From the Guidelines
Venlafaxine is more effective than desvenlafaxine in reducing hot flashes, with a higher reduction in hot flash score of 61% compared to 64% with desvenlafaxine at 12 weeks. When considering the treatment of hot flashes, particularly in breast cancer survivors, the choice between venlafaxine and desvenlafaxine should be based on their efficacy and safety profiles.
- Key differences between the two medications include their dosing regimens and side effect profiles.
- Venlafaxine has been shown to be effective in reducing hot flashes, with a median reduction in hot flash score of 37% at 37.5 mg/day, 61% at 75 mg/day, and 150 mg/day, compared to a 27% reduction with placebo 1.
- In contrast, desvenlafaxine has been shown to reduce hot flashes by 64% at 12 weeks with the 100 mg dose, compared to 51% with placebo 1.
- While desvenlafaxine may offer simpler once-daily dosing and potentially fewer drug interactions, venlafaxine's higher efficacy in reducing hot flashes makes it a better choice for patients with this condition.
- Additionally, venlafaxine has been shown to have a beneficial effect on daily living in breast cancer patients, with a significant reduction in hot flashes at 12 weeks 1.
- It is essential to consider individual patient factors, such as dosing preference, side effect profile, and insurance coverage, when making a decision between these medications.
From the Research
Comparison of Venlafaxine and Desvenlafaxine
- Both venlafaxine and desvenlafaxine are serotonin-norepinephrine reuptake inhibitors (SNRIs) used to treat major depressive disorder (MDD) 2, 3.
- Desvenlafaxine is the active metabolite of venlafaxine and has a different pharmacokinetic and pharmacodynamic profile 2.
- Studies have shown that desvenlafaxine has proven efficacy, acceptable safety and tolerability profiles, and minimal impact on cytochrome P450 enzyme system and adverse event-prone neuroreceptors 2, 3.
Efficacy and Safety
- Desvenlafaxine has been shown to have similar rates of response and remission to other SNRIs, including venlafaxine, at the recommended dose of 50 mg per day 3, 4.
- Higher doses of desvenlafaxine were not associated with greater efficacy, but did lead to more side effects 3.
- Venlafaxine has been shown to cause dose-dependent increases in blood pressure, particularly at high doses above 300 mg/day 5, 6.
- Desvenlafaxine may have a lower risk of blood pressure elevation compared to venlafaxine, although more studies are needed to confirm this 3, 4.
Head-to-Head Comparison
- A systematic review and meta-analysis found that desvenlafaxine may not be as efficacious as other antidepressants, including venlafaxine, in terms of response and remission rates 4.
- However, another study found that desvenlafaxine had a similar efficacy profile to venlafaxine in the treatment of MDD 3.
- More head-to-head studies are needed to fully compare the efficacy and safety of venlafaxine and desvenlafaxine 2, 3, 4.