What is the starting dose of Pristiq (desvenlafaxine) for adults?

Starting Dose of Pristiq (Desvenlafaxine)

The recommended starting dose of Pristiq (desvenlafaxine) is 50 mg once daily, which also serves as the therapeutic dose for most patients. 1

Standard Dosing

• 50 mg once daily is both the starting dose and the therapeutic dose for desvenlafaxine in adults with major depressive disorder 1
• The medication should be taken at approximately the same time each day, with or without food 1
• Tablets must be swallowed whole and cannot be divided, crushed, chewed, or dissolved 1

Evidence Supporting the 50 mg Dose

• Clinical trials demonstrated that doses of 50-400 mg/day were effective, but no additional therapeutic benefit was found at doses greater than 50 mg per day 1
• Higher doses were associated with more frequent adverse reactions and treatment discontinuations 1
• Response rates at 8 weeks with the 50 mg dose range from 51-63%, with remission rates of 31-45%, which are comparable to venlafaxine 2
• The 50 mg dose has been clearly distinguished from placebo in reducing major depressive disorder symptoms 3, 4

Dose Adjustments for Special Populations

Renal Impairment

• Moderate renal impairment (CrCl 30-50 mL/min): Maximum dose is 50 mg per day 1
• Severe renal impairment (CrCl 15-29 mL/min) or end-stage renal disease: Maximum dose is 25 mg daily or 50 mg every other day 1
• No supplemental doses should be given after dialysis 1

Hepatic Impairment

• Moderate to severe hepatic impairment (Child-Pugh score 7-15): Starting dose is 50 mg per day 1
• Dose escalation above 100 mg per day is not recommended in this population 1

Important Clinical Considerations

• The 25 mg dose is intended only for gradual dose reduction when discontinuing treatment, not as a starting therapeutic dose 1
• Desvenlafaxine has minimal CYP450 metabolism and is a weak CYP2D6 inhibitor, which reduces the risk of pharmacokinetic drug interactions compared to other antidepressants 5, 6
• Steady-state plasma concentrations are achieved within 4-5 days with once-daily dosing 3, 4
• The most common adverse effects include nausea, insomnia, somnolence, and dizziness 2