Prescriptions for Effexor XR should be written for the smallest quantity of capsules consistent with good patient management, in order to reduce the risk of overdose.A major depressive episode may be the initial presentation of The development of a potentially life-threatening serotonin syndrome has been reported with SNRIs and SSRIs, including Effexor XR alone, but particularly with concomitant use of other serotonergic drugs (including triptans, The concomitant use of Effexor XR with MAOIs (intended to treat psychiatric disorders) is contraindicated. Use caution in treating patients with pre-existing hypertension or cardiovascular or cerebrovascular conditions that might be compromised by increases in blood pressure. Caution patients about the risk of bleeding associated with the concomitant use of Effexor XR and NSAIDs, aspirin, or other drugs that affect coagulation.The pupillary dilation that occurs following use of many antidepressant drugs including Effexor XR may trigger an angle closure attack in a patient with anatomically narrow angles who does not have a patent iridectomy.Mania or hypomania was reported in Effexor XR treated patients in the premarketing studies in MDD, SAD, and PD (see Discontinuation symptoms have been systematically evaluated in patients taking venlafaxine, including prospective analyses of clinical studies in GAD and retrospective surveys of studies in MDD and SAD. Because there was much individual variability in clearance between patients with renal impairment, individualization of dosage may be desirable in some patients There is no body of evidence available from controlled studies to indicate how long patients with MDD, GAD, SAD, or PD should be treated with Effexor XR.It is generally agreed that acute episodes of MDD require several months or longer of sustained pharmacological therapy beyond response to the acute episode. Patients should be informed that the active medication has already been absorbed by the time the patient sees the spheroids.Talk to your healthcare provider if you do not think that your condition is getting better with Your healthcare provider or pharmacist can tell you if it is safe to take Tell your healthcare provider if you have any side effect that bothers you or that does not go away. In addition, at least 7 days should be allowed after stopping Effexor XR before starting an MAOI intended to treat psychiatric disorders Do not start Effexor XR in a patient who is being treated with linezolid or intravenous methylene blue, because there is an increased risk of serotonin syndrome. The complete text of the Medication Guide is reprinted at the end of this document.Patients should be advised of the following issues and should be asked to alert their prescriber if these occur while taking Effexor XR.Advise patients, their families and caregivers to look for the emergence of suicidality, worsening of depression, and other psychiatric symptoms (anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia, psychomotor restlessness, hypomania, mania, other unusual changes in behavior), especially early during treatment and when the dose is adjusted up or down. Indirect comparisons across similarly designed studies are fraught with confounding factors that may account for between-study differences. In case of an overdose, provide supportive care, including close medical supervision and monitoring. Consequently, caution is advised when Effexor XR is taken in combination with other CNS-active drugs.Adverse reactions, some of which were serious, have been reported in patients who have recently been discontinued from an MAOI and started on antidepressants with pharmacological properties similar to Effexor XR (SNRIs or SSRIs), or who have recently had SNRI or SSRI therapy discontinued prior to initiation of an MAOI Based on the mechanism of action of Effexor XR and the potential for serotonin syndrome, caution is advised when Effexor XR is coadministered with other drugs that may affect the serotonergic neurotransmitter systems, such as triptans, SSRIs, other SNRIs, linezolid (an antibiotic which is a reversible non-selective MAOI), lithium, tramadol, or St. John's wort.