Desvenlafaxine

Brand Name:

Pristiq

Drug Class: 

Serotonin and Norepinephrine Reuptake Inhibitor

How it works:

Boosts the effects of two neurotransmitters found in the brain called serotonin and norepinephrine.

What makes it unique: 

This is the active metabolite of Venlafaxine. It more potently increases the effects of serotonin over norepinephrine.

Side effects: 

Headaches and stomach aches are common when starting, but then often goes away. Sexual dysfunction can also occur. Blood pressure can be increased with this medication, especially as the dose increases. Desvenlafaxine may also cause nervousness, insomnia, and sedation.

Rare side effects include hyponatremia, seizures, induction of mania, and activation of suicidal ideation in people age 24 and younger.

How effective is it:

(1) An Australian study indirectly compared Desvenlafaxine to Venlafaxine using information from placebo-controlled trials. 27 trials were reviewed. The trials showed similar effectiveness but showed Desvenlafaxine caused less nausea.

(2) A study from India compared Desvenlafaxine to the SSRI, Escitalopram. 86 patients were studied. Changes in the HAM-A and HAM-D scales were reviewed. Escitalopram was slightly more effective and better tolerated as compared to Desvenlafaxine.

Clinical experience: 

I don’t see this all too often. I see the sister medication, Venlafaxine, much more commonly. The dosing of this medication can be tricky as well. Most of what I have seen says to not exceed 50mg daily, but I often see requests for higher dosing. Doses higher than 50mg may not be much more effective but will have the potential for more side effects. Pharmaceuticals should never be used as the sole treatment for mental illnesses. Therapy, exercise, meditation or other treatments should always accompany prescriptions.

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References:

1. Coleman KA, Xavier VY, Palmer TL, et al. An indirect comparison of the efficacy and safety of desvenlafaxine and venlafaxine using placebo as the common comparator. CNS Spectr. 2012 Sep;17(3):131-41.

2. Maity N, Ghosal MK, Gupta A, et al. Clinical effectiveness and safety of escitalopram and desvenlafaxine in patients of depression with anxiety: a randomized, open-label controlled trial. Indian J Pharmacol. 2014 Jul-Aug;46(4):433-7.

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