Adult: Initially, 50 mg once daily. Dosage recommendations may vary among individual products and between countries (refer to specific product guidelines).
What are the brands available for Desvenlafaxine in Hong Kong?
ESRD: 50 mg every other day. Supplemental doses must not be given after dialysis.
CrCl (mL/min)
Dosage
<30
50 mg every other day. Supplemental doses must not be given after dialysis.
30-50
50 mg once daily.
Hepatic Impairment
Moderate to severe (Child-Pugh class B and C): Initially, 50 mg once daily. Max: 100 mg once daily. Dosage recommendations may vary among individual products and between countries (refer to specific product guidelines).
Administration
Desvenlafaxine extended-release: May be taken with or without food. Swallow whole, do not divide/crush/chew/dissolve tab.
Contraindications
Concomitant use of MAOIs or within 14 days of discontinuing MAOIs. Initiation of MAOIs within 7 days of discontinuing desvenlafaxine. Concurrent use with IV methylthioninium chloride (methylene blue).
Special Precautions
Patient with pre-existing hypertension, CV or cerebrovascular conditions, lipid metabolism disorders; elevated intraocular pressure or those at risk of angle-closure glaucoma; personal or family history of mania or hypomania; seizure disorder; volume depletion. Avoid abrupt withdrawal. Moderate to severe renal and hepatic impairment. Elderly. Pregnancy and lactation.
Adverse Reactions
Significant: CNS depression, worsening of depression, emergence of suicidal ideation and behaviour, unusual changes in behaviour, activation of mania or hypomania, seizures, hyponatraemia or SIADH, mydriasis, sexual dysfunction (e.g. ejaculatory delay or failure, decreased libido, erectile dysfunction, abnormal orgasm, anorgasmia), increased risk of bone fractures, withdrawal syndrome, significant blood pressure elevation, increased risk of bleeding events. Rarely, ILD and eosinophilic pneumonia. Cardiac disorders: Tachycardia. Ear and labyrinth disorders: Vertigo, tinnitus. Endocrine disorders: Hypercholesterolaemia, hyperprolactinaemia. Eye disorders: Blurred vision. Gastrointestinal disorders: Nausea, dry mouth, constipation, vomiting, diarrhoea. General disorders and administration site conditions: Fatigue, asthenia, jitteriness, chills. Investigations: Increased LDL cholesterol, weight gain, abnormal LFTs. Metabolism and nutrition disorders: Decreased appetite. Musculoskeletal and connective tissue disorders: Musculoskeletal stiffness. Nervous system disorders: Dizziness, headache, somnolence. Psychiatric disorders: Insomnia. Respiratory, thoracic and mediastinal disorders: Yawning, epistaxis.
Skin and subcutaneous tissue disorders: Hyperhidrosis, alopecia, photosensitivity, rash. Vascular disorders: Syncope, hot flush. Potentially Fatal: Serotonin syndrome or NMS-like reactions.
PO: Z (Risk of postpartum haemorrhage, persistent pulmonary hypertension in infant and neonatal withdrawal/toxicity in late pregnancy use. Monitor closely.)
Patient Counseling Information
This drug may cause CNS depression, if affected, do not drive or operate machinery.
Monitoring Parameters
Monitor renal function, lipid panel (e.g. total cholesterol, LDL, triglycerides); blood pressure. Assess for signs of depression, clinical worsening, suicidality, psychosis or unusual change in behaviour.
Drug Interactions
Increased risk of bleeding with aspirin, NSAIDs, warfarin and other anticoagulants or antiplatelets. Increased risk of hyponatraemia with diuretics. Increased risk of toxicity with desipramine, atomoxetine, dextromethorphan, metoprolol, nebivolol, perphenazine, tolterodine. May increase serum concentration with ketoconazole and other potent CYP3A4 inhibitors. Potentially Fatal: Increased risk of serotonin syndrome with MAOIs (e.g. selegeline, tranylcypromine, isocarboxazid, phenelzine, linezolid, IV methylthioninium chloride [methylene blue]) and other serotonergic drugs including SSRIs, other SNRIs, 5-HT1 receptor agonists (e.g. sumatriptan, zolmitriptan), TCAs, opioids (e.g. fentanyl, tramadol, methadone, meperidine), lithium, tryptophan, buspirone, and amphetamines.
Food Interaction
Increased risk of serotonin syndrome with St. John's wort.
Lab Interference
May result in false-positive urine immunoassay screening test for phencyclidine (PCP) and amphetamine.
Action
Description: Mechanism of Action: Desvenlafaxine, a major active metabolite of venlafaxine, is a selective serotonin and norepinephrine reuptake inhibitor (SNRI). Its exact mechanism of action has not been fully established; however, it is believed to be related to the potentiation of serotonin and norepinephrine in the central nervous system (CNS) via reuptake inhibition. Pharmacokinetics: Absorption: Bioavailability: Approx 80%. Distribution: Enters breast milk. Plasma protein binding: 30%. Metabolism: Metabolised in the liver via conjugation (major pathway) by UGT isoenzymes and oxidation by CYP3A4 isoenzymes (minor pathway). Excretion: Via urine (45% as unchanged drug; approx 24% as metabolites). Elimination half-life: Approx 10-11 hours.
Chemical Structure
Desvenlafaxine Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 125017, Desvenlafaxine. https://pubchem.ncbi.nlm.nih.gov/compound/Desvenlafaxine. Accessed June 27, 2024.
Sign Out
