7 Venlafaxine Interactions to Be Aware of

Venlafaxine (Effexor XR) is an antidepressant that’s FDA-approved to treat depression and panic disorder. It can also treat two types of anxiety disorders: generalized anxiety disorder (GAD) and social anxiety disorder. It comes in both immediate-release and extended-release forms.

Venlafaxine belongs to a group of antidepressants called serotonin and norepinephrine reuptake inhibitors (SNRIs). It’s thought to work by raising the amount of serotonin and norepinephrine in the brain. Boosting levels of these chemical messengers may help improve mood.

Venlafaxine can interact with other medications and some beverages. If this is your first time taking this medication, you’ll want to know about these interactions.

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Below, we take a look at seven common venlafaxine interactions and how to manage them. But keep in mind that this isn’t a complete list. Talk to your healthcare provider and pharmacist. They can more thoroughly check for and help you limit interactions.

1. Monoamine oxidase inhibitors

Monoamine oxidase inhibitors (MAOIs) are antidepressants that treat Parkinson’s disease and depression. Examples of MAOIs include selegiline (Zelapar, Emsam) and rasagiline (Azilect). These medications have a lot of side effects and potential interactions with other medications and foods.

MAOIs and venlafaxine both raise levels of serotonin in the brain. Combining them can lead to dangerously high levels. In rare cases, too much serotonin in the brain can cause a serious condition called serotonin syndrome. Symptoms of this condition include a fast heart rate, excessive sweating, and uncontrolled body or eye movements. Severe cases of serotonin syndrome can be fatal.

You shouldn’t take an MAOI and venlafaxine together. If you’re switching from an MAOI to venlafaxine, you should wait at least 14 days after you stop taking the MAOI to begin taking venlafaxine. If you’ve been taking venlafaxine, you should wait at least 7 days after you stop taking it before starting an MAOI.

2. Bupropion

Bupropion is an antidepressant that’s sometimes used to boost the effects of other antidepressants. Some studies suggest that bupropion can raise levels of venlafaxine in the body. This can help make venlafaxine more effective at treating symptoms of depression.

But higher levels of venlafaxine in the body may raise the risk of side effects. These side effects may include nausea, dry mouth, and trouble sleeping.

This potential interaction may not require you to stop taking one of the medications. But a dose change of either bupropion or venlafaxine may be needed. Let your healthcare provider know if you notice new or worsening side effects after you start taking bupropion. They can advise you on next steps.

3. Other antidepressants

Many antidepressants raise serotonin levels in the brain. Combining venlafaxine with these medications can increase the risk of serotonin syndrome.

Commonly prescribed antidepressants that raise levels of serotonin include:

• Other SNRIs like duloxetine (Cymbalta)

• Selective serotonin reuptake inhibitors (SSRIs) like fluoxetine (Prozac)

• Tricyclic antidepressants (TCAs) like amitriptyline

• Atypical antidepressants like trazodone

Typically, taking more than one antidepressant isn’t recommended. But there may be times when the benefits outweigh the risks. If your healthcare provider prescribes you more than one antidepressant, watch out for any unusual side effects.

Rigid muscles, fever, and a rapid heart rate are all symptoms of serotonin syndrome. Let your healthcare provider know right away if you experience any of these symptoms.

4. Medications that raise serotonin levels

Taking venlafaxine with any medication that boosts serotonin can increase the risk of serotonin syndrome. And antidepressants aren’t the only medications that have these effects.

Examples of other medications that raise serotonin levels, known as serotonergic medications, include:

• Triptan migraine medications like sumatriptan (Imitrex)

• Some opioids like tramadol (Ultram)

• Lithium (Lithobid)

• St. John’s wort, an over-the-counter (OTC) herbal supplement

This isn’t a full list of medications that may raise serotonin levels in the body. If you need to take venlafaxine with a serotonergic medication, watch for symptoms of serotonin syndrome. Be sure to tell your healthcare provider right away if you experience any of these symptoms.

5. Blood thinners

Blood thinners is a term that refers to medications that help prevent unwanted blood clots. These include anticoagulants and antiplatelets. Both blood thinners and venlafaxine increase the risk of bleeding. Taking venlafaxine and blood thinners together can raise this risk even more.

Popularly prescribed blood thinners include:

• Apixaban (Eliquis)

• Clopidogrel (Plavix)

• Dabigatran (Pradaxa)

• Ticagrelor (Brilinta)

• Warfarin (Coumadin, Jantoven)

There may be a situation in which you need to take both venlafaxine and a blood thinner. If this is the case, look out for symptoms of excessive or serious bleeding. These include frequent nosebleeds, blood in your urine, and red stools or black stools. If you notice any of these symptoms, contact your healthcare provider right away. But don’t make any changes to your medication regimen before you get your provider’s OK.

6. Nonsteroidal anti-inflammatory drugs

Nonsteroidal anti-inflammatory drugs (NSAIDs) are a popular class of pain relievers that include OTC options. Although most NSAIDs aren’t considered blood thinners, they can have some blood-thinning effects. Taking venlafaxine with NSAIDs can raise the risk of stomach bleeding and ulcers.

Popular NSAIDs include:

• Aspirin

• Ibuprofen (Advil, Motrin)

• Meloxicam (Mobic)

• Naproxen (Aleve, Naprosyn)

Check with your healthcare provider before taking venlafaxine and NSAIDs together. They’ll help you weigh the risks and benefits of combining the medications. If it’s too risky for you to take NSAIDs, they may suggest an alternative pain reliever, such as acetaminophen (Tylenol).

7. Alcohol

One notable side effect of venlafaxine is drowsiness. Alcohol also has this effect. So drinking alcohol while taking venlafaxine can make drowsiness more intense. It can also affect your ability to focus or complete daily activities.

It’s best to avoid drinking alcohol while taking venlafaxine, especially regular or heavy drinking. The effects of having an occasional drink while taking venlafaxine hasn’t been well studied. So be sure to discuss whether it’s safe for you to drink any alcohol with your healthcare provider.

When should I contact my healthcare provider about a venlafaxine interaction?

It’s important to give your healthcare provider and pharmacist an up-to-date medication list before you start taking venlafaxine. Be sure to include all prescription and OTC medications and supplements on the list.

You should also let them know if you drink alcohol and how much. Having accurate information will help them discover and manage potential venlafaxine interactions.

Tell your healthcare provider if you develop any new or worsening side effects while taking venlafaxine. These can be signs of a potential interaction. Not all interactions require you to stop taking the medication; sometimes, a dose change is all that’s needed. But don’t stop taking venlafaxine or adjust your dose without talking to your healthcare provider first. If you stop taking it too quickly, it can cause unpleasant withdrawal symptoms.

Contact your healthcare provider or seek medical help if you’re experiencing severe side effects. This could include signs of excessive bleeding, uncontrolled body movements, or a fast heart rate. Side effects can indicate a serious interaction, especially if you’ve recently made a change with one or more of your medications.

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Written by:

Kristine Foley, PharmD

Kristine Foley is a licensed pharmacist with over 13 years of community pharmacy experience. She earned her Doctor of Pharmacy degree from Rutgers University.

Edited by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

Reviewed by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

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