desvenlafaxine (Rx)

Brand and Other Names:Pristiq, Khedezla
  • Print

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

tablet, extended release

  • 25mg
  • 50mg
  • 100mg
more...

Major Depressive Disorder

50 mg PO once daily

Higher dosages, up to 400 mg/day, have been used but have not been proved more efficacious; increased side effects have been reported

Assess periodically to determine need for continued treatment

Dosing Modifications

Renal impairment

  • CrCl ≥50 mL/min: Dosage adjustment not necessary
  • CrCl 30-50 mL/min: Not to exceed 50 mg once daily
  • CrCl <30 mL/min: 25 mg once daily or 50 mg every other day
  • Moderate-to-severe renal impairment: Do not increase dosing interval
  • End stage renal disease, requiring hemodialysis: 25 mg PO once daily
  • Do not administer supplemental dose after hemodialysis

Hepatic impairment

  • Recommended dosage: 50 mg PO once daily; dosages >100 mg/day not recommended

Dosing Considerations

When discontinuing, reduce dosage gradually, because abrupt discontinuance may result in adverse effects; if intolerable effects still occur, resume therapy at previously prescribed dosage and then decrease even more gradually

To minimize discontinuance symptoms, taper initial antidepressant before switching to desvenlafaxine

Wait at least 14 days between discontinuance of monoamine oxidase inhibitor (MAOI) and initiation of desvenlafaxine; wait at least 7 days between discontinuance of desvenlafaxine and initiation of MAOI

Administration

Take whole with fluid; do not divide, crush, chew, or dissolve

Take at approximately the same time every day

Safety and efficacy not established

Next:

Interactions

Interaction Checker

and desvenlafaxine

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

            All Interactions Sort By:
             activity indicator 
            Previous
            Next:

            Adverse Effects

            Adverse drug reactions (ADRs) shown occur with 50 mg/day dosage at rate higher than seen with placebo

            >10%

            Nausea (22-41%)

            Headache (20-29%)

            Dry mouth (11-25%)

            Hyperhidrosis (10-21%)

            Dizziness (13-16%)

            Insomnia (9-15%)

            Constipation (9-14%)

            Fatigue (7-11%)

            Diarrhea (5-11%)

            1-10%

            Decreased appetite (5-10%)

            Anxiety (0-10%)

            Elevated cholesterol and triglycerides (0-10%)

            Insomnia (0-10%)

            Tremor (2-9%)

            Proteinuria (5-8%)

            Mydriasis (2-6%)

            Male sexual dysfunction (0-6%)

            Anxiety (3-5%)

            Vertigo (1-5%)

            Blurred vision (3-4%)

            Abnormal dreams (2-4%)

            Urinary hesitation (2-4%)

            Yawning (1-4%)

            Feeling jittery (1-3%)

            Female sexual dysfunction (0-3%)

            Irritability (2%)

            Other (eg, abnormal liver function tests, increased blood prolactin, convulsion, syncope, extrapyramidal disorders, musculoskeletal stiffness, depersonalization, hypomania, bruxism, epistaxis, orthostatic hypotension) (<2%)

            Asthenia (1-2%)

            Nervousness (1-2%)

            Hot flush (1-2%)

            Rash (1-2%)

            Frequency Not Defined

            Ischemic cardiac events in patients with multiple underlying cardiac risk factors

            Gastrointestinal (GI) bleeding, hallucinations, photosensitivity reactions and severe cutaneous reactions (eg, Stevens-Johnson syndrome, toxic epidermal necrolysis, erythema multiforme) have occurred with other serotonin-norepinephrine reuptake inhibitors (SNRIs) or selective serotonin reuptake inhibitors (SSRIs)

            Suicidal thoughts and behaviors in adolescents and young adults

            Hyponatremia

            Interstitial lung disease and eosinophilic pneumonia

            Serotonin syndrome

            Elevated blood pressure

            Abnormal bleeding

            Narrow-angle glaucoma

            Activation of mania or hypomania

            Discontinuance syndrome

            Seizure

            Postmarketing Reports

            Angioedema

            Pancreatitis acute

            Previous
            Next:

            Warnings

            Black Box Warnings

            Antidepressants increase risk of suicidal thinking and behavior in children, adolescents, and young adults (18-24 years) in short-term studies

            Increased risk not observed in patients >24 years; slight decrease observed in patients >65 years

            In children and young adults, initiate only if benefits greatly outweigh risks

            Monitor closely for changes in behavior, clinical worsening, and suicidal tendencies during initial 1-2 months of therapy and dosage adjustments

            Patient’s family should communicate any abrupt behavioral changes to healthcare provider

            Worsening behavior and suicidal tendencies that are not part of presenting symptoms may necessitate discontinuance of therapy

            Not approved for use in pediatric patients

            Contraindications

            Hypersensitivity

            Coadministration with serotonergic drugs

            • Coadministration with MAOIs increases risk of serotonin syndrome
            • Use of MAOIs concomitantly within 14 days before initiating desvenlafaxine or within 7 days after discontinuing desvenlafaxine
            • Symptoms include tremor, myoclonus, diaphoresis, nausea, vomiting, flushing, dizziness, hyperthermia with features resembling neuroleptic malignant syndrome (NMS), seizures, rigidity, autonomic instability with possible rapid fluctuations of vital signs, and mental status changes that include extreme agitation progressing to delirium and coma
            • Starting desvenlafaxine in patient being treated with linezolid or IV methylene blue is contraindicated because of increased risk of serotonin syndrome
            • If linezolid or IV methylene blue must be administered, discontinue desvenlafaxine immediately and monitor for central nervous system (CNS) toxicity; therapy may be resumed 24 hours after last linezolid or methylene blue dose or after 2 weeks of monitoring, whichever comes first

            Cautions

            Suicidality; monitor for clinical worsening and suicide risk (especially in children, adolescents, and young adults aged 18-24 years), during early phases of treatment and alterations in dosages

            Consider risk of serotonin syndrome if administered concomitantly with other serotonergic drugs including triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone, amphetamines, and St. John’s Wort

            Serotonin syndrome or NMS-like reactions may occur; discontinue and initiate supportive therapy; closely monitor patients concomitantly receiving triptans, antipsychotics, or serotonin precursors

            Neonates exposed to SNRIs or SSRIs late in 3rd trimester of pregnancy have developed complications necessitating prolonged hospitalization, respiratory support, and tube feeding

            Control hypertension before initiating treatment; monitor blood pressure regularly during treatment; if sustained hypertension is observed, consider dosage reduction or discontinuance

            SSRIs and SNRIs may impair platelet aggregation and increase the risk of bleeding events, ranging from ecchymoses, hematomas, epistaxis, petechiae, and GI hemorrhage to life-threatening hemorrhage; concomitant use of aspirin, NSAIDs, warfarin, other anticoagulants, or other drugs known to affect platelet function may add to this risk

            Risk of mydriasis; may trigger angle closure attack in patients with angle closure glaucoma with anatomically narrow angles without a patent iridectomy

            Seizure disorder

            Screen patients for bipolar disorder; risk of mixed or manic episodes is increased in patients treated with antidepressants

            Activation of mania or hypomania

            Cardiovascular, cerebrovascular or lipid metabolism disorders; monitor patients who have history of or are at risk for these disorders

            Monitor serum lipids periodically; risk of elevations in fasting serum total cholesterol, low-density lipoprotein (LDL) and triglycerides is increased

            Hyponatremia due to syndrome of inappropriate antidiuretic hormone (SIADH); cases of serum sodium ≤110 mmol/L have been reported; monitor patients who are taking diuretics or at risk for volume depletion

            Rare reports of interstitial lung disease and eosinophilic pneumonia; monitor patients for progressive dyspnea, cough, or chest discomfort

            Risk of mydriasis; may trigger angle closure attack in patients with angle closure glaucoma with anatomically narrow angles without a patent iridectomy

            Dosages >50 mg/day offer no additional benefit but have worse adverse effects

            Prescriptioin should be written for smallest quantity consistent with good patient care

            May cause anxiety, nervousness, and insomnia

            May impair congnitive abilities; use caution operating heavy machinery

            Bone fractures reported with antidepressant treatment; consider possibility of  fracture if antidepressant-treated patient presents with unexplained bone pain

            May cause or exacerbate sexual dysfunction

            Taper dose when possible and monitor for discontinuation symptoms

            Previous
            Next:

            Pregnancy & Lactation

            Pregnancy category: C

            Lactation: Drug is excreted in breast milk; discontinue drug, or do not nurse; use only if benefits greatly outweigh risks

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

            more...
            Previous
            Next:

            Pharmacology

            Mechanism of Action

            Potent SNRI; major active metabolite of venlafaxine

            Absorption

            Bioavailability: 80%

            Peak plasma time: 7.5 hr

            Distribution

            Protein bound: 30%

            Vd: 3.4 L/kg

            Metabolism

            Primary: Conjugation (UDP-glucuronosyltransferase isoform mediated)

            Minor: CYP3A4 oxidative metabolism (N-demethylation)

            Enzymes inhibited: CYP2D6 (minimally)

            Elimination

            Half-life: 11 hr (prolonged in renal or hepatic dysfunction)

            Dialyzable: No

            Excretion: Urine (69%)

            Previous
            Next:

            Images

            Previous
            Next:

            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
            Additional Offers
            Email to Patient

            From:

            To:

            The recipient will receive more details and instructions to access this offer.

            By clicking send, you acknowledge that you have permission to email the recipient with this information.

            Email Forms to Patient

            From:

            To:

            The recipient will receive more details and instructions to access this offer.

            By clicking send, you acknowledge that you have permission to email the recipient with this information.

            Previous