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Initial Treatment of Major Depressive Disorder

The recommended dose for Pristiq (Desvenlafaxine) is 50 mg once daily, with or without food.

In clinical studies, doses of 50-400 mg per day were shown to be effective, although no additional benefit was demonstrated at doses greater than 50 mg per 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 Succinate (Pristiq) should be taken at approximately the same time each day. Tablets must be swallowed whole with fluid and not divided, crushed, chewed, or dissolved.

Special Populations

Pregnant women during the third trimester

Neonates exposed to SNRIs or SSRIs late in the third trimester have developed complications requiring prolonged hospitalization, respiratory support, and tube feeding. When treating pregnant women with Pristiq (Desvenlafaxine) during the third trimester, the physician should carefully consider the potential risks and benefits of treatment. The physician may consider tapering this medication in the third trimester.

Renal impairment

No dosage adjustment is necessary in patients with mild renal impairment (24-hr CrCl = 5080 mL/min).

The recommended dose in patients with moderate renal impairment (24-hr CrCl = 3050 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.

Hepatic impairment

The recommended dose in patients with hepatic impairment is 50 mg per day. Dose escalation above 100 mg per day is not recommended.

Elderly patients

No dosage adjustment is required solely on the basis of age; however, the possibility of reduced renal clearance of Pristiq (Desvenlafaxine) should be considered when determining the dose.

Maintenance / Continuation / Extended Treatment

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 Pristiq (Desvenlafaxine) at a dose of 50 mg per 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.

Discontinuing Pristiq

Symptoms associated with discontinuation of Pristiq (Desvenlafaxine), other SNRIs and SSRIs have been reported. Patients should be monitored for these symptoms when discontinuing treatment. A gradual reduction in the dose 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.

Switching Patients from other Antidepressants to Pristiq

Discontinuation symptoms have been reported when switching patients from other antidepressants, including venlafaxine, to Pristiq (Desvenlafaxine). Tapering of the initial antidepressant may be necessary to minimize discontinuation symptoms.

Switching Patients to or from a Monoamine Oxidase Inhibitor (MAOI)

At least 14 days must elapse between discontinuation of an MAOI and initiation of therapy with Desvenlafaxine (Pristiq). In addition, at least 7 days must be allowed after stopping this drug before starting an MAOI.

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