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 Name | Manufacturer | Strength/Dosage Form | Price (USD) |
---|
Pristiq | Pfizer | 50 mg Tablet | $4.50 |
Khedezla | Osmotica | 100 mg Tablet | $5.50 |
15 FAQs with Answers
- What is Desvenlafaxine used for? – Primarily for treating major depressive disorder.
- Can Desvenlafaxine be used for anxiety? – Yes, off-label for anxiety disorders.
- How should I take Desvenlafaxine? – Swallow the extended-release tablet whole.
- What are the common side effects of Desvenlafaxine? – Includes nausea, dizziness, and dry mouth.
- Is Desvenlafaxine safe during pregnancy? – Category C, potential risks should be discussed with a doctor.
- Can Desvenlafaxine be combined with alcohol? – Alcohol may increase the risk of side effects; avoidance recommended.
- What is the maximum daily dose of Desvenlafaxine? – Should not exceed 100 mg per day.
- What should I avoid while taking Desvenlafaxine? – Avoid activities requiring full mental alertness until effects are known.
- What are signs of serotonin syndrome with Desvenlafaxine? – Symptoms include agitation, hallucinations, and rapid heart rate.
- Is Desvenlafaxine addictive? – Not habit-forming, but discontinuation should be gradual under medical supervision.
- Should I stop taking Desvenlafaxine suddenly? – No, should be tapered off under doctor’s guidance to avoid withdrawal symptoms.
- What are the rare but serious side effects of Desvenlafaxine? – Severe hypertension and suicidal thoughts.
- What other medications interact with Desvenlafaxine? – Interacts with MAO inhibitors and serotonergic drugs.
- Who should not take Desvenlafaxine? – Individuals with uncontrolled hypertension or those on MAO inhibitors.
- How does Desvenlafaxine work to alleviate depression? – It increases the levels of serotonin and norepinephrine in the brain to improve mood.