Pharmacy Author: Omudhome Ogbru, PharmD
Medical and Pharmacy Editor: Jay W. Marks, MD
GENERIC NAME: desvenlafaxine
BRAND NAME: Pristiq
DRUG CLASS AND MECHANISM: Desvenlafaxine is an oral drug that is used
for treating depression. It is in a class of drugs called selective serotonin
and norepinephrine reuptake inhibitors (SNRI); a class that also contains
venlafaxine (Effexor) and duloxetine (Cymbalta). (Desvenlafaxine is an active
metabolite of venlafaxine, that is, it is a product of venlafaxine that is
manufactured by the body from venlafaxine.) Desvenlafaxine affects
neurotransmitters, the chemicals that nerves within the brain make and release
in order to communicate with each other. Neurotransmitters either travel across
the space between nerves and attach to receptors on the surface of nearby nerves
or they attach to receptors on the surface of the nerves that produced them, to
be taken up by the nerve and released again (a process referred to as
re-uptake).
Many experts believe that an imbalance among neurotransmitters is the cause
of depression. Serotonin and norepinephrine are two neurotransmitters released
by nerves in the brain. Desvenlafaxine works by preventing the reuptake of
serotonin and epinephrine by nerves after they have been released. Since uptake
is an important mechanism for removing released neurotransmitters and
terminating their actions on adjacent nerves, the reduced uptake caused by
desvenlafaxine increases the effect of serotonin and norepinephrine in the
brain. The FDA approved desvenlafaxine in February 2008.
PRESCRIPTION: Yes
GENERIC AVAILABLE: No
PREPARATIONS: Tablets (extended release): 50, and 100 mg
STORAGE: Tablets should be kept at room temperature, 68-77 F
(20-25 C).
PRESCRIBED FOR: Desvenlafaxine is used for the treatment of major
depression.
DOSING: The recommended dose of desvenlafaxine is 50 mg daily, with or
without food. Doses greater than 50 mg are not more effective but cause more
side effects.
DRUG INTERACTIONS: All SNRIs, including desvenlafaxine, should not be
taken with any of the monoamine oxidase inhibitor (MAOI) class of
antidepressants, for example, isocarboxazid (Marplan), phenelzine (Nardil),
tranylcypromine (Parnate), selegiline (Eldepryl), and
procarbazine (Matulane) or
other drugs that inhibit monoamine oxidase [for example,
linezolid (Zyvox)]. Such combinations may
lead to confusion, high blood pressure, tremor, hyperactivity,
coma, and death.
Desvenlafaxine should not be administered within 14 days after stopping MAOIs
and MAOIs should not be administered within 7 days of stopping desvenlafaxine.
Similar reactions may occur if desvenlafaxine is combined with other SNRIs,
selective serotonin reuptake inhibitors [for example, fluoxetine (Prozac) or paroxetine
(Paxil)] or other drugs that increase serotonin in the brain, for example, tryptophan,
St. John's wort,
meperidine (Demerol) or tramadol (Ultram).
SNRIs may increase the effect of warfarin
(Coumadin), leading to excessive bleeding.
Warfarin therapy should be monitored more frequently in patients who are also
taking desvenlafaxine. Combining SNRIs with
aspirin,
nonsteroidal
antiinflammatory drugs (NSAIDs) or other drugs that affect bleeding may increase the
likelihood of upper gastrointestinal bleeding.
Ketoconazole (Nizoral, Extina, Xolegel, Kuric) may reduce the breakdown of desvenlafaxine, therefore increasing
concentrations of desvenlafaxine in the body and the risk of adverse effects.
Desvenlafaxine may reduce the concentration of midazolam (Versed).
PREGNANCY: There are no adequate studies of desvenlafaxine in
pregnant
women.
NURSING MOTHERS: Desvenlafaxine is secreted in breast milk. Mothers
who are taking desvenlafaxine should consider not
breastfeeding.
SIDE EFFECTS: Desvenlafaxine can cause nausea,
headaches, anxiety,
insomnia, drowsiness, constipation, weakness, dry mouth, sweating, diarrhea and
loss of appetite. Increased blood pressure can occur and should be monitored.
Seizures have been reported. Sexual dysfunction (decreased sex drive and delayed
orgasm and ejaculation) has been associated with desvenlafaxine. Some patients
may experience withdrawal reactions upon stopping desvenlafaxine. Symptoms of
withdrawal include anxiety, nausea, nervousness, and insomnia. The dose of
desvenlafaxine should be gradually reduced when therapy is discontinued to
prevent symptoms of withdrawal.
Antidepressants increased the risk of suicidal thinking and behavior
(suicidality) in short-term studies in children and adolescents with depression
and other psychiatric disorders. Anyone considering the use of desvenlafaxine or
any other antidepressant in a child or adolescent must balance this risk with
the clinical need. Patients who are started on therapy should be closely
observed for clinical worsening, suicidality, or unusual changes in behavior.
Last Editorial Review: 1/7/2009
Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.
- Antidepressants - Read about the differnent types of antidepressants (used to treat depression) their side effects, drug interactions, and warnings and precautions.
- Depression - Read about depression causes, symptoms, diagnosis, treatment and types, including manic depression (bipolar disorder), postpartum depression and clinical depression.
- Posttraumatic Stress Disorder - Read about post-traumatic stress disorder (PTSD) symptoms (nightmares, flashbacks), causes (war, traumatic events), effects (depression, suicide) and treatment (medications, exposure therapy).
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