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Venlafaxine Dose-Dependent Hypertension — MRCPsych Paper B MCQ

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ModerateMood DisordersVenlafaxine Dose-Dependent HypertensionMRCPsych Paper B

A 40-year-old man taking venlafaxine XL had his dose increased to 225 mg daily 6 weeks ago. His blood pressure was previously normal but is now 160/100 mmHg on repeated measurements. No alternative cause is apparent. Which statement most accurately describes the recognised relationship between venlafaxine and blood pressure?

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Correct answer: D — The risk is dose-related, so blood pressure should be reviewed after initiation and dose increases

Venlafaxine can cause dose-related increases in blood pressure, including occasional severe hypertension. This patient’s sustained hypertension following escalation to 225 mg daily is therefore a recognised adverse effect. Blood pressure should be assessed before treatment, reviewed periodically after initiation and checked after dose increases. The current UK SmPC does not specify a sharp threshold at which risk suddenly becomes significant, so the original claim that this occurs specifically above 200 mg daily was unnecessarily absolute. Hypertension can occur during maintenance treatment, not only during withdrawal or the first week, and the risk does not diminish as the dose rises. Clinically significant hypertension warrants prompt assessment and reconsideration of the venlafaxine regimen.

Reference: Ranbaxy (UK) Limited. Venlafaxine SUN Pharma XL prolonged-release tablets, Summary of Product Characteristics, section 4.4: Blood pressure. Updated 5 June 2025. https://www.medicines.org.uk/emc/product/5349/smpc