Effexor Alternatives
November 30, 2004 10:27 PM   Subscribe

Does anyone know of an alternative to Effexor (Venlafaxine)? It is not a tricyclic, MAO or a SSRI. (MI)

Effexor has just moved to a time-release formulation, which for physiological reasons my girlfriend can’t use. Has anyone found a useful replacement for Effexor (also non time-release) or know of a generic form (even foreign)? (I have tried to search Google for info but with drugs it is next to impossible to get past drug company hype and spam-web-pharmacies for any info)
posted by arse_hat to Health & Fitness (16 answers total)
Effexor has had a time-release formulation for several years; are you certain that the non- is no longer available?
posted by mookieproof at 11:11 PM on November 30, 2004

There are lots of alternatives, but they all have slightly different risks and benefits. And brain chemistry is one of those things that even professionals struggle to understand exactly how everything works together - presumably she is working with a doctor, yes?
posted by judith at 11:16 PM on November 30, 2004

mookieproof. According to our Dr. after the current supplies are gone it is only the time-relese formula.
judith. Yes she is working with our Dr. but he is a good soul and does not lie to us. He does not have a simple answer and is researching alternatives but is willing to look at anything we can dig up.
posted by arse_hat at 11:55 PM on November 30, 2004

They belong to a class of antidepressants known as heterocyclics. Other drugs in this class include Serzone (nefazodine) and Remeron (mirtazapine). (Sorry, we haven't done psych yet, so I don't really know much about these.)

I'm skeptical that Effexor XR will be the only formula of the drug available. Are you sure that Effexor isn't just going generic, so that Wyeth is going to stop making it when the generic manufacturers take over?

It looks like venlafaxine has marked blocking of norepinephrine, and moderate blocking of 5-HT (serotonin), according to my pharm book. I'd get on some of the depression bulletin boards and websites and post your question, I'm sure they know much more about what's going on.
posted by gramcracker at 12:08 AM on December 1, 2004

If such is the case, I *highly* recommend that she very gradually lower her dosage (with yr doctor's help) before supplies run out. Effexor withdrawal is extremely unpleasant.
posted by mookieproof at 12:14 AM on December 1, 2004

It's still encumbered by patents as of this moment. If history is any indicator, the time release version is just a way to get a new patent and maintain company profits. The non XR version should still be available, though potentially not through your local pharmacy. If there's a market for it, when the patent runs out you should see a generic form.

One way to handle it is to find samples either from sales reps or from the doctors they push them on. They will often be given to a variety of doctors who you may not consider to be your typical doctor to prescribe such a drug. I got my supply of Welbutrin in sample sizes for years from my ENT. (He never prescribed it and the rep just kept dumping boatloads of it on him.) Effexor may not be as easy to come by using this method, but it couldn't hurt to ask your doctor(s).

Another option would be to go to your pharamcy and ask questions. They are better prepared to answer your questions about the supply of prescription drugs.

There are mail order pharmacies, which your insurance company can point you. These aren't Internet drug companies. They are worth looking in to. In fact, call your insurance company, they may be able to help you.

Your last, and most direct option, is to call or write the company directly. It may take some effort, but they'll have the definitive answer.

As for additional drugs, you may want to look into Buspar (antianxiety), Wellbutrin (antidepressant) and Desyrel (antidepressant). Serzone was pulled from the market by Bristol-Myers Squibb on May 20, 2004. (1) Remeron is commonly associated with weight gain, but it's probably valuable to look into it with your doctor.
posted by sequential at 12:51 AM on December 1, 2004

If you really don't want to take a delayed-release preparation, just buy a mortar and pestle and crush it up. Delayed release depends on surface area; I think of it as a waxy preparation of the drug that is slower to dissolve, although that is a simplification.

If you crush something to powder, it will absorb like a quick-dissolving tablet no matter how it's formulated.
posted by ikkyu2 at 2:40 AM on December 1, 2004

Effexor withdrawal is extremely unpleasant.

I have a family member going through this right now. It is really really ugly. Effexor is a scary drug.
posted by Quartermass at 6:46 AM on December 1, 2004

"If you really don't want to take a delayed-release preparation, just buy a mortar and pestle and crush it up. Delayed release depends on surface area; I think of it as a waxy preparation of the drug that is slower to dissolve, although that is a simplification."

the time release drug isn't a tablet, but a capsule that shakes like a little maraca (i take effexor and i shake that little maraca every morning). i don't think crushing something that is supposed to release over time is a good or safe idea.
posted by heather at 7:58 AM on December 1, 2004

Effexor is a fantastic drug, but the withdrawal is pretty awful.

DO NOT crush an Effexor XR capsule. My bottles are covered with warnings about how that will do everything from making the baby Jesus cry to setting the White House lawn on fire.

What your doc should do is call his "detail person" from Wyeth and explain the situation, and ask for a big supply of the non-XR.
posted by Sidhedevil at 8:28 AM on December 1, 2004 [1 favorite]

What are the symptoms of Effexor withdrawal?
posted by initapplette at 8:41 AM on December 1, 2004

*shrug* my Effoxor withdrawal was pretty uneventful, maybe i'm a lucky one. I'm now on lexapro (similar to celexa), getting better results and almost nil side effects. Effexor gave me so many side effects, i just had to stop using it.
posted by escher at 9:02 AM on December 1, 2004

The thing about Effexor withdrawal is that it can be awful if not managed properly. This page has a bunch of links to research papers and personal accounts of Effexor withdrawal.

My psychiatrist, who is great, went over this issue in detail with me before I started taking Effexor. I'm not looking forward to dealing with the withdrawal, but I have been so happy with the medication otherwise that I don't regret taking it for a second.

I think, though, that it should be mandatory to give information about the possible problems with withdrawal as well as other side effects before Effexor is prescribed.
posted by Sidhedevil at 10:12 AM on December 1, 2004

Thanks for the input. Perhaps getting the doctor or pharmacist to build up a small stock might be a good idea. We also now have some alternative names to ask about. Unfortunately this is becoming more of a problem. A lot of drugs are now out in time release formula only or are hard to find in regular form.
posted by arse_hat at 12:28 PM on December 1, 2004

Serzone is definitely not a time-release formula, but there have been several reported cases of liver failure among individuals that have taken it. I don't know the specific number of cases, but it was enough to merit a giant warning in the drug monograph. The brand name has been discontinued, but I believe it is still available as a generic.
posted by makonan at 2:05 PM on December 1, 2004

Your doctor could be wrong. I recently had a doctor tell me that, henceforth, Paxil would only be available in the Continuous Release form. This turned out not to be true. Remember: a lot of the info that doctors get about their meds comes through drug reps and drug reps have been known to misrepresent the truth a little bit from time to time. I found out the truth by simply asking my pharmacist.
posted by Clay201 at 3:32 PM on December 1, 2004

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