Desvenlafaxine Dosage

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Usual Adult Dose for:

Additional dosage information:

Usual Adult Dose for Depression

50 mg orally once a day, with or without food
Maximum dose: 400 mg orally per day

Comments:
-There is no evidence that doses greater than 50 mg per day provide additional benefit.
-Side effects and discontinuations were more common at higher doses.

Use: Treatment of major depressive disorder (MDD)

Renal Dose Adjustments

-Moderate renal impairment (CrCl 30 to 50 mL/min): 50 mg per day
-Severe renal impairment (CrCl less than 30 mL/min) or end-stage renal disease (CrCl less than 15 mL/min): 50 mg every other day

Liver Dose Adjustments

-Moderate to severe hepatic impairment (Child-Pugh Class B to C): 50 mg per day
-Doses above 100 mg per day are not recommended.

Dose Adjustments

-Either dose reduction or discontinuation should be considered in patients who develop a sustained increase in blood pressure.
-When discontinuing treatment, gradual dose reduction is recommended to minimize discontinuation symptoms.

Precautions

BOXED WARNING(S):
SUICIDAL THOUGHTS AND BEHAVIORS
-Antidepressants increased the risk of suicidal thoughts and behavior in children, adolescents, and young adults in short-term studies. These studies did not show an increase in the risk of suicidal thoughts and behavior with antidepressant use in patients over age 24. There was a reduction in risk with antidepressant use in patients aged 65 and older.
-In patients of all ages who are started on antidepressant therapy, monitor closely for worsening, and for emergence of suicidal thoughts and behaviors. Advise families and caregivers of the need for close observation and communication with the prescriber.
-Desvenlafaxine Extended-Release Tablets is not approved for use in pediatric patients.

Safety and efficacy have not been established in patients younger than 18 years.

Consult WARNINGS section for additional precautions.

Dialysis

Supplemental doses should not be administered after dialysis.

Other Comments

Administration advice:
-Tablets should be taken at approximately the same time each day.
-Tablets should be swallowed whole with fluid and not divided, crushed, chewed, or dissolved.

General:
-Patients should be periodically reassessed to determine the need for continued treatment.
-A gradual dose reduction is recommended whenever possible.
-If intolerable symptoms develop following a decrease in the dose or upon discontinuation, resuming the previously prescribed dose should be considered.
-Discontinuation symptoms have been reported when switching from other antidepressants, including venlafaxine, to desvenlafaxine.

Monitoring:
-Psychiatric: Patients should be monitored for discontinuation symptoms, and for worsening and emergence of suicidal thoughts.
-Neurologic: Patients should be monitored for symptoms of serotonin syndrome.
-Cardiovascular: Patients should have regular monitoring of blood pressure.

Patient advice:
-Patients should be cautioned about operating machinery, until they are certain treatment will not affect their ability to engage in these activities.
-Patients should be advised to avoid alcohol.

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