desvenlafaxine

Adjunctive therapy

Brands: Pristiq

Last reviewed 2025-12-29

Reviewed by PsychMed Editorial Team.

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Quick answers

What is desvenlafaxine?
Desvenlafaxine (brand Pristiq) is the primary active metabolite of venlafaxine and an SNRI approved for major depressive disorder.
What is Pristiq?
Pristiq is a brand name for desvenlafaxine.
What is Pristiq (desvenlafaxine) used for?
Label indications include: Major depressive disorder.
What drug class is Pristiq (desvenlafaxine)?
Serotonin-norepinephrine reuptake inhibitor (SNRI); active metabolite of venlafaxine.
What strengths does Pristiq (desvenlafaxine) come in?
Extended-release tablets: 25 mg, 50 mg, 100 mg.

Snapshot

Class: Adjunctive therapy
Common US brands: Pristiq
Therapeutic drug monitoring not routinely recommended.
Last reviewed: 2025-12-29

Label indications

Major depressive disorder.

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Clinical Highlights

Desvenlafaxine (brand Pristiq) is the primary active metabolite of venlafaxine and an SNRI approved for major depressive disorder. Because activation does not require CYP2D6, exposure is more predictable across metabolizer phenotypes and drug–drug interaction profiles than venlafaxine.

Clinicians often choose desvenlafaxine after SSRI nonresponse or when venlafaxine’s CYP2D6 interactions are problematic. Blood pressure monitoring and taper planning are key considerations due to dose-related hypertension and withdrawal symptoms.
The compare view, desvenlafaxine evidence feed, and bipolar disorder hub can be used together when planning tapers, monitoring blood pressure effects, and accounting for bipolar-spectrum risk.
Benefit typically builds over several weeks; early side effects (nausea, sweating, sleep changes) may occur earlier than mood improvement and may improve with time or dosing adjustments.
Discontinuation symptoms can occur with abrupt stopping; predictable taper plans and refill coordination help prevent avoidable withdrawal.
Major depressive disorder (adults) (FDA 2008)
Generic: Generic extended-release tablets available since 2017.

Dosing & Formulations

Extended-release tablets: 25 mg, 50 mg, 100 mg. Label dose is 50 mg once daily with or without food; doses >100 mg/day add little efficacy and increase adverse effects.

Renal impairment: 50 mg every other day for CrCl 30–50 mL/min; 25 mg daily or 50 mg every other day for CrCl <30 mL/min; label recommends avoiding when CrCl <15 mL/min or on hemodialysis.
Tapering over ≥1–2 weeks can reduce discontinuation symptoms (dizziness, dysesthesias, irritability).

Monitoring & Risks

Boxed warning: Antidepressants increase risk of suicidal thoughts and behaviors in young adults during initial treatment; monitor closely. Nausea: Most common adverse effect, typically transient.

Dizziness: Often linked to dose changes or discontinuation.
Insomnia or somnolence: Dose timing can be adjusted based on patient response.
Dry mouth/constipation: Hydration and fiber intake can help.
Hyperhidrosis: Hydration and clothing adjustments can help.

Drug Interactions

Contraindicated with MAOIs or within 7 days of stopping desvenlafaxine (risk of serotonin syndrome). Serotonergic agents (SSRIs, SNRIs, triptans, linezolid) increase serotonin syndrome risk—monitoring for agitation, clonus, and autonomic instability is important.

Additive bleeding risk with NSAIDs, antiplatelets, or anticoagulants.
Strong CYP3A4 inducers (carbamazepine, rifampin) may lower exposure; clinical response is monitored.

Practice Notes

Tablet shell may appear in stool (ghost tablet); reassure patients that medication has been absorbed. Renal function is typically checked at baseline and periodically for long-term therapy so dosing stays aligned with kidney function.

Counseling often covers recognizing serotonin syndrome and when to seek care for sustained hypertension, severe sweating, or emergent mania/hypomania.
If blood pressure rises during titration, reassess dose, other sympathomimetics, and baseline hypertension management before assuming the antidepressant has failed.

References

Pristiq (desvenlafaxine) prescribing information — DailyMed (2025)
CANMAT 2024 Clinical Guidelines for Major Depressive Disorder — Canadian Journal of Psychiatry (2024)
Thase2010 Desvenlafaxine
Liebowitz2013 Desvenlafaxine MDD