Venlafaxine chemical structureAn Effexor XR 75mg Capsule
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Venlafaxine

Venlafaxine hydrochloride is a synthetic derivative of phenethylamine and a prescription antidepressant first introduced by Wyeth in 1993, and marketed under the trade names Effexor® for tablets and Effexor XR® for extended-release capsules. Efexor® / Efectin® and Efexor XR® / Efexor® Depot / Efectin ER® are alternate trade name spellings used in some countries. Since venlafaxine is under patent, under current United States law, a generic will not be available to U.S. citizens until 2008. The European patent on the drug will hold until 2017. more...

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Uses

Venlafaxine is used primarily for the treatment of depression, generalized anxiety disorder, and social anxiety disorder in adults. It is known as one of the most activating of the newer antidepressants. While this can be helpful to some, as many depressed patients report feeling exhausted and unmotivated, to others it poses the risk of increased anxiety and agitation.

Venlafaxine is an effective antidepressant for many persons; however, it seems to be especially effective for those with treatment-resistant depression. Some of these persons have taken two or more antidepressants prior to venlafaxine with no relief. It has also been found to reduce the severity of 'hot-flashes' in menopausal women. In addition, a September 2004 Consumer Reports study ranked venlafaxine as the most effective among six commonly prescribed antidepressants. (However, this should not be considered a definitive finding, and responses to psychiatric medications vary significantly from individual to individual.)

Off-label / Investigational Uses

Substantial weight loss in patients with major depression, generalized anxiety disorder, and social phobia has been noted, but the manufacturer does not recommend the use as anorectical drug either alone or in combination with phentermine or other amphetamine-like drugs.

Description of Compound

The chemical structure of venlafaxine is designated (R/S)-1- cyclohexanol hydrochloride or (±)-1- cyclohexanol hydrochloride and it has the empirical formula of C17H27NO2 · HCl. It is a white to off-white crystalline solid, distributed in pentagon-shaped peach-colored tablets of 25 mg, 37.5 mg, 50 mg, 75 mg, and 100 mg. There is also an extended-release version distributed in capsules of 37.5 mg (gray/peach), 75 mg (peach), and 150 mg (brownish red).

Mechanism of Action

Venlafaxine is a bicyclic antidepressant, and is usually categorized as a serotonin-norepinephrine reuptake inhibitor, but it has been referred to as a serotonin-norepinephrine-dopamine reuptake inhibitor. It works by blocking the transporter "reuptake" proteins for key neurotransmitters affecting mood, thereby leaving more active in the synapse. At low dosages, venlafaxine blocks serotonin reuptake alone, similarly to a selective serotonin reuptake inhibitor (SSRI). At medium dosages (about 225mg/day), venlafaxine blocks the reuptake of norepinephrine as well as serotonin. At dosages above 300mg/day, it blocks dopamine reuptake in addition to serotonin and norepinephrine.

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Depression remission higher with venlafaxine than SSRIs - Largest Pooled Analysis
From OB/GYN News, 8/1/03 by Bruce Jancin

SAN FRANCISCO -- Venlafaxine outperformed selective serotonin reuptake inhibitors in achieving remission in major depression, according to a pooled analysis of data from 33 randomized, double-blind, comparative clinical trials.

Venlafaxine is a dual inhibitor of serotonin and norepinephrine reuptake. Many physicians who prescribe it consider it a more effective antidepressant than the selective serotonin reuptake inhibitors (SSRIs). The pooled analysis of 7,611 randomized patients with major depressive disorder supports this impression, Dr. Charles B. Nemeroff said at the annual meeting of the American Psychiatric Association.

This was the largest and most comprehensive pooled analysis ever to examine original data from a complete set of published and unpublished comparative trials involving antidepressants. All 33 randomized trials and the pooled analysis were funded by Wyeth Pharmaceuticals, which markets venlafaxine as Effexor XR.

The 33 trials featured a total of 3,373 patients randomized to venlafaxine, 3,311 to SSRIs, and 927 to placebo. A total of 1,909 patients received immediate-release venlafaxine, while 1,464 received the newer sustained-release formulation of the drug.

The primary end point in the pooled analysis was the rate of remission, defined as a total score of 7 or less on the Hamilton Depression Rating Scale (HAM-D) at week 8. The remission rate was 41% with venlafaxine, significantly better than the 35% overall remission rate with SSRI therapy, which in turn was superior to the 24% rate with placebo, said Dr. Nemeroff, chair of psychiatry and behavioral sciences at Emory University, Atlanta.

The odds of remission were 31% greater with venlafaxine than with an SSRI. Looking specifically at the three SSRIs most widely studied in the trials, venlafaxine-treated patients were 41% more likely to achieve remission than those randomized to fluoxetine, 20% more likely to gain remission than patients on paroxetine, and 16% more likely to experience remission than sertraline-treated patients.

In separate presentations at the meeting, drawn from the same pooled data, other investigators reported that venlafaxine resulted in substantially greater improvement in a wide range of both psychic and somatic symptoms of depression than did the SSRIs. Significantly more venlafaxine-treated patients had complete resolution of physical symptoms of depression including muscle aches, headaches, backaches, fatigue, and heaviness of the limbs.

Venlafaxine also had higher remission rates in depressions longer than 52 weeks duration as well as in those of more recent onset. Remission rates in patients who had been depressed for more than 52 weeks prior to treatment were 38% with venlafaxine, 25% with SSRIs, and 19% with placebo. The rates were an absolute 10%-13% higher in depressions of shorter duration.

COPYRIGHT 2003 International Medical News Group
COPYRIGHT 2003 Gale Group

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