Desvenlafaxine (Pristiq)
SNRI antidepressant
- Major Depression2
- Social Anxiety1
- Panic2
Features
Dosing
50-100 mg qd for depression.
INTERACTIONS: Metabolized by UGT1A1 (outside liver) and depends on p-glycoprotein transporter to enter brain (genes are ABCB1 and ABCC1). People with abnormal p-glycoprotein genes may need higher doses (100-200 mg).
Management
Medically safest of the SNRIs. Metabolite of venlafaxine, but less weight gain/WD problems than venlafaxine. One of few antidepressants with a dose-dependent response, up to 200 mg/day (15% of patients need higher dose due to problems getting it into the brain via p-glyoprotein).
TOLERABILITY: Nausea, sexual dysfunction, sleep disruption, restless legs.
RISKS: Osteopenia in post-menopausal women. Narrow-angle glaucoma. Hypotension in elderly. Hyponatremia. Serotonin syndrome.
EMR Text
Depression
Desvenlafaxine use based on FDA approval in major depressive disorder.
Desvenlafaxine side effects reviewed with patient.
Anxiety Disorders
Desvenlafaxine use based on trials of SNRIs in anxiety disorders.
Desvenlafaxine side effects reviewed with patient.