Upped venlafaxine dose, have some questions

Hi everyone, if anyone could help me out I would be eternally grateful.

Initially, my doc wanted me on 75mg per day but it was too intense, so we scaled it back to 35mg for 2 weeks, then 57mg for 2 weeks, and now moved up to 75mg.

I was on the instant release tablets (so twice a day), but when I was taking a full 35mg tablet in the evening I literally could not sleep. I was super restless, kept tossing and turning. :frowning:

I did some research and a lot of people here recommended switching to prolonged release, so I spoke to my doc and when I was due to go up to 75mg we switched to prolonged tablets (viepax).

I’ve now been taking the 75mg prolonged release for a week and a half, and initially whilst everything seemed ok I’ve been having it rough these last couple of days. When I wake up, I’m sooo dizzy and nauseas, my head feels heavy, there’s pressure in the back of my head, I thought I was getting better because my dizziness seemed to be going away but it’s back with a vengeance this weekend. Honestly I’m so scared and depressed right now.

Could this just be the increased dose and it will settle, or is it because I switched from instant release?

Thanks for reading
Momo x

Please don’t leave the Category blank.

I very much doubt you will ever get a definite answer to that question. There probably isn’t one. This condition changes constantly. It doesn’t appreciate change and drugs are altering things in the brain. Venlafaxine is very difficult to get on or off. Even doctors often don’t appreciate that fact. Questions relating to new of increased side effects occur on this site almost daily. Might I suggest you use the excellent Search facility and key in tirating or starting Venlafaxine (and/or Effexor, same drug) and read through the various threads. @nin’s diary is a good start. People tend to start Venlafaxine by opening capsules and counting out grains in order to avoid your current situation. General consensus in US is the extended release capsule is best form to take but you need to start low, very low and add in very slow. The regime you have been told to try is obviously far too much for your sensitive system. You probably need to go back to the beginning then start again from scratch. You will experience increased symptoms for some time and on each subsequent increases. Do please take some time to read those threads for further insights and links to more technical details if interested in such. Helen

I was on 75 mg ER initially and felt like I was on an insane stimulant. I felt really restless and agitated. I took it in the am but still had trouble sleeping. I could o lay make it for 1.5 weeks and then had to go off of it. I’ve also heard that it is really hard to go on and off, so much that people will count the drug beads to halve the dose. I was put on sertraline and it’s working much better for my depression and my anxiety but not for my headaches. This isn’t really an answer, just my experience!

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Hi mono,
Sorry to hear you’re having a rough time of it with the meds. You’ve made the right move switching to extended release so fair play making that decision. On the dosage, I suspect its still too much for you, effexor is quite a powerful med and it can kick in pretty quickly resulting in strong side effects.

For me and many others on this forum, it’s been a game changer so it’s worth stepping back and forming a new plan. We’re typically med sensitive so we’ve got to start low and slow and by low I mean even a few beads. As your body adjusts you can learn when you can increase and set the pace. Unfortunately neuros don’t have experience of taking these meds because if they did, they would not start you on 75mg… :grin:.

Whatever you decide on dose, I hope it starts to help. Stay strong and one day at a time x.


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It really is time the doctors started keeping up! Tiration is new or unique to MAVers. My own doctor who had, and still even after knowing me, still has no appreciation of our medicine sensitivities, tirated me up on Propranolol as a matter of course. She must be doing it all the time with beta blockers. Venlafaxine seems difficult for all takers. A few weeks back I happened upon a site for people who were prescribed it for depression etc and most were suffering the same problems. Pity the manufacturers cannot come up with a lower dose start up pill too. The accepted practice in England is to tirate up on the immediate release then change over.

Hi everyone,

Thanks so much for your responses and sorry for taking a long time to reply, I’ve honestly been having a really stressful time with the dizziness, working from home and moving house during lockdown. :frowning:
My doctor was also on holiday for a fortnight so that was also a nightmare, and I was convinced I had corona at one point because I couldn’t stop coughing, but that was actually do to with the ven!!

I rang the doctors as I was having horrible problems on 75mg. My doc wasn’t in so they had me talk to the pharmacy doctor, who recommended i go back down to 37.5mg but on the prolonged release. I asked about a 50mg, but apparently they don’t do those over here. They also didn’t know anything about the extended release capsules with the beads in; i’ve been on the tablets and there’s no way to cut those without affecting the release.

I went down to the 37.5mg but after a week and a bit my dizziness was back in full force like it was before i started venlafaxine. The dizziness I was experiencing on the 75mg was different - probably related to the medicine rather than my vertigo - and it was easy to tell the difference. This made me panic a bit. :frowning: I stuck it out until my regular doctor was back in and then asked if there was anything else we could try. I really wanted 50 somehow, because 37.5 was too low and 75 was too much.

My doctor said that there was a work around - I would take the 37.5mg prolonged release one day, and the next day take the 75mg, and so on. Apparently this would equate to 50mg because of how the prolonged release works and its half life (or something sciency I don’t really understand). So I’ve been trying that for about 5 days now. I feel like it might be working but I’m not sure. I definitely don’t feel as vertigo-dizzy as I had on 37.5mg, but it’s not been very long and I could just be convincing myself. My doctor says to give it a month and get back to him, so fingers crossed. I also spoke to him about the fact that I was coughing horrendously at night, and he said it could be acid reflux from the venlafaxine, so I’ve been taking antacids before bed at it seems to be helping in that respect.

The prolonged release is helping me sleep so much better than the instant release, I’m having weird, vivid dreams but I kind of like that (lol). The only thing is it is still SO hard in the mornings, I feel super hungover and just generally horrible for a couple of hours. :frowning: Does anyone else experience this? I don’t want to go back on instant release because I was literally wired and restless all night, so it feels like a catch-22 in some respects.

Today, I also feel SO sick. Nauseas, like I could throw up at any second. I’m hoping this is just my body getting used to the 37.5mg + 75mg combo.

I just feel really defeated. :frowning: Every day is a struggle right now!!

Hope you’re all doing ok x

Can you tell me what country you live in? Am bit confused regards drug availability. Helen

I’m sorry you’re having trouble. I’m on Ven extended release. I started slowly by counting the beads to increase my dosage. I have been trying to reach 75mg for some time but when I increase between 66mg and 75mg my visual symptoms and head pressure increase significantly. I believe for me, approx 66mg is where I get the maximum benefit. My Ven has 120 beads per 75 mg capsule, therefore each bead is .625mg. Even after 7 months of the medication a 3.25mg, (5) bead weekly increase is noticeable and increases my symptoms. I am not a doctor but trying to average out 35 and 75mg to 50mg every other day is not in your best interest. Try to get the extended release and count beads, but go slowly as any increase seems to increase symptoms temporarily,

From what I learned when I took venlafaxine, is that the half life is short, and that is why is difficult to stop venlafaxine. You need a steady dose, otherwise you are playing pin pon with your brain.


I live in the UK :slight_smile:

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I have been trying to get the extended release with beads but my doctor and the pharmacy doctor are convinced that they only do 37.5mg and 75mg tablets over here :frowning: where are you from and what brand name do you use?

I thought as much when the doctor suggested I do different doses each day, but I feel like I can’t go against what he says because he’s the doctor! lol

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Complete Twaddle. The extended release with beads comes in capsule form in above strengths. I don’t think you will find a 50mg dose in either tablet or capsule form. Not here in UK. Just find another pharmacy. The other alternative is to track down Vencarm XL Brand which is a capsule containing three tiny tablets each equivalent to 12.5mg. I really hate to disallusion you (that’s a complete lie come to think of it) but doctors aren’t the fonts of knowledge they would like us to believe they are when it comes to drugs availability. I am surprised at a commercial pharmacist though. They are usually hot on such things.

I use Venlafaxine hcl er 75mg cap. I’m located in the US.

You hit the nail on the head there. There was an article in the New Scientist on withdrawal and it stated specifically not to alternate dose levels to facilitate reduction because of resultant fluctuating drug levels.

Hi mono, sorry to hear you are still feeling so rough but fair play to you for your persistence in your search to find a path forward with this med. Never easy but you’ve got guts so as the others have suggested, go after the capsule and work out the beads for 50mg. Alternating the dosage is not good and I know because I did this at the very start and decided can’t be playing ping pong with am already unstable brain.
On the nausea, I still suffer from this. Sometimes it’s the migrane and often it’s the timing in relation to food. If I take it without food or with something light, nausea will kick in after 2 hours but once I eat something substantial with it like porridge then I don’t have a problem. Ring around a few pharmacies tomorrow as they usually have different suppliers. Best of luck x

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