Desvenlafaxine, sold under the brand name Pristiq among others, is a medication used to treat major depressive disorder. It is recommended that the need for further treatment be occasionally reassessed. It appears less effective than its parent compound venlafaxine. It is taken by mouth. Common side effects include dizziness, trouble sleeping, increased sweating, constipation, sleepiness, anxiety, and sexual problems. Serious side effects may include suicide in those under the age of 25, serotonin syndrome, bleeding, mania, and high blood pressure. A withdrawal syndrome may occur if the dose is rapidly decreased. It is unclear if use during pregnancy or breastfeeding is safe. It is an antidepressant of the serotonin-norepinephrine reuptake inhibitor class. Desvenlafaxine was approved for medical use in the United States in 2008. Use in Europe was declined in 2009. In the United States the wholesale cost is about US$25.20 per month. In 2017, it was the 235th most commonly prescribed medication in the United States, with more than two million prescriptions.
Medical uses
Desvenlafaxine is primarily used as a treatment for major depressive disorder. Use has only been studied up to 8 weeks. It may be less effective than venlafaxine, although some studies have found comparable efficacy with a lower rate of nausea. Doses of 50–400 mg/day appear effective for major depressive disorder, although no additional benefit was demonstrated at doses greater than 50 mg/day, and adverse events and discontinuations were more frequent at higher doses. Desvenlafaxine improves the HAM-D17 score and measures of well being such as the Sheehan Disability Scale and 5-item World Health OrganizationWell-Being Index.
Adverse effects
Frequency of adverse effects: Very common adverse effects include:
Nausea
Headache
Dizziness
Dry mouth
Hyperhidrosis
Diarrhea
Insomnia
Constipation
Fatigue
Common adverse effects include:
Tremor
Blurred vision
Mydriasis
Decreased appetite
Sexual dysfunction
Insomnia
Anxiety
Elevated cholesterol and triglycerides
Proteinuria
Vertigo
Feeling jittery
Asthenia
Nervousness
Hot flush
Irritability
Abnormal dreams
Urinary hesitation
Yawning
Rash
Uncommon adverse effects include:
Hypersensitivity
Syncope
Depersonalization
Hypomania
Withdrawal syndrome
Urinary retention
Epistaxis
Alopecia
Orthostatic hypotension
Peripheral coldness
Rare adverse effects include:
Hyponatraemia
Seizures
Extrapyramidal side effects
Hallucinations
Angioedema
Photosensitivity reaction
Stevens–Johnson syndrome
Common however unknown intensity of adverse effects include:
Desvenlafaxine is a synthetic form of the isolated major active metabolite of venlafaxine, and is categorized as a serotonin-norepinephrine reuptake inhibitor. When most normal metabolizers take venlafaxine, approximately 70% of the dose is metabolized into desvenlafaxine, so the effects of the two drugs are expected to be very similar. It works by blocking the "reuptake" transporters for key neurotransmitters affecting mood, thereby leaving more active neurotransmitters in the synapse. The neurotransmitters affected are serotonin and norepinephrine. It is approximately 10 times more potent at inhibiting serotonin uptake than norepinephrine uptake.
A satisfactory FDA inspection of Wyeth's Guayama, Puerto Rico facility, where the drug is to be manufactured;
Several postmarketing surveillance commitments, and follow-up studies on low-dose use, relapse, and use in children;
Clarity by Wyeth around the company's product education plan for physicians and patients;
Approval of desvenlafaxine's proprietary name, Pristiq.
The FDA approved the drug for antidepressant use in February 2008, and was to be available in US pharmacies in May 2008. In March 2017, the generic form of the drug was made available in the US.
In 2009, an application to market desvenlafaxine for major depressive disorder in the European Union was declined. In 2012, Pfizer received authorization in Spain to market desvenlafaxine for the disorder but it is not being sold.
