Desvenlafaxine
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Desvenlafaxine (succinate)
Pristiq
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Summary
Pharmacy
Starting dose
50 mg PO once daily (no titration required, distinguishing it favorably from venlafaxine)
Preparations
ER tablets 25, 50, 100 mg
US FDA Max
50 mg/day (no efficacy benefit shown for higher doses despite the 100 mg strength being available)
Pharmacology
Routes
Oral
Onset
Antidepressant effect emerges over 1-2 weeks
Duration
24 hours
Half-life
~11 hours[1]
Bioavailability
~80% (oral)[1]
Pregnancy
Observational signal for neonatal adaptation syndrome with late-pregnancy exposure (SNRI class effect).[citation needed]
Legal status
Purported mechanism
Serotonin and norepinephrine reuptake inhibitor. The active metabolite of venlafaxine formed by CYP2D6 O-demethylation, separately marketed as a parent compound to bypass the CYP2D6 activation step.0 The pharmacological advantage over venlafaxine: less inter-individual variability (no CYP2D6 genotype dependence for activation), fewer CYP-mediated interactions, and simpler 50 mg once-daily dosing without titration. The same SNRI-class concerns apply: severe discontinuation syndrome on abrupt stop (slow taper essential) and dose-dependent diastolic hypertension at higher doses[1].
References
- ↑ 1.0 1.1 1.2 1.3 FDA Prescribing Information, Pristiq (desvenlafaxine succinate), Pfizer/Wyeth, current revision. https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/021992s048lbl.pdf