Desvenlafaxine

FDA label

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Renal Moderate: max 50 mg/day; severe or ESRD: 25 mg/day or 50 mg every other day; no post-dialysis supplement

Hepatic Moderate-to-severe: max 100 mg/day

Instructions

• Swallow tablets whole; do not divide, crush, chew, or dissolve
• Take at about the same time each day, with or without food
• Taper gradually when discontinuing to minimize discontinuation symptoms

Contraindications

• MAOIs (concurrently or within 14 days of stopping MAOI); allow 7 days after stopping desvenlafaxine before starting an MAOI due to risk of serotonin syndrome

Cautions

• Serotonin syndrome (also alone, not only with other serotonergics)
• Elevated blood pressure - control before starting, monitor
• Increased bleeding risk with NSAIDs/aspirin/anticoagulants
• Angle-closure glaucoma
• Activation of mania/hypomania
• Discontinuation syndrome - taper
• Seizure; hyponatremia
• Interstitial lung disease / eosinophilic pneumonia
• Sexual dysfunction

Adverse reactions

• Nausea, dizziness, insomnia, hyperhidrosis, constipation, somnolence, decreased appetite, anxiety, male sexual dysfunction

Pregnancy SNRI exposure near delivery associated with <2-fold increased postpartum hemorrhage risk; third-trimester use may cause neonatal discontinuation syndrome

Lactation Low levels in human milk; no adverse reactions reported in breastfed infants