Desvenlafaxine

Oral
Depression

CrCl (mL/min)	Dosage
<30 or ESRD	25 mg daily or 50 mg every other day. Supplemental doses should not be given after dialysis.
30-50	Max: 50 mg once daily.

Moderate to severe: 50 mg daily. Max: 100 mg once daily.

extended-release: May be taken with or without food. Take at the same time each day. Swallow whole, do not divide/crush/chew/dissolve tab.

Concurrent use or w/in 14 days of discontinuing MAOIs (e.g. linezolid, IV methylene blue). Initiation of MAOI at least 7 days after discontinuing desvenlafaxine.

Patient w/ pre-existing HTN or other conditions that may be compromised by increased BP, raised intraocular pressure, personal or family history of mania or hypomania; CV, cerebrovascular or lipid metabolism disorders; seizure disorder. Avoid abrupt withdrawal. Renal and moderate to severe hepatic impairment. Pregnancy and lactation.

Suicidal thinking/behaviour, HTN, mydriasis, seizure, hyponatraemia, interstitial lung disease and eosinophilic pneumonia; nausea, dizziness, insomnia, hyperhidrosis, constipation, somnolence, decreased appetite, anxiety, sexual function disorders in males (e.g. anorgasmia, decreased libido, abnormal orgasm, delayed ejaculation, erectile dysfunction, ejaculation disorder, ejaculation failure, sexual dysfunction).
Potentially Fatal: Serotonin syndrome or neuroleptic malignant syndrome-like reactions; haemorrhage.

PO: Z (Risk of postpartum haemorrhage, persistent pulmonary hypertension in infant and neonatal withdrawal/toxicity in late pregnancy use. Monitor closely.)

May impair ability to drive or operate machinery.

Monitor renal function, BP, lipid panel (e.g. total cholesterol, LDL, triglycerides); signs/symptoms of serotonin syndrome; mental status for depression, suicidal ideation (esp at the beginning of therapy or when doses are increased or decreased); intraocular pressure (in patients w/ baseline elevations or history of glaucoma).

Increased risk of bleeding w/ aspirin or other NSAIDs, warfarin and other anticoagulants.
Potentially Fatal: Increased risk of serotonin syndrome w/ MAOIs (e.g. linezolid, IV methylene blue).

Avoid alcohol. May increase risk of serotonin syndrome w/ St John's wort.

May cause false positive urine immunoassay screening tests for phencyclidine and amphetamine.

Description:
Mechanism of Action: Desvenlafaxine is the principal active metabolite of venlafaxine. The exact mechanism is unknown, but is thought to be related to the potentiation of serotonin and norepinephrine in the CNS, through inhibition of their reuptake.
Pharmacokinetics:
Absorption: Well absorbed. Bioavailability: 80%. Time to peak plasma concentration: Approx 7.5 hr.
Distribution: Volume of distribution: 3.4 L/kg. Plasma protein binding: Approx 30%.
Metabolism: Hepatic, via conjugation (major pathway), and oxidation by CYP3A4 (minor pathway).
Excretion: Via urine, as unchanged drug (45%) and as metabolites (approx 24%). Elimination half-life: Approx 10-11 hr.

Source: National Center for Biotechnology Information. PubChem Database. Desvenlafaxine, CID=125017, https://pubchem.ncbi.nlm.nih.gov/compound/Desvenlafaxine (accessed on Jan. 20, 2020)

Store between 20-25°C.

Antidepressants

N06AX23 - desvenlafaxine ; Belongs to the class of other antidepressants.

Anon. Desvenlafaxine. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 06/11/2015.

Buckingham R (ed). Desvenlafaxine Succinate. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com . Accessed 06/11/2015.

McEvoy GK, Snow EK, Miller J et al (eds). Desvenlafaxine Succinate. AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). https://www.medicinescomplete.com. Accessed 06/11/2015.

Pristiq Extended-Release Tablet (Wyeth Pharmaceuticals Inc., a subsidiary of Pfizer Inc). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 06/11/2015.