Desvenlafaxine

DEA Class;  Rx

Common Brand Names; Pristiq, Khedezla (DSC)

Hypersensitivity to desvenlafaxine succinate, venlafaxine hydrochloride or to any excipients in the desvenlafaxine formulation

Adverse drug reactions (ADRs) shown occur with 50 mg/day dosage at rate higher than seen with placebo

• Nausea (22-41%)
• Dry mouth (11-25%)
• Hyperhidrosis (10-21%)
• Dizziness (10-16%)
• Insomnia (9-15%)
• Constipation (9-14%)
• Somnolence (4-12%)
• Fatigue (7-10%)
• Increased total cholesterol of ≥50 mg/dL and an absolute value of ≥261 mg/dL (3-10%)
• Decreased appetite (5-10%)
• Vomiting (3-9%)
• Tremor (2-9%)
• Anorgasmia (3-8%)
• Ejaculation delayed (1-7%)
• Libido decreased (3-6%)
• Triglycerides, fasting ≥327 mg/dL (2-6%)
• Mydriasis (2-6%)
• Vertigo (2-5%)
• Anxiety (3-5%)
• Blurred vision (3-4%)
• Chills (1-4%)
• Yawning (1-4%)
• Abnormal dreams (2-3%)
• Feeling jittery (1-3%)
• Orgasm abnormal (1-3%)
• Nervousness (<2%)
• Tachycardia (<2%)
• Asthenia (<2%)
• Weight increased, liver function test abnormal, blood prolactin increased (<2%)
• Musculoskeletal stiffness (<2%)
• Syncope, convulsion, dystonia (<2%)
• Depersonalization, bruxism (<2%)
• Urinary retention (<2%)
• Rash, alopecia, photosensitivity reaction, angioedema (<2%)

Suicidality; monitor for clinical worsening and suicide risk (especially in children, adolescents, and young adults aged 18-24 years), during early phases of treatment and alterations in dosages

Neonates exposed to SNRIs or SSRIs late in 3rd trimester of pregnancy have developed complications necessitating prolonged hospitalization, respiratory support, and tube feeding

Control hypertension before initiating treatment; monitor blood pressure regularly during treatment; if sustained hypertension is observed, consider dosage reduction or discontinuance

Risk of mydriasis; may trigger angle closure attack in patients with angle closure glaucoma with anatomically narrow angles without a patent iridectomy; avoid use of antidepressants, including desvenlafaxine, in patients with untreated anatomically narrow angles

Use caution in patients with history of seizure disorders

Screen for bipolar disorder; risk of mixed or manic episodes is increased in patients treated with antidepressants

May precipitate shift to mania or hypomania in patients with bipolar disorder; avoid monotherapy in patients with bipolar disorder; screen for bipolar disorder patients presenting with depressive symptoms

Cardiovascular, cerebrovascular or lipid metabolism disorders; monitor patients who have history of or are at risk for these disorders

Pregnancy H3

No published studies on desvenlafaxine in pregnant women; however published epidemiologic studies of pregnant women exposed to venlafaxine, the parent compound, have not reported a clear association with adverse developmental outcomes

Available limited data from published literature show low levels of desvenlafaxine in human milk, and have not shown adverse reactions in breastfed infants

There are no data on the effects of desvenlafaxine on milk production