, Agogué C, Martin BZ, St-André M, Francoeur D, Bérard A | title = Effects of selective serotonin reuptake inhibitors and venlafaxine during pregnancy in term and preterm neonates | journal = Pediatrics | volume = 119 | issue = 1 | pages = 52–59 | date = January 2007 | pmid = 17200271 | doi = 10.1542/peds.2006-2133 | s2cid = 27443298 }}</ref> and rarely resulting in severe complications.<ref name="pmid15900008">{{cite journal | vauthors = Moses-Kolko EL, Bogen D, Perel J, Bregar A, Uhl K, Levin B, Wisner KL | title = Neonatal signs after late in utero exposure to serotonin reuptake inhibitors: literature review and implications for clinical applications | journal = JAMA | volume = 293 | issue = 19 | pages = 2372–2383 | date = May 2005 | pmid = 15900008 | doi = 10.1001/jama.293.19.2372 | s2cid = 30284439 }}</ref>

 

According to the [[International Society for Bipolar Disorders|ISBD]] Task Force report on antidepressant use in bipolar disorder,<ref>{{cite journal | vauthors = Pacchiarotti I, Bond DJ, Baldessarini RJ, Nolen WA, Grunze H, Licht RW, Post RM, Berk M, Goodwin GM, Sachs GS, Tondo L, Findling RL, Youngstrom EA, Tohen M, Undurraga J, González-Pinto A, Goldberg JF, Yildiz A, Altshuler LL, Calabrese JR, Mitchell PB, Thase ME, Koukopoulos A, Colom F, Frye MA, Malhi GS, Fountoulakis KN, Vázquez G, Perlis RH, Ketter TA, Cassidy F, Akiskal H, Azorin JM, Valentí M, Mazzei DH, Lafer B, Kato T, Mazzarini L, Martínez-Aran A, Parker G, Souery D, Ozerdem A, McElroy SL, Girardi P, Bauer M, Yatham LN, Zarate CA, Nierenberg AA, Birmaher B, Kanba S, El-Mallakh RS, Serretti A, Rihmer Z, Young AH, Kotzalidis GD, MacQueen GM, Bowden CL, Ghaemi SN, Lopez-Jaramillo C, Rybakowski J, Ha K, Perugi G, Kasper S, Amsterdam JD, Hirschfeld RM, Kapczinski F, Vieta E | title = The International Society for Bipolar Disorders (ISBD) task force report on antidepressant use in bipolar disorders | journal = The American Journal of Psychiatry | volume = 170 | issue = 11 | pages = 1249–1262 | date = November 2013 | pmid = 24030475 | pmc = 4091043 | doi = 10.1176/appi.ajp.2013.13020185 | doi-access = free }}</ref> during the course of treatment for depression with those suffering from bipolar I and II, venlafaxine "appears to carry a particularly high risk of inducing pathologically elevated states of mood and behavior." Because venlafaxine appears to be more likely than [[Selective serotonin reuptake inhibitor|SSRIs]] and [[bupropion]] to induce mania and mixed episodes in these patients, provider discretion is advised through "carefully evaluating individual clinical cases and circumstances."

 

A rare but serious side effect of venlafaxine is liver injury. It appears to affect both male and female patients with a median age of 44. Cessation of venlafaxine is one of the appropriate measures of management. While the mechanism of venlafaxine-related liver injury remains unclear, findings suggest that it may be related to a CYP2D6 polymorphism.<ref name="Stadlmann Portmann Tschopp Terracciano 2012 pp. 1724–1728">{{cite journal | vauthors = Stadlmann S, Portmann S, Tschopp S, Terracciano LM | title = Venlafaxine-induced cholestatic hepatitis: case report and review of literature | journal = The American Journal of Surgical Pathology | volume = 36 | issue = 11 | pages = 1724–1728 | date = November 2012 | pmid = 23073329 | doi = 10.1097/pas.0b013e31826af296 | publisher = Ovid Technologies (Wolters Kluwer Health) }}</ref>

 

Most patients overdosing with venlafaxine develop only mild symptoms. Plasma venlafaxine concentrations in overdose survivors have ranged from 6 to 24&nbsp;mg/L, while postmortem blood levels in fatalities are often in the 10–90&nbsp;mg/L range.<ref>{{cite book| vauthors = Baselt R |title=Disposition of Toxic Drugs and Chemicals in Man |edition=8th |publisher=Biomedical Publications |location=Foster City, CA |year=2008 |pages=1634–1637 |isbn=978-0-9626523-7-0}}</ref> Published retrospective studies report that venlafaxine overdosage may be associated with an increased risk of fatal outcome compared to that observed with SSRI antidepressant products, but lower than that for tricyclic antidepressants. Healthcare professionals are advised to prescribe Effexor and Effexor XR in the smallest quantity of capsules consistent with good patient management to reduce the risk of overdose.<ref>{{cite web |year=2006 |title=Wyeth Letter to Health Care Providers |publisher=Wyeth Pharmaceuticals Inc |url=https://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm150546.htm |access-date=6 August 2009 |archive-date=27 August 2009 |archive-url=https://web.archive.org/web/20090827092615/http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm150546.htm |url-status=live }}</ref> It is usually reserved as a second-line treatment for depression due to a combination of its superior efficacy to the first-line treatments like fluoxetine, paroxetine and citalopram and greater frequency of side effects like nausea, headache, insomnia, drowsiness, dry mouth, constipation, sexual dysfunction, sweating and nervousness.<ref name=pmid19185342 /><ref>{{cite journal | vauthors = Taylor D, Lenox-Smith A, Bradley A | title = A review of the suitability of duloxetine and venlafaxine for use in patients with depression in primary care with a focus on cardiovascular safety, suicide and mortality due to antidepressant overdose | journal = Therapeutic Advances in Psychopharmacology | volume = 3 | issue = 3 | pages = 151–161 | date = June 2013 | pmid = 24167687 | pmc = 3805457 | doi = 10.1177/2045125312472890 }}</ref>

 

There is no specific [[antidote]] for venlafaxine, and management is generally supportive, providing treatment for the immediate symptoms. Administration of [[activated charcoal]] can prevent absorption of the drug. Monitoring of cardiac rhythm and vital signs is indicated. Seizures are managed with [[benzodiazepine]]s or other anticonvulsants. [[Forced diuresis]], [[hemodialysis]], [[exchange transfusion]], or [[hemoperfusion]] are unlikely to be of benefit in hastening the removal of venlafaxine, due to the drug's high [[volume of distribution]].<ref>{{cite journal | vauthors = Hanekamp BB, Zijlstra JG, Tulleken JE, Ligtenberg JJ, van der Werf TS, Hofstra LS | title = Serotonin syndrome and rhabdomyolysis in venlafaxine poisoning: a case report | journal = The Netherlands Journal of Medicine | volume = 63 | issue = 8 | pages = 316–318 | date = September 2005 | pmid = 16186642 | url = http://www.njmonline.nl/getpdf.php?id=432 | access-date = 6 November 2013 | url-status = live | format = PDF | archive-url = https://web.archive.org/web/20160304231924/http://www.njmonline.nl/getpdf.php?id=432 | archive-date = 4 March 2016 }}</ref>

 

{{Main|Antidepressant withdrawal syndrome}}

 

The higher risk and increased severity of withdrawal symptoms relative to other antidepressants may be related to the short [[biological half-life|half-life]] of venlafaxine and its active metabolite.<ref name="pmid11347722">{{cite journal | vauthors = Haddad PM | title = Antidepressant discontinuation syndromes | journal = Drug Safety | volume = 24 | issue = 3 | pages = 183–197 | date = March 2001 | pmid = 11347722 | doi = 10.2165/00002018-200124030-00003 | s2cid = 26897797 }}</ref> After stopping venlafaxine, the levels of both serotonin and [[norepinephrine]] decrease, leading to the hypothesis that the withdrawal symptoms could result from an overly rapid reduction of neurotransmitter levels.<ref name="PMC1681629">{{cite journal | vauthors = Campagne DM | title = Venlafaxine and serious withdrawal symptoms: warning to drivers | journal = MedGenMed | volume = 7 | issue = 3 | pages = 22 | date = July 2005 | pmid = 16369248 | pmc = 1681629 }}</ref>

 

{| class="wikitable" style = "float: right; margin-left:15px; text-align:center"

!Transporter

!''K''_i [nM]<ref>{{cite journal | vauthors = Bymaster FP, Dreshfield-Ahmad LJ, Threlkeld PG, Shaw JL, Thompson L, Nelson DL, Hemrick-Luecke SK, Wong DT | title = Comparative affinity of duloxetine and venlafaxine for serotonin and norepinephrine transporters in vitro and in vivo, human serotonin receptor subtypes, and other neuronal receptors | journal = Neuropsychopharmacology | volume = 25 | issue = 6 | pages = 871–880 | date = December 2001 | pmid = 11750180 | doi = 10.1016/S0893-133X(01)00298-6 | doi-access = free }}</ref>

|-

|[[Serotonin transporter|SERT]]

|7647

|{{abbr|ND|No data}}

|}

{| class="wikitable" style = "float: right; margin-left:15px; text-align:center"

| [[Alpha-1A adrenergic receptor|α_1A]] || >1000 || Human

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Venlafaxine indirectly affects [[opioid receptor]]s as well as the α₂-adrenergic receptor, and was shown to increase pain threshold in mice. These benefits with respect to pain were reversed with [[naloxone]], an opioid antagonist, thus supporting an opioid mechanism.<ref>{{cite book | vauthors = Stern TA, Fava M, Wilens TE, Rosenbaum JF |title=Massachusetts General Hospital Comprehensive Clinical Psychiatry |date=2015 |publisher=Elsevier Health Sciences |isbn=978-0-323-29507-9 |page=860 |url=https://books.google.com/books?id=deR1BwAAQBAJ&pg=PA860 |access-date=9 May 2020 |archive-date=27 August 2021 |archive-url=https://web.archive.org/web/20210827181241/https://books.google.com/books?id=deR1BwAAQBAJ&pg=PA860 |url-status=live }}</ref><ref>{{cite book |title=The Opioid System as the Interface between the Brain's Cognitive and Motivational Systems |date=2018 |publisher=Academic Press |isbn=978-0-444-64168-7 |page=73 |url=https://books.google.com/books?id=sEFyDwAAQBAJ&pg=PA73 |access-date=9 May 2020 |archive-date=27 August 2021 |archive-url=https://web.archive.org/web/20210827181238/https://books.google.com/books?id=sEFyDwAAQBAJ&pg=PA73 |url-status=live }}</ref>

Venlafaxine extended release is chemically the same as normal venlafaxine. The extended release (controlled release) version distributes the release of the drug into the [[gastrointestinal tract]] over a longer period than normal venlafaxine. This results in a lower peak plasma concentration. Studies have shown that the extended release formula has a lower incidence of [[nausea]] as a side effect, resulting in better compliance.<ref>{{cite journal | vauthors = DeVane CL | title = Immediate-release versus controlled-release formulations: pharmacokinetics of newer antidepressants in relation to nausea | journal = The Journal of Clinical Psychiatry | volume = 64 | issue = Suppl 18 | pages = 14–19 | year = 2003 | pmid = 14700450 }}</ref>

 

==Society and culture==

[[Image:EffexorXR 75and150mg.png|thumbnail|right |150px |Effexor XR 75 mg and 150 mg capsules]]

[[Image:Venlafaxin Krka.jpg|thumbnail|right |150px |Generic 75mg (top) and 150mg (bottom) venlafaxine capsules by Krka]]

As of January 2020, venlafaxine is marketed under many brand names worldwide, many with alternative extended release forms (not shown): Adefaxin, Alenthus, Altven, Alventa, Amfax, Anapresin, Ansifix, Arafaxina, Argofan, Arrow Venlafaxine, Axone, Axyven, Benolaxe, Blossom, Calmdown, Dalium, Defaxine, Depefex, Depretaxer, Deprevix, Deprexor, Deprixol, Depurol, Desinax, Dislaven, Dobupal, Duofaxin, Easyfor, Ectien, Eduxon, Efastad, Efaxin, Efaxine, Efectin, Efegen, Efevelon, Efevelone, Efexiva, Efexor, Effegad, Effexine, Effexor, Elafax, Elaxine, Elify, Enpress, Enlafax, Envelaf, Falven, Faxigen, Faxine, Faxiprol, Faxiven, Faxolet, Flavix, Flaxen, Fobiless, Ganavax, Idixor, Idoxen, Intefred, Illovex, Lafactin, Lafaxin, Lanvexin, Laroxin, Levest, Limbic, Linexel, Maxibral, Mazda, Melocin, Memomax, Mezine, Neoxacina, Neoxacina, Nervix, Norafexine, Norezor, Norpilen, Noviser, Nulev, Odiven, Olwexya, Oriven, Paxifar, Politid, Pracet, Prefaxine, Psiseven, Quilarex, Rafax, Senexon, Sentidol, Sentosa, Serosmine, Seroxine, Sesaren, Subelan, Sulinex, Sunveniz, Sunvex, Symfaxin, Tedema, Tifaxin, Tonpular, Trevilor, Tudor, Vafexin, Valosine, Vandral, Velaf, Velafax, Velahibin, Velaxin, Velaxor, Velept, Velpine, Venax, Venaxin, Venaxx, Vencarm, Vencontrol, Vendep, Venegis, Venex, Venexor, Venfalex, Venfax, Ven-Fax, Venfaxine, Venforin, Venforspine, Veniba, Veniz, Venjoy, Venla, Venlabax, Venlablue, Venlabrain, Venladep, Venladex, Venladoz, Venlaf, Venlafab, Venlafaxin, Venlafaxina, Venlafaxine, Venlagamma, Venlalic, Venlamax, Venlamylan, Venlaneo, Venlapine, Venla-Q, Venlasand, Venlatrin, Venlavitae, Venlax, Venlaxin, Venlaxine, Venlaxor, Venlazid, Venlectine, Venlifax, Venlift, Venlix, Venlobax, Venlofex, Venlor, Venorion, Venozap, Vensate, Ventab, Venxin, Venxor, Vextor, Venzip, Vexamode, Vfax, Viepax, ViePax, Voxafen, Zacalen, Zanfexa, Zaredrop, Zarelis, Zarelix, and Zenexor.<ref name="brands">{{cite web|url=https://www.drugs.com/international/venlafaxine.html|title=Venlafaxine|date=January 2020|website=Drugs.com|publisher=Drugsite Trust|location=Dallas, Texas<!--data hosting location-->|at=Brand Names|access-date=24 January 2020|archive-date=6 September 2020|archive-url=https://web.archive.org/web/20200906074924/https://www.drugs.com/international/venlafaxine.html|url-status=live}}</ref>

 

 

Veterinary overdose in [[dog]]s is very well treated by [[Cyproheptadine]] HCl.<ref name="Gupta-2012">{{cite book | edition=2 | year=2012 | publisher=[[Academic Press]] | publication-place=[[Amsterdam]] [[Boston]] | veditors = Gupta RC | title=Veterinary Toxicology : Basic and Clinical Principles | isbn=978-0-12-385926-6 | oclc=794491298 | pages=xii+1438}}</ref>{{rp|page=1371}}

 

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