Venlafaxine Extended Release in Pediatric Anxiety and Depression

Abstract

Venlafaxine extended release (XR) is the once-daily preparation of venlafaxine, which inhibits the reuptake of serotonin and norepinephrine. At lower doses, venlafaxine XR preferentially blocks the reuptake of serotonin, while at higher doses it blocks the reuptake of serotonin and norepinephrine. Although venlafaxine XR is not approved for pediatric use, it is increasingly being used in the treatment of pediatric anxiety and depressive disorders. While in the past several years there have been numerous randomized, placebo-controlled trials in pediatric generalized and social anxiety and depression, more studies are needed to determine when the utilization of venlafaxine XR in the pediatric population is warranted. Results from completed studies show improvement in generalized and social anxiety symptoms in children and adolescents, but only minimal improvement in depressive symptoms in adolescents, with no improvement in children. Gastrointestinal symptoms are the most commonly reported adverse events. Venlafaxine XR may affect weight, heart rate and blood pressure in the short-term, while its long-term effects are unknown. The most recent and comprehensive meta-analysis reports a 4% risk difference of suicidal ideation/attempt for venlafaxine XR versus placebo in depression trials, and a 1% risk difference for generalized and social anxiety studies. This paper will review available data regarding the safety and efficacy of venlafaxine XR use in the pediatric population, as well as the pharmacokinetics and pharmacodynamics of this medication.