From the Guidelines
Desvenlafaxine can potentially cause or worsen hypertension (HTN) due to its noradrenergic activity, and patients with pre-existing hypertension or cardiovascular disease should be monitored closely while taking this medication. The typical starting dose of desvenlafaxine is 50 mg once daily, which is also the recommended maintenance dose. For patients with hypertension, it's advisable to ensure blood pressure is well-controlled before initiating desvenlafaxine, as recommended by the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults 1.
Some key points to consider when managing hypertension in patients taking desvenlafaxine include:
- Monitoring blood pressure regularly, especially during the initial treatment period and after dose increases
- Adjusting antihypertensive medications or considering a dose reduction or discontinuation of desvenlafaxine if blood pressure elevations occur
- Weighing the benefits of desvenlafaxine against the potential risks of blood pressure elevation in patients with pre-existing hypertension or cardiovascular disease
- Considering the use of antihypertensive medications that are recommended for patients with hypertension, such as ACE inhibitors, ARBs, dihydropyridine CCBs, and thiazide or thiazide-like diuretics, as outlined in the 2024 ESC guidelines for the management of elevated blood pressure and hypertension 1.
It's also important to note that the blood pressure effects of desvenlafaxine are dose-related, and the medication's noradrenergic activity can lead to vasoconstriction, as discussed in the context of treating hypertension in the prevention and management of ischemic heart disease 1. However, the most recent and highest quality study on this topic is the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline, which provides recommendations for the management of hypertension in adults 1.
From the FDA Drug Label
Treatment with desvenlafaxine at all doses from 50 mg per day to 400 mg per day in controlled studies was associated with sustained hypertension, defined as treatment-emergent supine diastolic blood pressure (SDBP) ≥90 mm Hg and ≥10 mm Hg above baseline for 3 consecutive on-therapy visits Patients receiving desvenlafaxine should have regular monitoring of blood pressure since increases in blood pressure were observed in clinical studies Pre-existing hypertension should be controlled before initiating treatment with desvenlafaxine. Caution should be exercised in treating patients with pre-existing hypertension, cardiovascular, or cerebrovascular conditions that might be compromised by increases in blood pressure.
Desvenlafaxine may increase blood pressure in some patients, and regular monitoring of blood pressure is recommended.
- Pre-existing hypertension should be controlled before starting treatment with desvenlafaxine.
- Caution is advised when treating patients with pre-existing hypertension, cardiovascular, or cerebrovascular conditions. 2 2 2
From the Research
Desvenlafaxine and Hypertension
- Desvenlafaxine, a serotonin-norepinephrine reuptake inhibitor (SNRI), has been associated with increases in blood pressure 3, 4.
- Studies have shown that desvenlafaxine can cause clinically significant blood pressure elevation, particularly at higher doses 3, 5, 4.
- The incidence of new onset hypertension was found to be higher in patients treated with desvenlafaxine compared to placebo, with significant differences observed at doses of 50,200, and 400 mg/day 4.
Comparison with Other Antidepressants
- SNRIs, including desvenlafaxine, have been shown to carry a greater risk of hypertension compared to selective serotonin reuptake inhibitors (SSRIs) 6.
- Tricyclic antidepressants have also been associated with increases in blood pressure, as well as orthostatic hypotension 6, 5.
- Desvenlafaxine's effect on blood pressure is similar to that of venlafaxine, its parent compound, which has been shown to cause dose-related increases in mean blood pressure 5.
Clinical Implications
- Clinicians should carefully monitor blood pressure in patients treated with desvenlafaxine, particularly those with pre-existing hypertension or cardiovascular disease 3, 5, 4.
- Desvenlafaxine may be a suitable treatment option for patients with major depressive disorder who do not have significant cardiovascular comorbidities 7.
- The potential for drug-drug interactions and the need for dose adjustments in patients with renal impairment should also be considered when prescribing desvenlafaxine 7, 4.