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Usual Adult Dose for:
Additional dosage information:
Usual Adult Dose for Depression
Initial dose: 50 mg orally once daily, with or without food.
In clinical studies, doses of 50 to 400 mg/day were shown to be effective, although no additional benefit was demonstrated at doses greater than 50 mg/day and adverse events and discontinuations were more frequent at higher doses.
When discontinuing therapy, gradual dose reduction is recommended whenever possible to minimize discontinuation symptoms.
Desvenlafaxine should be taken at approximately the same time each day.
Tablets must be swallowed whole with fluid and not divided, crushed, chewed, or dissolved.
It is generally agreed that acute episodes of major depressive disorder require several months or longer of sustained pharmacologic therapy. However, the longer term efficacy of desvenlafaxine at doses of 50 mg/day that was effective in short-term, controlled studies has not been studied. Patients should be periodically reassessed to determine the need for continued treatment.
Renal Dose Adjustments
The recommended dose in patients with moderate renal impairment (24 hr CrCl = 30 to 50 mL/min) is 50 mg per day. The recommended dose in patients with severe renal impairment (24 hr CrCl = 30 mL/min) or end-stage renal disease (ESRD) is 50 mg every other day. The doses should not be escalated in patients with moderate or severe renal impairment or ESRD.
Liver Dose Adjustments
No adjustment of the starting dosage is necessary for patients with hepatic impairment. However, dose escalation above 100 mg/day is not recommended.
For patients who experience a sustained increase in blood pressure while receiving desvenlafaxine, either dose reduction or discontinuation should be considered.
Symptoms associated with discontinuation of desvenlafaxine, as well as other SNRIs and SSRIs have been reported. Patients should be monitored for these symptoms when discontinuing treatment. A gradual reduction in the dose (by giving 50 mg of desvenlafaxine less frequently) rather than abrupt cessation is recommended whenever possible. If intolerable symptoms occur following a decrease in the dose or upon discontinuation of treatment, then resuming the previously prescribed dose may be considered. Subsequently, the physician may continue decreasing the dose, but at a more gradual rate.
At least 14 days must elapse between discontinuation of an MAOI and initiation of therapy with desvenlafaxine. In addition, at least 7 days must be allowed after stopping desvenlafaxine before starting an MAOI.
Safety and effectiveness have not been established in pediatric patients (less than 18 years of age).
The recommended dose in patients with moderate renal impairment (24 hr CrCl = 30 to 50 mL/min) is 50 mg per day. The recommended dose in patients with severe renal impairment (24 hr CrCl = 30 mL/min) or end-stage renal disease (ESRD) is 50 mg every other day. Supplemental doses should not be given to patients after dialysis. The doses should not be escalated in patients with moderate or severe renal impairment or ESRD.
Less than 5% of the drug in the body was cleared during a standard 4 hour hemodialysis procedure.
Analyses of the relationships between treatment outcome and age and treatment outcome and gender did not suggest any differential responsiveness on the basis of these patient characteristics. There was insufficient information to determine the effect of race on outcome in these studies.