The neurotransmitters serotonin and norepinephrine are thought to be particularly linked to the occurrence of panic disorder. Some of us do better with more than one daily preventative :mrgreen: Thanks you guys for the info. Just praying that this new dose will return me to feeling better. I used to be super afraid of these meds, but after a while, it’s just what you have to do to get your life back. There are alot of other med options and its all trial and error. I am wondering if the Effexor stopped working. Long-term elevated levels are linked to numerous conditions and symptoms. Depending on tolerability and the need for further clinical effect, the dose may be increased to 150 mg/day. I certainly hope so. You expressed a wonderful sentiment. Pristiq and Effexor are medications that have similar compositions and are produced by the same manufacturing company. Dr. Hain started me out at 37 mg. and I then moved up to 75 mg. This effect (or lack of therapeutic effect) on higher doses is referred to as a flattening of the SSRI's dose-response curve.On the other hand, the dose-response Effexor XR does not seem to to flatten as easily, and I had been led to believe that the higher Effexor XR dose… Serotonin and norepinephrine reuptake inhibitors (SNRIs) are a class of medications that are effective in treating depression. said that works better for pain. Thanks for your post Mary! I have both the generic and the Effexor XR. Serotonin–norepinephrine reuptake inhibitors (SNRIs) are a class of antidepressant drugs that treat major depressive disorder (MDD), anxiety disorders, obsessive–compulsive disorder (OCD), social phobia, attention-deficit hyperactivity disorder (ADHD), chronic neuropathic pain, fibromyalgia syndrome (FMS), and menopausal symptoms. Often, in conditions linked to low NE activity, they don't know whether the level itself is the problem. What George wrote earlier had a bit of a conflict to it…it says effexor works like an ssri at low dose (meaning it only hits serotonin) and becomes a dual agent at higher doses (like 150 or more) and eventually hits all sero, NE and Dopamine at the highest doses…So anyone who says Effexor hits noriephinerine at the low dose is mistaken. Venlafaxine HCl (Effexor®, Effexor® XR) is the first and most commonly used SNRI. Yes, Effexor has massive stimulant-like effects and will interfere with your sleep, especially at levels above 150mg where Norepinephrine reuptake is significantly impacted. Most docs would agree that if you can get control with just one medicine, all the better. Effexor and Effexor-XR are the two brand names in the United States under which the generic medication venlafaxine is sold 3. I never really followed up on that? At what dose does Effexor hit norepinephrine? The dose may be increased in 75-mg increments every four days as needed until … antidepressants, mirtazapine does not employ serotonin or norepinephrine reuptake blockade as its main pharmacologic action. I actually found conflicting information about both. Cymbalta causes side effects like fatigue and constipation, Effexor does not. I’m wondering if norephemine or serotonin will help with the driving. It seems to me that many here have had success when one or a combo of medications are effecting BOTH serotonin and norephemine. Effexor inhibits the reabsorption of serotonin quite a bit more than it does norepinephrine. 5-HT 2a and 5-HT 2c receptors play a role in reducing REM and slow Serotonin has a complex effect on sleep and its array of receptor subtypes are involved in different effects. And Kelley really helped me understand a little about this. How many of you are taking the Effexor at night? Well interesting you say that because I didn’t feel a lot better until I hit Effexor at 150 mg. that’s where I am at now and am soo much better. A monoamine is a type of neurotransmitter. Effexor is a prescription drug used in the treatment of depression, social phobias, and generalized anxiety disorder. How Does Remeron (Mirtazapine) Work? I believe that the Effexor at 150 is working so well for me is because it’s hitting norepinephrine. My thought is to make a long term plan of switching to effexor from the zoloft or trying the nort again…but without the risk of the serontonin syndrome? In various ways, different antidepressants seem to affect how these neurotransmitters … It is available in an extended-release formula to treat depression, and anxiety and panic disorders. Doctors typically provide answers within 24 hours. Psychologist Gary Greenberg expressed his concern, citing studies that showed high doses of these drugs cause changes in neurons.The more dramatic side effects, such as violent impulses and agitation amazingly have not been confirmed or disproved in the psychiatric … That makes so much sense. As previously mentioned, Effexor is a serotonin-norepinephrine reuptake inhibitor (SNRI). While Remeron has a variety of effects, it is thought to primarily work by antagonizing central alpha 2-receptors. I know I need to give it more time. By continuing, I confirm that I am over 16 years old and agree to HealthTap's. Kelley. It has been used to treat major depressive disorders and dysphoric moods, which interfere with daily life. I recall it was at least 2 months before each step up in dosage and it took quite a while to feel better after each. 1. By comparison, Cymbalta (for example) has about a 10:1 ratio. Did Hain start you out at 75mg? Below 150mg, Effexor (venlafaxine) acts on serotonin. Effexor XR and other SNRIs improve symptoms of depression and anxiety by increasing available levels of the neurotransmitters serotonin and norepinephrine in the brain. My dr just increased my Effexor to 112.5mg and I’m hoping that will improve my symptoms. Effexor XR contains the drug venlafaxine in its extended-release (XR) form. 5-HT 2a and 5-HT 2c receptors play a role in reducing REM and slow Effexor (venlafaxine): Effexor (venlafaxine) is a fairly balanced compound in that it works on both norepinephrine and serotonin fairly equally (unlike Cymbalta for instance which skews to the serotonin side a bit more). Norepinephrine-Dopamine Reuptake Inhibitors (NDRIs) are a class of antidepressant drugs. Effexor (venlafaxine) is a fairly balanced compound in that it works on both norepinephrine and serotonin fairly equally (unlike Cymbalta for instance which skews to the serotonin side a bit more). Hi Ed, I’m still an amateur at the drug thing, and trying to learn more. I am going to try switching to mornings next weekend and then increase to 25 if I feel okay. Content on HealthTap (including answers) should not be used for medical advice, diagnosis, or treatment, and interactions on HealthTap do not create a doctor-patient relationship. I didn’t give it enough time because some of the side effects were not fun. If it does not, what other drugs have a strong effect on norepinephrine other … Since norepinephrine is used by the sympathetic division of the autonomic nervous system (see discussion of the autonomic nervous system in Chapter 16), noradrenergic drugs can be used to treat a range of disorders involving autonomic function, including glaucoma, migraine, and low blood pressure. I just took an additional dose of 12.5 this morning and did okay today. So, you'll be getting the norepinephrine reuptake inhibition at every dose strength. High Norepinephrine Activity . Cymbalta also treats fibromyalgia, musculoskeletal and nerve pain. Call your doctor or 911 if you think you may have a medical emergency. Effexor has passed clinical tests, and your doctor prescribed it to you (I presume) because they thought it was good for you. Find out the similarities and differences of Pristiq and Effexor in this article. Venlafaxine is used to treat major depressive disorder, anxiety and panic disorder. “Venlafaxine functions like an SSRI in low doses (75 mg/day), a dual mechanism agent in moderate doses (150-225 mg/day) and affects serotonin, norepinephrine, and dopamine in high doses (375 mg/day).”. 75 mg. helped but I still had some bad days. It is synthesized from dopamine by dopamine-beta-hydroxylase. The prescription medication is absorbed and metabolized by the liver. Effexor, also known as venlafaxine, is a prescription drug used to treat major depression and anxiety disorders. There's only one way to find out how the medication will affect you: try it out . Duloxetine HCl (Cymbalta®), manufactured by Eli Lilly, is a newer antidepressant on the market. Venlafaxine (Effexor): prescribing information (PDF) Venlafaxine ER for generalized anxiety disorder (GAD) February 2008: FDA licenses antidepressant desvenlafaxine (Pristiq) Agomelatine Valdoxan, Melitor, Thymanax) versus venlafaxine (Effexor) Refs and further reading. [64934] Dilution Dilute norepinephrine 4 mg in 1,000 mL of 5% Dextrose Injection, 0.9% Sodium Chloride Injection, or 5% Dextrose and 0.9% Sodium Chloride Injection for a concentration of 4 mcg/mL. At least 150mg: One usually needs to get up to at least 150 mg to start to see the effects of the 2 neurotransmitter( serotonin plus norepinephrine ), and one needs to get to at least 225 before you may see the effect of the 3rd ( dopamine) come into play. Since above 150mg Effexor (venlafaxine) increases norepinephrine, would I be better switching to an SSRI, or increase Effexor (venlafaxine)? However, cancer is not the only reason that PSA levels may be increased ().Other reasons your PSA may be elevated include: If norepinephrine increases restlessness and anxiety, among other effects, how can Effexor (venlafaxine) be a treatment for anxiety. The first 5 days I felt like I was getting worse but that is starting to die down. What drug are you on? I am on day 11 of the generic at 12.5 at night. It has been used to treat major depressive disorders and dysphoric moods, which interfere with daily life. Cymbalta also treats fibromyalgia, musculoskeletal and nerve pain. Effexor is designed to work on norepinephrine at any dose. Effexor Side Effects Overview. The reason why I ask is because I was feeling so good for several weeks at that dose, but than all of a sudden, I started to feel worse again. Posted by CamW. But I am going to ask him to try tofranil since I always felt better I think. Can I ask whether you guys would recommend as being more effective,…nortriptyline or effexor? As previously mentioned, Effexor is a serotonin-norepinephrine reuptake inhibitor (SNRI). Answer. IF it were me, I would go up on my effexor. GAD 80% better at 150 mg of Effexor (venlafaxine). It did help me sleep last night but I felt a little foggier than normal today. Effexor is a brand (trade) name for venlafaxine. Cymbalta and Effexor cause withdrawal symptoms if you stop taking them suddenly. The question about driving is hard to answer. In reply to Re: Effexor XR -- dose vs. tiredness ?» John2222, posted by Dinah on July 30, 2002, at 20:15:22. The recommended initial dose of venlafaxine is 75 mg daily taken as two or three equal doses. It’s just something that allows me to live my life. The recommended starting dose for Effexor is 75 mg/day, administered in two or three divided doses, taken with food. For these, please consult a doctor (virtually or in person). I couldnt get my Effexor (venlafaxine) filled in time and had to go without for a week, now the med is making me act foul and feel depressed? It is used to treat major depressive disorder (MDD), generalized anxiety disorder (GAD), panic disorder, and social phobia. I should be and am thankful. A somewhat high NE activity level makes you happy, and a really high level makes you euphoric. Cymbalta and Effexor cause withdrawal symptoms if you stop taking them suddenly. You have a great way of explaining this stuff and I appreciate you always taking the time to further explain. The actions of norepinephrine are vital to the fight-or-flight response. In addition, its effects on each neurotransmitter system take place sequentially—with serotonin reuptake blocking happening first, and that of norepinephrine second. My doc prescribed .5 of Xanax to help me sleep because the Effexor was definitely keeping me up at night. Never disregard or delay professional medical advice in person because of anything on HealthTap. Effexor (Venlafaxine) is a drug that was introduced in 1993 as a pharmaceutical antidepressant by Wyeth; its marketing rights are now owned by Pfizer. Effexor has disproportionate reuptake inhibition effects. It’s effects are mediated primarily through interaction at α-1 and β-1 receptors. antidepressants, mirtazapine does not employ serotonin or norepinephrine reuptake blockade as its main pharmacologic action. To learn more, please visit our. When my doc added in Effexor (NOT generic) he said we would cap at 75mg for the reason that was stated in last post. What about at exactly 150mg? mavprincess, At least 150mg: One usually needs to get up to at least 150 mg to start to see the effects of the 2 neurotransmitter( serotonin plus norepinephrine ), and one needs to get to at least 225 before you may see the effect of the 3rd ( dopamine) come into play. Have you used tryciclic (sp) the old antidepresants? med.) I’m hoping the increase will kill the rest of this crap. I didn’t and still don’t understand how that happened? I wonder if Nort would have the same effect. Experts aren't exactly sure how venlafaxine works but believe its effects may be due to its ability to block the reuptake of serotonin and norepinephrine, and to some extent dopamine, three neurotransmitters in the brain associated with depression. Norepinephrine (Levophed) is indicated for blood pressure control in certain acute hypotensive states (e.g., pheochromocytomectomy, sympathectomy, poliomyelitis, spinal anesthesia, myocardial infarction, septicemia, blood transfusion, and drug reactions). Effexor XR: At What Dose It Affects Norepinephrine Posted by Mishal on July 8, 2007, at 23:34:49 Some say norepinephrine effects start to kick in over 75mg, Others say it can only be achieved on doses higher than 225mg a day. I have an dilemma in that I am a high dose of zoloft and after a quick try of nort(a couple of weeks in which nort was pushed up too high too quickly and the zoloft pushed down too quickly) I was taken off the nort…Recently put on topamax, did not last long. Don’t have any insights on what proportions of seratonin and norepinephrine are effected via various dosages of effexor; Kelley and others on this board have a more informed opinion than I. I did want to tell you that I’m probably one of the few patients Dr. Hain prescribed 150 mg. of effexor. Norepinephrine (Levophed) is indicated for blood pressure control in certain acute hypotensive states (e.g., pheochromocytomectomy, sympathectomy, poliomyelitis, spinal anesthesia, myocardial infarction, septicemia, blood transfusion, and drug reactions). They hypothesize instead that while norepinephrine is involved in depression, it is due rather to a dysfunction of a brain area where norepinephrine is present. Physicians prescribe it primarily for depression and anxiety disorders, although not for low-grade, everyday anxiety, the Mayo Clinic reports. But if not, don’t get discouraged. I did not care I felt better. Cymbalta, according to my research, is usually better tolerated in the sexual side effects department. If needed, the dose should be further increased up to 225 mg/day. Did you feel bad at first when you upped it? i want to know if abilify affects norepinephrine or does it only affect serotonin and dopamine. Good luck to all. For potential or actual medical emergencies, immediately call 911 or your local emergency service. Even though both drugs tend to be metabolized in the same way, it does not necessarily mean that they are completely identical. 6 It has been approved by the FDA for depression, panic disorder, social phobia, and generalized anxiety disorder (GAD). I could not handle verapamil. I have been on 3 daily preventatives for about 5 years and function at about 95%! So I went online to read more about both of these and the medications that affect both parts of the brain (very fascinating stuff). It's my second day. They do make your mouth dry. Even at 150 mg (where it begins to affect serotonin), consider this: Effexor has a SE:NE (serotonin:norepinephrine) reuptake-inhibition ratio of 30:1 – or, said simply, it’s 30 times more potent on serotonin than on norepinephrine. I take 112.5 of it and I take the generic. Serotonin is … I’m currently at 75mg and doing much better, probably about 70-75%. Effexor has passed clinical tests, and your doctor prescribed it to you (I presume) because they thought it was good for you. I made that mistake the first night and literally slept maybe 2 hours. » Dinah. Do you know if it’s hitting norepinephrine at this dose. Severe Effexor side effects may include those affecting the cardiovascular and nervous system, the skin and musculoskeletal system, and may include birth defects when Effexor is taken during pregnancy. Any advice would be great! I’m still a wee bit confused. The 150 mg. dosage took a while to kick in but I’ve been at 90 - 95% for well over a year. Both neurotransmitters play a role in regulating certain functions and emotions that can affect the onset of this condition. It belongs to a class of drugs known as selective serotonin and norepinephrine reuptake inhibitors, or SNRIs. Connect with a U.S. board-certified doctor by text or video anytime, anywhere. I also take 120 mg. of verapamil. One source says that Effexor hits serotonin at a low dose and norephemine at a high dose. I’m a little scared of it since its a Tricyclic AD. Dopamine plays a key role in movement and affects motivation, perception of reality, and the ability to experience pleasure. Effexor XR works by increasing the levels of two different chemicals (the neurotransmitters called serotonin and norepinephrine) that naturally occur in the brain. I finally realized that having to take effexor didn’t make me a weak person. The Merck Manual for Health Care Professionals says: I am very interested in Nort, but my dr wants me to give the increase in Effexor 4-6 weeks than I will entertain the idea of Nort! I have a great MAV doctor in Dr. Fife but I love getting info from all of you since you are the ones actually trialling these drugs. Meds concentrating on serotonine did nothing. Venlafaxine, also known as Effexor, is one of the most commonly prescribed antidepressants in the United States. HealthTap uses cookies to enhance your site experience and for analytics and advertising purposes. Inherited traits play a role in how antidepressants affect you. There's only one way to find out how the medication will affect you: try it out . Dinah & John - I do think that there is a direct correlation between Effexor XR™ (venlafaxine) dose and longterm side effects, such as being tired during the day. How can snri's such as Cymbalta and Effexor (venlafaxine) control anxiety if they work on norepinephrine..would not this increase anxiety? Cymbalta (duloxetine) and Effexor (XR, venlafaxine) are antidepressants that belong to the SNRI drug class, and are used to treat depression, anxiety, and pain. Yes Effexor (venlafaxine) can affect BP; it … You have made me more educated on this and now I can ask my dr about it when I see him in June. I would not suggest taking it at night. Because they affect two important brain chemicals — serotonin and norepinephrine — these drugs are sometimes called dual reuptake inhibitors or dual-acting antidepressants. Norepinephrine is also hypothesized to be involved in depression, and is synthesized from dopamine, another mood neurotransmitter. Norepinephrine (NE) is an endogenous catecholamine and a direct acting adrenergic agonist. When doctors talk about low norepinephrine activity, they don't necessarily mean the amount in your body is abnormally low. The highest recommended dose of venlafaxine for most people is 225 mg total per day. Effexor (venlafaxine) is an antidepressant used to treat depression, depression with associated symptoms of anxiety, generalized anxiety disorder, social anxiety disorder, and adults with panic disorder. Like you driving was a big issue for me. How did you feel at that amount? These receptors have a wide ranging function, but in the context of mirtazapine, they are involved in a negative feedback loop and activation typically causes inhibition of norepinephrine release Experts aren't exactly sure how venlafaxine works but believe its effects may be due to its ability to block the reuptake of serotonin and norepinephrine, and to some extent dopamine, three neurotransmitters in the brain … It was introduced by Wyeth in 1994. Yes Effexor (venlafaxine) can affect BP; it … By comparison, Cymbalta (for example) has about a 10:1 ratio. With effexor I had a way better mood increase (5-10x better) and also had a huge increase in motivation, and I had this great response on a low 37.5mg dose. Pharmacodynamically, it functions primarily as a serotonin-norepinephrine reuptake inhibitor (SNRI) and is understood to be the first-ever “dual reuptake inhibitor” approved by the FDA for the treatment of major depressive disorder. Drugdad : Venlafaxine is an oral antidepressant agent of the Serotonin-Norepinephrine Reuptake Inhibitor class. Norepinephrine is thought to play a role in the body’s stress response and helps to regulate sleep, alertness, and blood pressure. Venlafaxine may be used in the treatment of depression. Unless you start to feel much worse on your new dosage I’d suggest trying to give it a trial of at least 60 days. What is this Hormone’s Effect on Mood? Cymbalta is a more balanced SNRI, which means it hits sero and NE in a more balanced way…I have read 10:1, but my docs say it’s more half and half. Venlafaxine, sold under the brand name Effexor among others, is an antidepressant medication of the serotonin-norepinephrine reuptake inhibitor (SNRI) class. Good luck to you. 6 Cymbalta causes side effects like fatigue and constipation, Effexor does not. Effexor (Venlafaxine) Effexor was the first SNRI to be approved in the United States in 1993. Above 150mg, it acts on both serotonin and noradrenaline. Norepinephrine is similar to adrenaline. NE is the body’s primary adrenergic neurotransmitter. So, you'll be getting the norepinephrine reuptake inhibition at every dose strength. Effexor was the first SNRI to be approved in the United States in 1993. You are right, I want to try for the medication that hits the most norepinephrine. The sexual side effects for me have been a little weird, but so far manageable. Venlafaxine belongs to a group of drugs known as selective serotonin – norepinephrine reuptake inhibitors (SNRIs). Do you take Effexor or the generic? It was later increased to 75 but I think 37.5 gave me just as good of a response. Delgato and F.A. I would be willing to give it another try in the future if things don’t get better but I’d like to see if I can find something more effective. What meds are you on? I My appetite can back (I am too skinny) , slept better. is a prescription drug used in the treatment of depression, social phobias, and generalized anxiety disorder. It is a serotonin-norepinephrine reuptake inhibitor (SNRI). Effexor (venlafaxine) XR only works on norephinephrine above 150..Therefore at 150 it is basically an ssri...Is high blood pressure associated with Effexor (venlafaxine) at 150? I know I have probably asked this of you before but I just don’t remember. discontinuation, raise dose to stop much more slowly Withdrawal effects can be more common or more severe with venlafaxine than with some other antidepressants Pharmacokinetics • Parent drug has 3–7 hour half-life • Active metabolite has 9–13 hour half-life • Food does not affect … Effexor is a prescription medication that is used to treat depression, generalized anxiety disorder and social phobias. The first drug I tried was a Tricyclic ad and it was imipramine (Tofranil). I am now on 112.5 of Effexor and the first few days have made me worse. For the record, 75mg of effexor is the usual starting dose for many people…150 is still considered a reasonable amount as some people need to go up to 375!! I was just afraid to stay on the klonopin any longer (been about 3-4 months) because I have read that it makes it more difficult for your brain to normally adjust to this condition. The Migraine Associated Vertigo Community. Are you taking any other meds? It has been approved by the FDA for depression, panic disorder, social phobia, and generalized anxiety disorder (GAD). They are primarily used in the treatment of depression, but are also prescribed for smoking cessation and for the treatment of attention deficit disorder. Many recreational drugs get people "high" by increasing levels of norepinephrine (and the related neurotransmitter dopamine). Just interested, I currently take 150mg. Venlafaxine may be used in the treatment of depression. Hope that helps! Of course your psychiatrist will be able to determine which dose you will need to most effectivly manage both your seratonin and norepinephrine levels. An extended-release form of a drug slowly releases the active ingredient over a prolonged period of time. Aside from the adrenal glands, norepinephrine is also produced in certain brain areas where it can affect wide-ranging parts of the brain. My current pain management (Also pshyciatry and int. You have no idea how much better I felt when I read your reply. Sign up for free to ask U.S. doctors your own question! In going cold turkey from effexor, (venlafaxine) does the norepinephrine increase or decrease? Are you feeling any better? It seems to me that if it’s affecting both serotonin and norephemine, then that would be a GOOD thing for MAV! I truly don’t think there’s a way to measure exactly. By using our website, you consent to our use of cookies. What side affects can I expect from upping my dose of Effexor (venlafaxine) XR from 150mg to 225mg? Serotonin and norepinephrine reuptake inhibitors (SNRIs) ... especially in the first few weeks after starting or when the dose is changed. Physicians prescribe it primarily for depression and anxiety disorders, although not for low-grade, everyday anxiety, the Mayo Clinic reports. How many hours need to be in between doses of effexor (venlafaxine)? (Not you George)… I seriously thought I was the only MAV person who needed to take more than 75mg and good to hear that Dr Hain sometimes goes over that. But I could not find specific information about what doses of Effexor hit norephemine and what amount of dosage affects serotonin? "Bicyclic" antidepressant; drug is structurally unrelated to SSRIs, MAOIs, and tricyclic antidepressants (TCAs), but it and its metabolite are potent inhibitors of serotonin and norepinephrine reuptake and weak inhibitors of dopamine reuptake; it does not have MAOI activity or activity for H1 histaminergic, muscarinic cholinergic, or alpha2-adrenergic receptors It is taken by mouth. Your story inspires me to stay on it and stick with it. My first drug was a Tricyclic AD (imipramine) and I felt worse on it. P.L. Even at 150 mg (where it begins to affect serotonin), consider this: Effexor has a SE:NE (serotonin:norepinephrine) reuptake-inhibition ratio of 30:1 – or, said simply, it’s 30 times more potent on serotonin than on norepinephrine. Hang in there, I hope effexor ends up being your answer to feeling better. Is it even possible to get the “brand name” anymore? Effexor and Effexor-XR are the two brand names in the United States under which the generic medication venlafaxine is sold 3. Venlafaxine works by increasing the availability of serotonin and norepinephrine in your brain 1 2 3 . Effexor (Venlafaxine) Prescription Facts & Regulations. Raising norepinephrine is not necessarily a bad thing. It may be that your body doesn't use it efficiently. Effexor XR is an antidepressant and anti-anxiety medication that belongs to the family of selective serotonin and norepinephrine reuptake inhibitors (SNRIs). The question about driving is hard to answer. Serotonin has a complex effect on sleep and its array of receptor subtypes are involved in different effects. Effexor (venlafaxine) was the first antidepressant in the class of drugs known as serotonin-norepinephrine reuptake inhibitors (SNRIs). Jou, Handen, and Hardan (2005) reported on a consecutive case series involving 20 children with ASDs aged 6–19 years. Effexor XR (venlafaxine extended-release) can affect the prostate but is not directly associated with increased PSA (Prostate-Specific Antigen) levels.There is a correlation between elevated PSA levels and prostate cancer. Kelley. on July 31, 2002, at 1:31:28. How long did it take? Low Norepinephrine Activity . Thank you Kelley(rockysmom) for your help on this too. I feel great off of it. The prescription medication is absorbed and metabolized by the liver. None of us know what tomorrow holds, so lets make today the best we can… Re: Effexor XR -- dose vs. tiredness ? It … Norepinephrine is inactivated in alkaline solutions; do not mix with bicarbonate. Pam, thanks for sending me your response. Also known by its generic name as venlafaxine, this drug is classified as a serotonin-norepinephrine reuptake inhibitor (SNRI), which works by helping to restore the balance of serotonin and norepinephrine in the brain. It was approved by the FDA and released on the market in August 2004. Norepinephrine, substance that is released predominantly from the ends of sympathetic nerve fibers and that acts to increase the force of skeletal muscle contraction and the rate and force of contraction of the heart. It is said that cymbalta's serotonin to norephinephrine is 1:1..Does that make it an even ratio...And is it then stronger/weaker than effexor/pristiqe?