From the FDA Drug Label
- 1 Drugs Having Clinically Important Interactions with Desvenlafaxine Table 8: Clinically Important Drug Interactions with Desvenlafaxine Other Serotonergic Drugs Clinical Impact Concomitant use of desvenlafaxine with other serotonergic drugs increases the risk of serotonin syndrome Intervention Monitor for symptoms of serotonin syndrome when desvenlafaxine is used concomitantly with other drugs that may affect the serotonergic neurotransmitter systems. If serotonin syndrome occurs, consider discontinuation of desvenlafaxine and/or concomitant serotonergic drugs [see Warnings and Precautions (5. 2)]. Examples other SNRIs, SSRIs, triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, buspirone, amphetamines, tryptophan, and St. John’s Wort
The use of desvenlafaxine with Vyvanse (an amphetamine) may increase the risk of serotonin syndrome. Monitor for symptoms of serotonin syndrome when desvenlafaxine is used concomitantly with Vyvanse 1.
From the Research
Combining desvenlafaxine with Vyvanse requires close medical supervision due to potential serotonergic interactions, and should only be considered for patients with co-occurring depression and ADHD who have not responded to other treatments. When considering this combination, it's essential to weigh the potential benefits against the risks, including increased blood pressure, heart rate, and potentially serotonin syndrome in rare cases 2. The most recent and highest quality study on desvenlafaxine, published in 2021, highlights its efficacy and safety in the treatment of major depressive disorder, but does not specifically address its use with Vyvanse 3. However, the study suggests that desvenlafaxine may be a valuable treatment option for patients with comorbid physical illnesses, and its relatively low potential for drug-drug interactions makes it a suitable choice for patients with complex medical histories. Typical dosing for desvenlafaxine is usually at 50-100mg daily, and Vyvanse starting at 30mg daily, potentially adjusted based on response and side effects. Patients should monitor for symptoms like agitation, rapid heartbeat, excessive sweating, tremors, or confusion, which could indicate adverse interactions. The medications work through different but complementary mechanisms - desvenlafaxine increases serotonin and norepinephrine levels while Vyvanse increases dopamine and norepinephrine. Regular follow-ups are crucial to assess effectiveness and monitor for side effects, and the combination should only be initiated under close medical supervision. It's also important to note that desvenlafaxine has been shown to be effective in reducing depressive symptoms, with significant improvements in HAM-D scores, and has a favorable safety and tolerability profile 4, 5, 6. However, the potential risks associated with combining desvenlafaxine with Vyvanse must be carefully considered, and alternative treatment options should be explored before initiating this combination.