Nurses Compass
Drug Guide
Desvenlafaxine Succinate
Classification
Therapeutic: Antidepressant
Pharmacological: Serotonin-Norepinephrine Reuptake Inhibitor (SNRI)
FDA Approved Indications
- Major depressive disorder
Mechanism of Action
Desvenlafaxine inhibits the reuptake of serotonin and norepinephrine in the brain, increasing their levels to help improve mood and alleviate depression.
Dosage and Administration
Adult: Start at 50 mg once daily. Dose may be adjusted based on response and tolerability. Maximum dose is 400 mg daily.
Pediatric: Not approved for use in pediatric patients.
Geriatric: No initial dose adjustment necessary, but caution in elderly due to increased risk of side effects.
Renal Impairment: Adjust dose in severe renal impairment (creatinine clearance <30 mL/min).
Hepatic Impairment: Use with caution; no specific dosage adjustment recommended but monitor closely.
Pharmacokinetics
Absorption: Well absorbed; bioavailability approximately 80%.
Distribution: Widely distributed; protein binding about 30%.
Metabolism: Primarily metabolized via conjugation, minimal CYP450 involvement.
Excretion: Excreted mainly via urine; about 45% unchanged drug.
Half Life: Approximately 11 hours.
Contraindications
- Use of monoamine oxidase inhibitors (MAOIs) within 14 days.
- History of hypersensitivity to desvenlafaxine.
Precautions
- History of hypertension, agitation, or increased blood pressure; may require monitoring.
- Suicidal thoughts or behaviors, especially in early treatment.
- Discontinuation symptoms if stopped abruptly.
Adverse Reactions - Common
- Nausea (Often)
- Dizziness (Often)
- Insomnia (Often)
- Sweating (Often)
- Dry mouth (Often)
Adverse Reactions - Serious
- Hypertension (Less common)
- Serotonin syndrome (Rare)
- Hyponatremia (Rare)
- Seizures (Very rare)
Drug-Drug Interactions
- MAOIs, other serotonergic drugs, antihypertensives, bleeding risk with anticoagulants
Drug-Food Interactions
- No significant food interactions identified
Drug-Herb Interactions
- St. John's Wort, other herbal serotonergic agents
Nursing Implications
Assessment: Monitor blood pressure, mental status, mood, and suicidal ideation.
Diagnoses:
- Risk for suicide
- Ineffective coping
- Altered safety
Implementation: Administer once daily, preferably in the morning. Educate patient on potential side effects and adherence.
Evaluation: Assess for improvement in depressive symptoms and monitor for side effects.
Patient/Family Teaching
- Take medication exactly as prescribed.
- Do not discontinue abruptly.
- Be aware of side effects like increased blood pressure, nausea, and sleep disturbances.
- Seek medical attention for signs of serotonin syndrome (agitation, hallucinations, increased temperature).
Special Considerations
Black Box Warnings:
- Suicidality in children, adolescents, and young adults with depression.
Genetic Factors: Genetic polymorphisms may affect drug metabolism, but no routine testing recommended.
Lab Test Interference: None known.
Overdose Management
Signs/Symptoms: Dizziness, tremor, agitation, hallucinations, seizures, tachycardia, hypertension.
Treatment: Supportive measures, activated charcoal if ingestion recent, benzodiazepines for agitation, and supportive care for cardiovascular symptoms.
Storage and Handling
Storage: Store at room temperature, 20°C to 25°C (68°F to 77°F).
Stability: Stable under recommended conditions.