Tapering Venlafaxine

Pre-Tapering Assessment

The American College of Cardiology recommends screening for cardiac risk factors, including cardiac conduction abnormalities, before initiating venlafaxine taper 2
The Centers for Disease Control and Prevention recommends considering the duration of current venlafaxine treatment, as longer duration requires slower tapers 3

The National Institute of Mental Health suggests reducing venlafaxine from 150 mg to 112.5 mg daily (25% reduction) and starting the new anti-anxiety medication at its lowest starting dose 1
The Mayo Clinic recommends starting the new anti-anxiety medication at its lowest starting dose, such as 12.5 mg/day for paroxetine or 30 mg once daily for duloxetine 2, 4, 5

The Centers for Disease Control and Prevention recommends slowing the taper rate to 10% reductions per month if withdrawal symptoms become intolerable 3, 6, 1
The Mayo Clinic suggests temporarily reinstating the previous dose until symptoms resolve if withdrawal symptoms become intolerable 6, 1
The American Psychiatric Association recommends considering adjunctive medications, such as clonidine for autonomic symptoms, trazodone or gabapentin for insomnia and anxiety 1

The Centers for Disease Control and Prevention recommends never abruptly discontinuing venlafaxine, as severe withdrawal reactions can occur even after missing a single dose 6
The Mayo Clinic suggests monitoring blood pressure throughout the taper and after starting the new medication, as venlafaxine withdrawal can cause blood pressure changes 2, 1

The National Institute of Mental Health recommends weekly visits or phone contacts during the entire cross-taper period to assess withdrawal symptoms and medication efficacy 1
The Centers for Disease Control and Prevention suggests monthly follow-ups minimum for patients engaging in medication transitions 3
The Mayo Clinic recommends evaluating full therapeutic response 4-6 weeks after reaching target dose of the new medication 2, 1