Venlafaxine (Effexor) inhibits the reuptake of both serotonin and norepinephrine at their respective presy-naptic sites. This drug does not have significant effects at muscarinic, histamine, or a-adrenergic receptors and therefore is devoid of many of the side effects associated with the TCAs. Venlafaxine and its active metabo lite, O-desmethyl-venlafaxine, have half lives of 5 and 11 hours respectively, so dosing twice a day is necessary. However, an extended release preparation (Effexor XR) now allows for once-daily dosing and better tolerance. Venlafaxine has a side effect profile similar to that of the SSRIs (Table 33.2). Higher doses of venlafaxine result in modest increases in blood pressure in approximately 5% of patients. Venlafaxine has minimal effects on the cytochrome P450 enzyme system.
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