Generic Name and Formulations:
Desvenlafaxine (as succinate) 50mg, 100mg; ext-rel tabs.
Major depressive disorder.
Swallow whole. 50mg once daily. Moderate renal impairment: max 50mg/day. Severe renal impairment (CrCl <30mL/min), ESRD: 50mg every other day. Do not give supplemental dose after dialysis. Hepatic impairment: max 100mg/day. Withdraw gradually.
Serotonin and norepinephrine reuptake inhibitor.
Allow ≥14 days after MAOI discontinuance before starting desvenlafaxine; allow ≥7 days after desvenlafaxine discontinuance before starting an MAOI. Concomitant linezolid, IV methylene blue.
Increased risk of suicidal thinking or behavior; monitor for clinical worsening or unusual changes. Not for treating bipolar depression. Monitor for serotonin syndrome; discontinue if occurs. Monitor BP; reduce dose or discontinue if elevated BP persists. Cardio- or cerebrovascular disease. Hypercholesterolemia. Increased intraocular pressure. Mania/hypomania. Severe renal dysfunction. Seizure disorder. Reevaluate periodically. Write ℞ for smallest practical amount. Elderly. Labor & delivery. Pregnancy (Cat.C; avoid in 3rd trimester; taper). Nursing mothers: not recommended.
See Contraindications. Avoid alcohol, concomitant venlafaxine, other forms of desvenlafaxine. Increased risk of serotonin syndrome with other serotonergic drugs (eg, triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone, St. John's Wort) or with drugs that impair serotonin metabolism (eg, MAOIs, linezolid, IV methylene blue). Increased risk of bleeding with concomitant NSAIDs, aspirin, anticoagulants; monitor. May be potentiated by potent CYP3A4 inhibitors. May antagonize CYP3A4 substrates. May cause false (+) urine immunoassay screening tests for PCP and amphetamine.
Nausea, dizziness, insomnia, hyperhidrosis, constipation, somnolence, decreased appetite, anxiety, sexual dysfunction; rare: hyponatremia/SIADH (esp. in elderly), interstitial lung disease, eosinophilic pneumonia, serotonin syndrome, mydriasis.
Tabs—14, 30, 90