Desvenlafaxine

Introduction

  • Generic Name: Desvenlafaxine
  • Brand Names: Pristiq, Khedezla
  • Pharmacological Class: Serotonin-norepinephrine reuptake inhibitor (SNRI)
  • Mechanism of Action: Enhances neurotransmitter activity in the brain to improve mood, relieve pain, and decrease anxiety.

Indications

  • Primary Use: Treatment of major depressive disorder (MDD)
  • Other Uses: May be used off-label to treat anxiety, panic disorders, and neuropathic pain.

Dosage

  • Adults: Typically starts at 50 mg once daily, with or without food. Doses may be adjusted based on efficacy and tolerability up to 100 mg daily.
  • Elderly: Use caution; start at a lower dose due to increased risk of side effects.
  • Children: Not recommended for use in children under the age of 18.

Administration

  • Method: Oral intake.
  • Precautions: Swallow tablets whole; do not split, chew, or crush them.

Forms Available

  • Extended-Release Tablets: 25 mg, 50 mg, 100 mg

Side Effects

  • Common: Nausea, dizziness, dry mouth, sweating, fatigue.
  • Less Common: Weight loss, sexual dysfunction, increased blood pressure.
  • Rare but Serious: Serotonin syndrome, suicidal thoughts in young adults and adolescents, severe hypertension.

Warnings

  • Suicide Risk: Black box warning for increased risk of suicidal thoughts and behaviors in children, adolescents, and young adults.
  • Contraindications: Should not be used in conjunction with MAO inhibitors or within 14 days of stopping such treatment.

Precautions

  • General: Monitor for mood changes, suicidal ideation, and serotonin syndrome.
  • Health Conditions: Use with caution in patients with cardiovascular disease, glaucoma, or history of seizures.

Interactions

  • Medications: Risk of serotonin syndrome with other serotonergic drugs, NSAIDs may increase bleeding risk.
  • Food: No significant interactions known, but consistent intake with or without food is recommended to maintain drug levels.

Monitoring Parameters

  • Mental Health: Regular psychiatric assessments to monitor for worsening depression or emergent suicidal thoughts.
  • Blood Pressure: Monitor blood pressure regularly due to potential increases.

Use in Children

  • Guidelines: Not approved for depression in patients younger than 18 years due to risk of suicidal thoughts.

Use in Pregnancy

  • FDA Category: C. Risks to the fetus cannot be ruled out; use only if potential benefits justify potential risks.

Use in Elderly

  • Considerations: Increased sensitivity to side effects; dosage adjustments may be necessary.

Use in Kidney Disease

  • Adjustments: May require dose adjustments based on renal function.

Use in Liver Disease

  • Caution: Use with caution in patients with severe liver impairment; dosage adjustments may be needed.

Patient Counselling Points

  • Medication Use: Importance of adherence to prescribed dosage.
  • Side Effects: Encourage patients to report all side effects, especially mood changes or unusual bleeding.
  • Lifestyle: Discuss potential effects on driving and operating machinery.

Table of Brand Names, Manufacturer, and Prices in USD

Brand NameManufacturerStrength/Dosage FormPrice (USD)
PristiqPfizer50 mg Tablet$4.50
KhedezlaOsmotica100 mg Tablet$5.50

15 FAQs with Answers

  1. What is Desvenlafaxine used for? – Primarily for treating major depressive disorder.
  2. Can Desvenlafaxine be used for anxiety? – Yes, off-label for anxiety disorders.
  3. How should I take Desvenlafaxine? – Swallow the extended-release tablet whole.
  4. What are the common side effects of Desvenlafaxine? – Includes nausea, dizziness, and dry mouth.
  5. Is Desvenlafaxine safe during pregnancy? – Category C, potential risks should be discussed with a doctor.
  6. Can Desvenlafaxine be combined with alcohol? – Alcohol may increase the risk of side effects; avoidance recommended.
  7. What is the maximum daily dose of Desvenlafaxine? – Should not exceed 100 mg per day.
  8. What should I avoid while taking Desvenlafaxine? – Avoid activities requiring full mental alertness until effects are known.
  9. What are signs of serotonin syndrome with Desvenlafaxine? – Symptoms include agitation, hallucinations, and rapid heart rate.
  10. Is Desvenlafaxine addictive? – Not habit-forming, but discontinuation should be gradual under medical supervision.
  11. Should I stop taking Desvenlafaxine suddenly? – No, should be tapered off under doctor’s guidance to avoid withdrawal symptoms.
  12. What are the rare but serious side effects of Desvenlafaxine? – Severe hypertension and suicidal thoughts.
  13. What other medications interact with Desvenlafaxine? – Interacts with MAO inhibitors and serotonergic drugs.
  14. Who should not take Desvenlafaxine? – Individuals with uncontrolled hypertension or those on MAO inhibitors.
  15. How does Desvenlafaxine work to alleviate depression? – It increases the levels of serotonin and norepinephrine in the brain to improve mood.