From the FDA Drug Label
Elevations in fasting serum total cholesterol, LDL (low density lipoproteins) cholesterol, and triglycerides occurred in the controlled studies. The percentage of patients who exceeded a predetermined threshold value is shown in Table 4 Table 4: Incidence (%) of Patients With Lipid Abnormalities of Potential Clinical Significance* Desvenlafaxine Placebo 50 mg 100 mg 200 mg 400 mg Total Cholesterol 2 3 4 4 10 *(Increase of ≥50 mg/dl and an absolute value of ≥261 mg/dl) LDL Cholesterol 0 1 0 1 2 *(Increase ≥50 mg/dl and an absolute value of ≥190 mg/dl) Triglycerides, fasting 3 2 1 4 6 *(Fasting: ≥327 mg/dl)
The FDA drug label does not answer the question.
From the Research
Pristiq (desvenlafaxine) is likely to cause fewer elevations of cholesterol and triglycerides compared to fluoxetine, based on the most recent and highest quality study available 1.
Key Points to Consider
- The study published in 2023 1 found significant associations between the use of fluoxetine and higher total cholesterol, LDL-C, and triglycerides, and lower HDL-C, compared to participants not taking the medication.
- Another study from 2018 2 demonstrated that fluoxetine induces lipid metabolism abnormalities by acting on the liver in patients and mice with depression, leading to increased serum TG, TC, and LDL levels.
- In contrast, desvenlafaxine, the active ingredient in Pristiq, is a serotonin-norepinephrine reuptake inhibitor (SNRI) that tends to have a more favorable metabolic profile than fluoxetine, a selective serotonin reuptake inhibitor (SSRI).
- Clinical data suggests that while fluoxetine has been associated with modest increases in total cholesterol and triglycerides in some patients, Pristiq's effects on lipid parameters are generally minimal at therapeutic doses (typically 50-100 mg daily) 1, 2.
Recommendations for Clinical Practice
- For patients with pre-existing hyperlipidemia or cardiovascular risk factors, regular monitoring of lipid profiles is recommended regardless of which antidepressant is chosen.
- The difference in lipid effects should be considered alongside other factors such as efficacy for depression symptoms, side effect profiles, and cost when selecting between these medications.
- Individual responses to antidepressants can vary significantly, and other factors like diet, exercise, genetics, and concurrent medications play important roles in determining lipid outcomes.
Important Considerations
- The study from 2013 3 compared the effects of fluoxetine and imipramine on serum total cholesterol and triglyceride levels, and found that fluoxetine decreased TC and TG levels, while imipramine increased them.
- However, this study is older and has a smaller sample size compared to the more recent study from 2023 1, which provides more robust evidence for the comparison between different antidepressants.