Home Drug Guide Desvenlafaxine fumarate

Drug Guide

Generic Name

Desvenlafaxine fumarate

Brand Names Pristiq

Classification

Therapeutic: Antidepressant

Pharmacological: Serotonin-Norepinephrine Reuptake Inhibitor (SNRI)

FDA Approved Indications

  • Major depressive disorder

Mechanism of Action

Inhibits the reuptake of serotonin and norepinephrine, increasing their levels in the synaptic cleft, which helps elevate mood and alleviate depression symptoms.

Dosage and Administration

Adult: Start at 50 mg once daily. Dose may be adjusted between 50-400 mg/day based on response and tolerability.

Pediatric: Not approved for pediatric use.

Geriatric: No specific dose adjustment; monitor for tolerability.

Renal Impairment: Adjust dose in severe renal impairment (CrCl <30 mL/min). Typically, a starting dose of 50 mg daily is recommended.

Hepatic Impairment: Use with caution; monitor for adverse effects, and consider a lower dose due to decreased metabolism.

Pharmacokinetics

Absorption: Well absorbed after oral administration.

Distribution: Moderately bound to plasma proteins.

Metabolism: Primarily via conjugation to inactive metabolites; minimal CYP450 involvement.

Excretion: Excreted mainly in urine as unchanged drug and metabolites.

Half Life: About 11 hours.

Contraindications

  • Use with monoamine oxidase inhibitors (MAOIs) or within 14 days of discontinuing an MAOI.
  • Known hypersensitivity to venlafaxine or desvenlafaxine.

Precautions

  • History of hypertension, seizure disorders, or bleeding disturbances.
  • Increase in blood pressure observed in some patients; monitor BP regularly.

Adverse Reactions - Common

  • Nausea (Common)
  • Dizziness (Common)
  • Sweating (Common)
  • Dry mouth (Common)

Adverse Reactions - Serious

  • Hypertension (Less common)
  • Serotonin syndrome (Rare but serious)
  • Suicidal thoughts or behavior in young adults and adolescents (Serious)

Drug-Drug Interactions

  • Other serotonergic drugs, like SSRIs, SNRIs, triptans, tramadol, lithium, etc.
  • Inhibitors of CYP3A4.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor mood, mental status, and suicidal ideation; monitor blood pressure.

Diagnoses:

  • Risk for suicidal ideation
  • Altered mental status

Implementation: Administer with or without food; monitor BP and heart rate; counsel regarding side effects.

Evaluation: Assess symptom improvement and monitor for adverse effects.

Patient/Family Teaching

  • Take medication as prescribed, even if feeling well.
  • Report adverse effects such as increased blood pressure, mood changes, or suicidal thoughts.
  • Avoid alcohol and caution regarding driving until response is known.

Special Considerations

Black Box Warnings:

  • Increased risk of suicidal thinking and behavior in children, adolescents, and young adults.
  • Serotonin syndrome risk with serotonergic drugs.

Genetic Factors: Genetic variations may influence metabolism and response.

Lab Test Interference: May affect blood pressure and serotonin levels.

Overdose Management

Signs/Symptoms: Dizziness, tachycardia, vomiting, somnolence, seizures.

Treatment: Supportive care, activated charcoal if ingested recently, seizure management; dialysis is generally not effective.

Storage and Handling

Storage: Store at room temperature, away from moisture and light.

Stability: Stable under recommended storage conditions.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.