Desvenlafaxine (Pristiq) Dosage Increase Protocol
You can increase from 50mg to 100mg of desvenlafaxine after 1 week if you're experiencing inadequate symptom control with the initial dose. 1
Dosage Titration Guidelines
The optimal approach to increasing desvenlafaxine dosage follows a structured protocol:
- Initial dose: Start with 50mg once daily
- Evaluation period: Assess for 1 week
- Dose increase: If symptom control is inadequate, increase to 100mg once daily 1
- Maximum dose: 100mg daily is the maximum recommended dose for most patients 2, 3
Efficacy Considerations
- The 50mg dose has demonstrated significant efficacy in clinical trials 2, 4
- No consistent additional therapeutic benefits have been found at doses above 50mg/day 2, 3
- However, individual response varies, and some patients may benefit from the 100mg dose 4
Safety and Tolerability
When increasing to 100mg, be aware of potential side effects:
- Common side effects: Nausea is the most frequent adverse effect 5
- Blood pressure: Monitor for potential increases in blood pressure, especially if you have cardiac disease 1
- Discontinuation symptoms: If you later need to decrease the dose, a gradual taper is recommended to minimize withdrawal symptoms 1
Special Considerations
- Renal impairment: If you have severe renal impairment (creatinine clearance ≤30 mL/min), alternate-day dosing should be implemented 2
- Hepatic impairment: If you have moderate to severe hepatic impairment, daily doses should not exceed 100mg 2
Monitoring After Dose Increase
After increasing to 100mg:
- Monitor for symptom improvement within 1-2 weeks
- Watch for potential side effects, particularly nausea and blood pressure changes
- Regular follow-up is essential during the first month after dose adjustment 1
Important Cautions
- Never abruptly discontinue desvenlafaxine as this can lead to withdrawal symptoms
- Do not take with MAOIs due to risk of serotonin syndrome 1
- If side effects become intolerable at 100mg, returning to 50mg is appropriate
Remember that while 50mg is often sufficient, increasing to 100mg may provide additional benefit for some patients without significantly increasing side effects in most cases.