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.
|Trade names||Pristiq, Desfax, Ellefore, others|
|Protein binding||Low (30%)|
|Metabolism||CYP3A4, (CYP2D6 is not involved)|
|Elimination half-life||11 h|
|Excretion||45% excreted unchanged in urine|
|Chemical and physical data|
|Molar mass||263.38 g/mol g·mol−1|
|3D model (JSmol)|
|(what is this?)|
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 (SNRI) 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 25.20 USD per month. In 2016, it was the 272nd most prescribed medication in the United States, with more than a million prescriptions.
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.
Very common adverse effects include:
- Dry mouth
Common adverse effects include:
Uncommon adverse effects include:
Rare adverse effects include:
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 (SNRI). 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 (5-hydroxytryptamine) and norepinephrine (noradrenaline). It is approximately 10 times more potent at inhibiting serotonin uptake than norepinephrine uptake.
Wyeth announced on 23 January 2007 that it received an approvable letter from the Food and Drug Administration for desvenlafaxine. Final approval to sell the drug was contingent on a number of things, including:
- 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.
Desvenlafaxine is classified as a schedule 4 (prescription only) drug in Australia. It was listed on the PBS (Pharmaceutical Benefits Scheme) in 2008 for the treatment of major depressive disorders.
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