Desvenlafaxine Tablet Uses

Desvenlafaxine is FDA-approved exclusively for the treatment of major depressive disorder (MDD) in adults. 1

Primary Indication

Major Depressive Disorder (MDD): Desvenlafaxine succinate is a serotonin-norepinephrine reuptake inhibitor (SNRI) approved for treating MDD in adult patients 1, 2
The recommended therapeutic dose is 50 mg once daily, with no additional therapeutic benefit demonstrated at higher doses (100-400 mg/day) 2, 3
Steady-state plasma concentrations are achieved within 4-5 days with once-daily dosing 2, 4

Patients receiving desvenlafaxine must have regular blood pressure monitoring, as the drug causes dose-dependent increases in blood pressure. 1

Pre-existing hypertension must be controlled before initiating desvenlafaxine therapy 1
Sustained hypertension (defined as supine diastolic BP ≥90 mm Hg and ≥10 mm Hg above baseline for 3 consecutive visits) occurred in 1.3% at 50 mg/day and 2.3% at 400 mg/day 1
Mean increases in supine systolic BP ranged from 1.2-2.5 mm Hg and diastolic BP from 0.7-2.3 mm Hg across doses 1
Cases of elevated blood pressure requiring immediate treatment have been reported 1

Exercise caution in patients with pre-existing hypertension, cardiovascular, or cerebrovascular conditions that might be compromised by BP increases 1
For sustained BP elevation during treatment, consider dose reduction or discontinuation 1
Monitor for orthostatic hypotension, particularly in patients ≥65 years (8% incidence vs 2.5% placebo) 1

Patients with impaired renal function require significant dose modifications due to reduced drug clearance. 4

Severe renal impairment (CrCl <30 mL/min): Administer 50 mg every other day or 50 mg once daily (maximum dose) 1, 4
End-stage renal disease (ESRD) on dialysis: 50 mg every other day; do not administer supplemental doses after dialysis 1, 4
Moderate renal impairment (CrCl 30-50 mL/min): Consider dose reduction to 50 mg once daily 4
Mild renal impairment (CrCl 50-80 mL/min): No dose adjustment typically required, but monitor closely 4

Calculate creatinine clearance before initiating therapy in patients with suspected renal dysfunction 4
Pharmacokinetic studies show significantly increased drug exposure in renal impairment, necessitating dose adjustments 4

Absolute contraindication: Concurrent use with MAOIs or within 14 days of MAOI discontinuation due to risk of serotonin syndrome 1
Serotonin syndrome risk: Monitor for mental status changes, autonomic instability, neuromuscular symptoms, and GI symptoms when combined with other serotonergic drugs 1
Bleeding risk: Increased risk when combined with aspirin, NSAIDs, warfarin, or other anticoagulants 1

Most frequent: nausea, dizziness, hyperhidrosis (sweating), constipation, somnolence, decreased appetite, and insomnia 1, 2
Sexual dysfunction occurs in both men (erectile dysfunction 3-11%, ejaculation delay 1-7%) and women (anorgasmia 1-3%) 1
Hyperhidrosis increases dose-dependently from 4% (placebo) to 21% (400 mg) 1

Monitor fasting lipids: elevations in total cholesterol (3-10%), LDL (1-2%), and triglycerides (2-6%) occurred in clinical trials 1
Transient proteinuria (≥trace) observed in 5-8% of patients, generally not associated with BUN or creatinine increases 1
Monitor liver function tests, as abnormal results have been reported 1

Uncommon reports of ischemic cardiac events (myocardial ischemia, MI, coronary occlusion) occurred more frequently than placebo in patients with underlying cardiac risk factors 1
Use with extreme caution in patients with cardiovascular or cerebrovascular disease 1

Gradual dose reduction is mandatory to prevent discontinuation syndrome. 1

Abrupt cessation causes nausea, sweating, dysphoric mood, irritability, agitation, dizziness, sensory disturbances (electric shock sensations), tremor, anxiety, confusion, headache, and insomnia 1
Taper gradually rather than stopping abruptly whenever possible 1