Adult Dosing
Major Depressive Disorder (MDD)
- Start 50 mg PO qd
- Elderly: 50 mg PO every other day
- Dosage greater than 50 mg/day has no added benefits and adverse events are more at higher doses
Maintenance/Continuation/Extended Treatment
- Long term efficacy at a dose of 50 mg/day has not been studied, monitor patient periodically to determine the need for continued treatment
Discontinuing of desvenlafaxine
- Drug should be discontinued with gradual reduction in the dose, if intolerable symptoms occur resume the previous dose
Switching Patients From Other Antidepressants
- Taper initial antidepressant to minimize discontinuation symptoms
Switching Patients To or From a Monoamine Oxidase Inhibitor (MAOI)
- Initiate desvenlafaxine after 14 days of discontinuation of an MAOI
- Initiate MAOI least 7 days after stopping desvenlafaxine
Pediatric Dosing
- Safety and effectiveness in pediatric patients have not been established
[Outline]
Renal Dose Adjustment (Based on CrCl)
- Mild Renal impairment (50-80 mL/min): No dose adjustments
- Moderate Renal impairment (30-50 mL/min): 50 mg/day
- Severe Renal impairment (<30 mL/min) or End stage renal disease(ESRD): 50 mg PO qod
- Hemodialysis: No supplement
- Note: Do not escalate the dose in moderate/severe renal impairment or ESRD
Hepatic Dose Adjustment
- Hepatic impairment: Max 100 mg/day
- Note: Dose escalation above 100 mg/day is not recommended
See Supplemental Patient Information
- Therapy may increase the risk of suicidality in patients with major depressive disorder or other psychiatric disorders [US Black Box Warning]
- Studies suggested that suicidality risk was not increased in patients >24 yrs and risk decreased in patients >65 yrs [US Black Box Warning]
- During the initial few months of therapy, or at times of dose changes, close monitoring should be done for clinical worsening, suicidality, or unusual changes in behavior [US Black Box Warning]
- The following symptoms, anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia (psychomotor restlessness), hypomania, and mania, have been reported in adult and pediatric patients being treated with antidepressants drugs
- Discontinue the therapy by tapering the dose in patient with depression or suicidality, severe symptoms
- Close supervision by family and caregivers should be done during therapy. Desvenlafaxine is not approved for use in pediatric patients with major depressive disorder (MDD) [US Black Box Warning]
- Patient with depressive symptoms should be screened to determine risk of bipolar disorder
- Life threatening serotonin syndrome may occur with SNRIs and SSRIs, including desvenlafaxine treatment, particularly with concomitant use of serotonergic drugs
- Concomitant use of desvenlafaxine with MAOIs intended to treat depression is contraindicated
- Do not use desvenlafaxine with serotonin precursors (such as tryptophan)
- Monitor blood pressure during therapy
- Rise in fasting serum total cholesterol, LDL cholesterol and triglycerides were observed
- Abrupt discontinuation or dose reduction may associated with the appearance of new symptoms that include dizziness, nausea, headache, irritability, insomnia, diarrhea, anxiety, fatigue, abnormal dreams, and hyperhidrosis
- Hyponatremia have occurred with SSRIs and SNRIs. Discontinuation of drug in patient with symptomatic hyponatremia and appropriate medical intervention should be instituted
- Interstitial lung disease and eosinophilic pneumonia associated with venlafaxine
Cautions: Use cautiously in
- Hepatic impairment
- Diabetes mellitus
- Volume depletion
- Pre-existing hypertension
- Narrow-angle glaucoma
- Cardiovascular disorder
- Cerebrovascular
- Lipid metabolism disorders
- History of myocardial infarction
- Concomitant administration of diuretics
- Fluid and electrolyte imbalance
- History of seizure disorder
- History of mania/hypomania
- Co administration of NSAID's, Warfarin, Aspirin (may increase risk of bleeding)
- Co administration of venlafaxine
- Co administration of serotonergic drugs or serotonin precursors
- Pregnancy (3rd trimester)
Supplemental Patient Information
- Advise family and caregivers for need of close supervision for clinical worsening, suicidality, or unusual changes in behavior
Pregnancy Category:C
Breastfeeding: Safety unknown as no published data exists for use of desvenlafaxine during breastfeeding. Desvenlafaxine is the active metabolite of venlafaxine which is likely to be excreted in large amounts in breast milk. Other agents may be preferred due to risk of neonatal withdrawl symptoms. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 25 January 2011). As per manufacture data decision should be made whether or not to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.
Pricing data from www.DrugStore.com in U.S.A.
- Pristiq 50 MG TB24 [Bottle] (WYETH)
30 mg = $150.98
90 mg = $429.97 - Pristiq 100 MG TB24 [Bottle] (WYETH)
30 mg = $152.99
90 mg = $439.99
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
Drug Name: 24 HR Pristiq 100 MG Extended Release Tablet
Ingredient(s): Desvenlafaxine
Imprint: W;100
Color(s): Orange
Shape: Square
Size (mm): 9.00
Score: 1
Inactive Ingredient(s): hypromellose 2208 (15000 cps) / cellulose, microcrystalline / talc / magnesium stearate / titanium dioxide / polyvinyl alcohol / polyethylene glycol / ferric oxide yellow / fd&c yellow no. 6
Drug Label Author:
Wyeth Pharmaceuticals Company
DEA Schedule:
Non-Scheduled
Drug Name: 24 HR Pristiq 50 MG Extended Release Tablet
Ingredient(s): Desvenlafaxine
Imprint: W;50
Color(s): Pink
Shape: Square
Size (mm): 8.00
Score: 1
Inactive Ingredient(s): hypromellose 2208 (15000 cps) / cellulose, microcrystalline / talc / magnesium stearate / polyethylene glycol / titanium dioxide / ferric oxide red / polyvinyl alcohol / ferric oxide yellow
Drug Label Author:
Wyeth Pharmaceuticals Company
DEA Schedule:
Non-Scheduled
