What is the safety profile of Pristiq (desvenlafaxine) in the elderly population?

From the FDA Drug Label

Of the 4,158 patients in pre-marketing clinical studies with desvenlafaxine, 6% were 65 years of age or older No overall differences in safety or efficacy were observed between these patients and younger patients; however, in the short-term placebo-controlled studies, there was a higher incidence of systolic orthostatic hypotension in patients ≥65 years of age compared to patients <65 years of age treated with desvenlafaxine For elderly patients, possible reduced renal clearance of desvenlafaxine should be considered when determining dose SSRIs and SNRIs, including desvenlafaxine, have been associated with cases of clinically significant hyponatremia in elderly patients, who may be at greater risk for this adverse event

The safety profile of Pristiq (desvenlafaxine) in the elderly population includes:

• A higher incidence of systolic orthostatic hypotension compared to younger patients
• Possible reduced renal clearance, which should be considered when determining dose
• A greater risk for clinically significant hyponatremia 1

From the Research

Safety Profile of Pristiq (Desvenlafaxine) in the Elderly Population

The safety profile of Pristiq (desvenlafaxine) in the elderly population is a concern due to the potential for adverse effects. Some key points to consider include:

• Clearance rates of desvenlafaxine are reduced in the elderly, which may require dosage adjustments 2
• Desvenlafaxine is associated with several mild adverse effects, with the most common effect being nausea 2
• Less common, but more serious, adverse effects reported include hypertension, QTc interval prolongation, exacerbation of ischemic cardiac disease, elevated lipids, and elevated liver enzymes 2
• Orthostasis may be more common in older adults prescribed desvenlafaxine 3
• The use of desvenlafaxine in elderly patients with poor renal function requires caution 3

Adverse Effects in the Elderly Population

Some adverse effects that have been reported in the elderly population include:

• Nausea 2, 4
• Headache 4
• Dizziness 5, 4
• Dry mouth 3, 4
• Insomnia 5, 4
• Fatigue 4
• Hyperhidrosis 4
• Upper respiratory infection 4
• Nasopharyngitis 4

Special Considerations

Some special considerations for the use of desvenlafaxine in the elderly population include:

• Dosage adjustments may be necessary due to reduced clearance rates 2
• Caution is advised when using desvenlafaxine in elderly patients with poor renal function 3
• Monitoring of blood pressure and liver enzymes is recommended due to the potential for adverse effects 2