Pristiq (Desvenlafaxine) Adult Dosing

The recommended dose of Pristiq for adults is 50 mg once daily, which serves as both the starting dose and the therapeutic dose. 1

Standard Dosing

Administer 50 mg once daily with or without food at approximately the same time each day 1
Tablets must be swallowed whole and not divided, crushed, chewed, or dissolved 1
No additional benefit has been demonstrated at doses greater than 50 mg per day, and adverse reactions and discontinuations are more frequent at higher doses 1, 2, 3
While doses of 50-400 mg/day were shown to be effective in clinical studies, the 50 mg dose provides optimal efficacy with the best tolerability profile 1, 4

Dose adjustments are mandatory in patients with 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 (CrCl <15 mL/min): Maximum dose is 25 mg daily OR 50 mg every other day 1
No supplemental doses should be given after dialysis 1

For patients with moderate to severe hepatic impairment (Child-Pugh score 7-15):

Gradual dose reduction is strongly recommended when discontinuing treatment to minimize discontinuation symptoms 1:

The 25 mg per day dose is specifically intended for gradual reduction when discontinuing therapy 1
Taper the dose rather than stopping abruptly whenever possible 1

When switching from MAOIs:

Allow at least 14 days between discontinuation of an MAOI and initiation of desvenlafaxine 1
Allow at least 7 days after stopping desvenlafaxine before starting an MAOI 1

When switching from other antidepressants (including venlafaxine):

Tapering of the initial antidepressant may be necessary to minimize discontinuation symptoms 1

Long-term efficacy has been established with doses of 50-400 mg in maintenance trials 1
Patients should be periodically reassessed to determine the need for continued treatment 1
Acute episodes of major depressive disorder typically require several months or longer of sustained pharmacologic therapy 1

Response rates at 8 weeks with 50 mg dose: 51-63% 5
Remission rates at 8 weeks with 50 mg dose: 31-45% 5
Steady-state plasma concentrations are achieved within 4-5 days with once-daily dosing 2, 3

Do not exceed 50 mg daily in routine practice, as higher doses increase adverse effects without additional therapeutic benefit 1, 2
Do not crush or split tablets, as this alters the pharmacokinetic profile 1
Do not abruptly discontinue without tapering, as this increases risk of discontinuation syndrome 1
Always adjust dose in renal impairment, as desvenlafaxine clearance is significantly reduced 1