Desvenlafaxine

Desvenlafaxine is a prescription antidepressant in the serotonin-norepinephrine reuptake inhibitor (SNRI) class. It is the active metabolite of venlafaxine and is sold as desvenlafaxine succinate (Pristiq) and the desvenlafaxine brand Khedezla. It is approved for the treatment of major depressive disorder in adults and has been studied for other mood and anxiety disorders.

Desvenlafaxine works by inhibiting the reuptake of the neurotransmitters serotonin and norepinephrine in the brain, increasing their levels in the synaptic cleft. It has a relatively modest effect on dopamine at higher doses. The exact mechanism by which this translates into clinical benefit in depression is not fully understood.

Administered orally, desvenlafaxine is typically given once daily. The usual starting dose for Pristiq is 50 mg, which may be increased to 100 mg daily; the maximum recommended daily dose is 100 mg. Khedezla is dosed similarly. Desvenlafaxine can be taken with or without food. Peak plasma concentrations occur within a few hours, and the half-life is about 11 hours, with elimination largely via the kidney. Dose adjustments are often needed for renal impairment and caution is advised in hepatic impairment and in older adults.

Common side effects include nausea, dizziness, dry mouth, insomnia or sedation, sweating, and sexual dysfunction. Other risks include increased blood pressure, hyponatremia, and withdrawal symptoms if the drug is stopped abruptly; gradual tapering is recommended. Important drug interactions include contraindication with monoamine oxidase inhibitors and potential bleeding risks with NSAIDs or anticoagulants. Use in pregnancy or lactation should be based on a careful risk-benefit assessment.