Brian Zeidan #18

Psychotropic Medication Presentation

Venlafaxine/Fluvoxamine
Venlafaxine (Effexor, Effexor XR)
Indications: Generalized anxiety, social anxiety, major depressive
disorder, panic disorder, ADD
Dosage:
Depression:
Immediate Release
75 mg/day PO divided q8-12hr
Moderate: up to 225 mg/day PO divided q8-12 hr
Severe: up to 375 mg/day PO divided q8-12 hr
ER: 37.5 75 mg PO once daily, not to exceed 255 mg/day
Generalized Anxiety Disorder:
ER: 37.5 75 mg PO once daily, not to exceed 255 mg/day
Social Anxiety:
ER: 75 mg PO once daily, dosages >75 mg/day not show to be
more effective
Panic Disorder:
ER: 37.5 mg PO once daily for 7 days, then 75 mg once daily
ADD:
18.75-75 mg/day 150 mg/day after 4 weeks
Take with food
If discounting therapy after 7 days, taper dosage
Modifications: Mild to severe renal impairment reduce dosage by 2550%
Mild to moderate hepatic impairment- reduce dosage by
50%
MOA: SNRI antidepressant, works by blocking the transporter reuptake
of serotonin and norepinephrine. In high doses, weakly inhibits
reuptake of dopamine.
Adverse effects:
Discontinuation Syndrome
Serotonin syndrome (avoid use with MAOIs)
Suicide ideation (during initial 1-2 months, adjust therapy
accordingly)*

Brian Zeidan #18

Psychotropic Medication Presentation
Venlafaxine/Fluvoxamine

Increased BP
Insomnia, stimulant effects
Headache
Nausea
Mydriasis (may trigger angle closure attack in pts with glaucoma)
Fluvoxamine (Luvox, Luvox CR)
Indications: OCD, Social phobias (Panic disorder, PTSD: off
label)
Dosage: Typically take 4-8 wks fo to have effect
OCD:
Tablet: 50 mg qHS initially,
ER-Capsules: 100 mg PO qDay initially, can titrate in 50
mg/day/week
Dont exceed 300 mg/day
Social Phobia:
ER-Capsules: 100 mg PO qDay initially, can titrate in 50
mg/day/week
Dont exceed 300 mg/day
May be administered with food
MOA: Selective Serotonin Reuptake Inhibitor (SSRI) highest
affinity for receptor. Metabolized c-P450, half life 12-13 hrs
(single dose
Adverse Effects:

Suicidal thinking*
Serotonin Syndrome (when administered w/ MAOI, SNRIs,
TCAs)
o S/S: hyperthermia, confusion, myoclonus, CV
collapse, flushing, diarrhea, seizures
o Tx: cyproheptadine (Sertonin antagonist)
Sexual Dysfxn (decreased libido & anorgasmia)
Nausea
Vomiting
Loss of appetite
Sleep disturbances

Brian Zeidan #18

Psychotropic Medication Presentation
Venlafaxine/Fluvoxamine

*Self-destructive feelings and thoughts in patients taking

SSRIs may be the result of anxiety or akathisia. Sometimes
a person with hidden bipolar disorder receives an
antidepressant and develops an irritable manic reaction.
Some patients may recover their energy and therefore their
ability to act before mood improves or hope returns. The
danger is greatest in the first few weeks of treatment. If a
patient begins to have suicidal thoughts after many months
on an antidepressant, the drug is probably not to blame. It's
more likely to be caused by the underlying illness.
American Academy of Child & Adolescent Psychiatry &
National Inst. Of Mental Health