Desfoxine Special Precautions

Use with caution in patients with a personal or family history of mania or hypomania.
Potentially life-threatening serotonin syndrome has occurred with SNRIs, particularly when used combination with other serotonergic agents (e.g. triptans, tricyclic antidepressants [TCAs], fentanyl, lithium, tramadol, buspirone, St. John's wort, tryptophan) or agents that impair metabolism of serotonin (e.g. MAOIs intended to treat psychiatric disorders, linezolid, methylene blue IV). Closely monitor patients for signs of serotonin syndrome, such as mental status changes (e.g. agitation, hallucination, delirium, coma), autonomic instability (e.g. tachycardia, labile blood pressure, diaphoresis, flushing, hyperthermia), neuromuscular symptoms (e.g. tremor, rigidity, myoclonus, hyperreflexia), GI symptoms (e.g. nausea, vomiting, diarrhea), and/or seizures. Immediately discontinue treatment and any concomitant serotonergic agents if sign/symptom arise.
Desvenlafaxine may increase blood pressure and heart rate. Preexisting hypertension should be controlled before initiating Desvenlafaxine therapy and that regulate blood pressure monitoring be performed in patients receiving the drug. Desvenlafaxine should be used cautiously in patients with preexisting hypertension or other underlying conditions that may be compromised by increases in blood pressure. Dosage reduction or drug discontinuance should be considered in patients who experience a sustained increase in blood pressure during therapy.
Desvenlafaxine may increase the risk of bleeding events. Concurrent administration of aspirin, non-steroidal anti-inflammatory agents (NSAIDs), warfarin, and other anticoagulants may add to this risk. Patients be advised of the risk of bleeding associated with the concomitant use of Desvenlafaxine and aspirin or non-steroidal anti-inflammatory agents (NSAIDs), warfarin, or other drugs that affect coagulation or bleeding.
Desvenlafaxine may cause mild pupillary dilation and can lead to an episode of narrow-angle glaucoma. Therefore, patients with elevated intraocular pressure or those at risk of angle-closure glaucoma should be monitored during treatment of Desvenlafaxine.
Desvenlafaxine should be used with caution in patients with recent history of myocardial infarction, unstable heart disease, uncontrolled hypertension, tachyarrhythmias (e.g. atrial fibrillation) or other cardiovascular/cerebrovascular conditions.
Desvenlafaxine should be used with caution in patients with a seizure disorder.
Treatment with SSRIs and SNRIs, including Desvenlafaxine, may result in hyponatremia.
Interstitial lung disease and eosinophilic pneumonia associated with venlafaxine have been reported rarely. The possibility of such adverse effects should be considered in patients treated with Desvenlafaxine who present with progressive dyspnea, cough, or chest discomfort.
Dose-dependent, possibly clinically significant increases in fasting serum total cholesterol, low-density lipoprotein (LDL), and triglycerides. Consider measuring serum lipid concentration during Desvenlafaxine therapy.
Abrupt discontinuance or dosage reduction of Desvenlafaxine has been associated with the appearance of withdrawal effects, including dizziness, nausea, headache, irritability, insomnia, diarrhea, anxiety, fatigue, abnormal dreams, hyperhidrosis, tinnitus and seizures. Therefore, patients should be monitored for possible withdrawal symptoms when discontinuing Desvenlafaxine therapy. A gradual reduction in dosage rather than abrupt cessation is recommended whenever possible.
Use in the Elderly: Elderly with concurrent use of diuretics likely increase risk of the development of syndrome of inappropriate secretion of antidiuretic hormone (SIADHs). Discontinue treatment in patients with symptomatic hyponatremia.