Generic Name and Formulations:
Desvenlafaxine 50mg, 100mg; ext-rel tabs.
Major depressive disorder.
Swallow whole. 50mg once daily. Moderate renal impairment (CrCl 30–50mL/min): max 50mg/day. Severe renal impairment (CrCl <30mL/min), ESRD: max 50mg every other day. Do not give supplemental dose after dialysis. Moderate-to-severe hepatic impairment: max 100mg/day. Withdraw gradually.
During or within 14 days of MAOIs (see Interactions). Concomitant linezolid or IV methylene blue.
Increased risk of suicidal thinking and behavior in children, adolescents, and young adults; monitor for clinical worsening or unusual changes. Monitor for emergence of serotonin syndrome; discontinue if occurs. Pre-existing hypertension, cardio- or cerebrovascular disease. Monitor BP before and during treatment; consider dose reduction or discontinuation if elevated BP persists. Increased risk of bleeding. Angle-closure glaucoma. History of mania/hypomania. Renal or hepatic impairment. Seizure disorder. Avoid abrupt cessation. Reevaluate periodically. Write ℞ for smallest practical amount. Elderly. Pregnancy (Cat.C; avoid in 3rd trimester). Nursing mothers: not recommended.
See Contraindications. Allow ≥14 days after MAOI discontinuance before starting desvenlafaxine; allow ≥7 days after desvenlafaxine discontinuance before starting an MAOI. 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, amphetamines, 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, warfarin, or others that affect coagulation. May be affected by CYP2D6 substrates.
Nausea, dizziness, insomnia, hyperhidrosis, constipation, somnolence, decreased appetite, anxiety, specific male sexual dysfunction; hyponatremia (esp. in elderly); rare: interstitial lung disease or eosinophilic pneumonia (consider discontinuing if occurs).
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