What are the recommendations for using Pristiq (desvenlafaxine) during pregnancy?

From the Guidelines

Pristiq (desvenlafaxine) should be used during pregnancy only if the potential benefits outweigh the risks, and this decision should be made in consultation with a healthcare provider. For pregnant women already taking Pristiq, abruptly stopping the medication can lead to withdrawal symptoms and potential relapse of depression, which may pose risks to both mother and baby 1. If treatment is necessary during pregnancy, the lowest effective dose should be used. Some healthcare providers may recommend gradually tapering off Pristiq before pregnancy if possible and medically appropriate, or switching to an antidepressant with more pregnancy safety data, such as certain SSRIs like sertraline.

Key Considerations

• Potential risks of Pristiq during pregnancy include neonatal complications like respiratory distress, feeding difficulties, and irritability if taken late in pregnancy 1.
• There's also a small increased risk of persistent pulmonary hypertension in newborns 1.
• Regular prenatal care with additional fetal monitoring may be recommended.
• The decision to use Pristiq during pregnancy requires balancing the mother's mental health needs against potential fetal risks, as untreated depression during pregnancy can also lead to complications including preterm birth, low birth weight, and developmental issues 1.

Recommendations for Clinical Practice

• Women with mild depression with a recent onset should be monitored and encouraged to exercise and seek social support 1.
• Women with mild depression that does not improve within two weeks of diagnosis and women with moderate–to–severe depression should seek/be offered evidence-based treatment, which may include antidepressants like Pristiq or psychotherapy 1.
• The American Psychiatric Association and the American College of Obstetricians and Gynecologists recommend that women and their doctors should work together and consider severity of current symptoms, previous mental health history, and patient treatment preferences when making decisions about antidepressant use during pregnancy 1.

From the FDA Drug Label

There is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to antidepressants during pregnancy. Healthcare providers are encouraged to register patients by calling the National Pregnancy Registry for Antidepressants at 1-844-405-6185 There are 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 There are risks associated with untreated depression in pregnancy and with exposure to SNRIs and SSRIs, including desvenlafaxine, during pregnancy In reproductive developmental studies in rats and rabbits treated with desvenlafaxine succinate, there was no evidence of teratogenicity at a plasma exposure (AUC) that is up to 19-times (rats) and 0.5-times (rabbits) the exposure at an adult human dose of 100 mg per day

Recommendations for Pristiq (desvenlafaxine) during pregnancy:

• Pregnancy exposure registry: Healthcare providers should register patients by calling the National Pregnancy Registry for Antidepressants at 1-844-405-6185.
• No clear association with adverse developmental outcomes: Published epidemiologic studies of pregnant women exposed to venlafaxine have not reported a clear association with adverse developmental outcomes.
• Risks associated with untreated depression: There are risks associated with untreated depression in pregnancy.
• Risks associated with exposure to SNRIs and SSRIs: There are risks associated with exposure to SNRIs and SSRIs, including desvenlafaxine, during pregnancy.
• Reproductive developmental studies: In reproductive developmental studies in rats and rabbits, there was no evidence of teratogenicity at certain plasma exposures.
• Caution and monitoring: Patients should be informed of the potential risks and monitored closely during pregnancy.
• Dose adjustment: No specific dose adjustment recommendations are provided for pregnant women.
• Alternative treatments: No alternative treatments are recommended in the provided drug labels. 2

From the Research

Recommendations for Pristiq during Pregnancy

There are no research papers provided that directly address the use of Pristiq (desvenlafaxine) during pregnancy.

Available Information on Desvenlafaxine

• Desvenlafaxine is a serotonin-norepinephrine reuptake inhibitor (SNRI) approved for the treatment of major depressive disorder (MDD) in adults 3, 4, 5, 6.
• The recommended dose of desvenlafaxine ranges from 50 to 100 mg/day 4, 5.
• Desvenlafaxine has been shown to be effective in treating MDD with a favorable safety and tolerability profile 3, 4, 5, 6.
• It has several notable differences from other SNRIs, suggesting potential benefits in specific patient populations 6.

Considerations for Antidepressant Use during Pregnancy

• There is a lack of direct evidence on the use of desvenlafaxine during pregnancy in the provided studies.
• A study on the effectiveness of antidepressants in combination with psychotherapy found that desvenlafaxine had remission rates ranging from 1.59% to 75% in different patient subgroups 7.
• However, this study does not specifically address the use of desvenlafaxine during pregnancy.

Conclusion Not Available

As per the provided instructions, no conclusion can be drawn, and the information provided is based solely on the available evidence.