Do You Need To Taper Effexor XR?
In our latest question and answer, the pharmacist discusses why Effexor XR should be tapered slowly if you are going off the medication.
I have been taking Effexor XR 150 mg for depression. Is it likely that I will experience withdrawal symptoms if I abruptly stop or should I taper? I am concerned after reading how difficult it is to stop this medication.
Apr 28, 2021- Effexor XR should be gradually tapered rather than stopped abruptly because suddenly stopping can cause withdrawal symptoms like dizziness, nausea, flu-like symptoms, and electrical sensations.
- The risk of withdrawal symptoms depends on how long you've taken the medication, your dose, and how quickly you stop it.
- You should work with your doctor or pharmacist to create a personalized tapering plan rather than changing your dose on your own.
Answer
Hi there and thanks for reaching out!
Effexor XR (venlafaxine extended-release) should not be abruptly stopped as doing so can result in withdrawal symptoms, which can be severe.
The prescribing information for Effexor XR states the following:
A gradual reduction in the dose, rather than abrupt cessation, is recommended whenever possible. In clinical studies with Effexor XR, tapering was achieved by reducing the daily dose by 75 mg at one-week intervals. Individualization of tapering may be necessary
Reported withdrawal symptoms include:
- Agitation
- Anorexia
- Anxiety
- Confusion
- Impaired coordination and balance
- Diarrhea
- Dizziness
- Dry mouth
- Dysphoric mood
- Fatigue
- Flu-like symptoms
- Headaches
- Insomnia
- Nausea
- Nervousness
- Nightmares
- Sensory disturbances (e.g. electrical sensations)
- Sweating
You don't mention in your question how long you've been taking Effexor XR, but it is important to know the risk of these withdrawal symptoms occurring increases based on a number of factors, including:
- How long you have been taking the drug (the longer you have been on it, the risk increases)
- Dose (higher doses put you at greater risk)
- How abruptly you stopped (Stopping 'cold-turkey versus a gradual reduction in dose puts you at more risk)
I'm sorry to say too that Effexor XR, which is classified as an SNRI (serotonin-norepinephrine reuptake inhibitor), is generally associated with being the medication in that class that causes withdrawal reactions the most. The following is from the Practice Guidelines for the Treatment of Patients With Major Depressive Disorder:
Discontinuation symptoms, which are sometimes protracted, are more likely to occur with venlafaxine (and, by implication, desvenlafaxine) than duloxetine (100) and may necessitate a slower downward titration regimen or change to fluoxetine.
In terms of how to taper Effexor XR safely, taper regimens/protocols are highly patient-specific and there is no one-size-fits-all method — which is exactly why you should consult your prescribing physician or pharmacist before making any changes to your dose. Some sources recommend decreasing by no more than 75mg per week, but there may certainly be situations where a slower tapering plan is recommended.
Final Words
Thanks again for reaching out to us!
References & sources
- Practice guideline for the treatment of patients with major depressive disorder (revision). American Psychiatric Association — Am J Psychiatry . 2000 Apr;157(4 Suppl):1-45.
- Effexor XR Prescribing Information — Pfizer
Glossary — Terms in This Answer
- Effexor XR
- A brand name for the extended-release form of venlafaxine, a medication used to treat depression and anxiety.
- Withdrawal symptoms
- Uncomfortable or distressing physical and mental effects that occur when stopping certain medications too quickly.
- Tapering
- Gradually reducing the dose of a medication over time rather than stopping it abruptly.
- SNRI
- A class of antidepressant medication that works by increasing levels of serotonin and norepinephrine in the brain.
- Serotonin-norepinephrine reuptake inhibitor
- A type of antidepressant that prevents the reabsorption of two brain chemicals, serotonin and norepinephrine, to improve mood.
- Discontinuation symptoms
- Physical and emotional reactions that occur when stopping a medication, similar to withdrawal symptoms.
- Dysphoric mood
- A state of feeling unhappy, anxious, or experiencing a depressed emotional state.
- Titration
- The process of adjusting the dose of a medication, either increasing or decreasing it gradually to find the right amount.
Dr. Brian Staiger, PharmD
Doctor of Pharmacy, board certified clinical pharmacist (BCPS), American Herbalist Guild, Medication Therapy Management certified
Brian Staiger, PharmD, BCPS, is a licensed pharmacist with more than 13 years of experience across retail pharmacy, clinical pharmacy, medication safety, pharmacy program development, and healthcare administration. He is the founder of HelloPharmacist.com, where he helps patients...
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