Names and pronunciation
Khedezla, Pristiq
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Drug reference
Khedezla, Pristiq
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Func. class.: Antidepressant
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Chem. class.: Serotonin-receptor norepinephrine reuptake inhibitor (SNRI)
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Do not confuse: Pristiq/Prilosec
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ACTION: May work by blocking the central presynaptic reuptake of 5-HT and NE, resulting in an increased sustained level of these neurotransmitters
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USES: Major depressive disorder
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Unlabeled uses: Vasomotor symptoms (hot flashes) associated with menopause
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CONTRAINDICATIONS: Hyper- sensitivity to this product or venlafaxine, MAOI therapy Precautions: CNS depression, abrupt dis- continuation, hypertension, hepatic/renal disease, hyponatremia, geriatric patients, pregnancy, labor and delivery, breastfeeding, angina, bleeding, cardiac dysrhythmias, MI, stroke, mania, hypovolemia, dehydration, increased intraocular pressure, anticoagu- lant therapy, bipolar disorder
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Black Box Warning: Children, suicidal ideation Black Box Warning: Suicidal thoughts/ behaviors: mental status and mood; iden- tify suicidal ideation • Serious skin reactions: assess dur- ing and after treatment; discontinue prod- uct immediately if rash develops • Serotonin syndrome, neuroleptic malignant syndrome–like symp- toms: assess for nausea/vomiting, se- dation, dizziness, diaphoresis (sweat- ing), facial flush, hallucinations, mental status changes, myoclonia, restless- ness, shivering, elevated B/P, hyper- thermia, muscle rigidity, autonomic in- stability, mental status changes; if serotonin syndrome occurs, discontinue desvenlafaxine and any other seroto- nergic agents • Monitor B/P baseline and periodically during treatment, lipid levels, signs of glau- coma • Appetite and nutritional intake; weight loss is common, change diet as needed to support weight • Pregnancy/breastfeeding: no well- controlled studies; use only if benefit out- weighs fetal risk; discontinue breastfeed- ing or product, excreted in breast milk Black Box Warning: To report immedi- ately suicidal thoughts/behaviors; have family members look for symptoms of suicidal ideation • Not to operate machinery or engage in hazardous activities until reaction is known, may cause dizziness, drowsi- ness • To avoid all other products unless ap- proved by prescriber • To report if pregnancy is planned or suspected or if breastfeeding • Serious skin reactions: to report im- mediately allergic reactions, including rash, hives, difficulty breathing, or swell- ing of face, lips • Serotonin syndrome, neuroleptic malignant syndrome: to report immedi- ately nausea/vomiting, sedation, dizzi- ness, sweating, facial flush • That continuing follow-up exams will be needed; that low sodium levels may occur, to watch for headache, confusion, weakness
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SIDE EFFECTS CNS: Dizziness, drowsiness, headache, tremor, paresthesias, asthenia, suicidal thoughts/behaviors, seizures, fatigue, chills, yawning, hot flashes, flushing, irritability, insomnia, anxiety, abnor- mal dreams, fatigue CV: Palpitations, sinus tachycardia, increased B/P, orthostatic hypotension EENT: Blurred vision, mydriasis, tinnitus, bruxism GI: Nausea, xerostomia, diarrhea, con- stipation, vomiting, anorexia, weight loss, dysgeusia, hypercholesterolemia, hypertriglyceridemia GU: Urinary retention/hesitancy, orgasm dysfunction, decreased libido, impo- tence, proteinuria HEMA: Impaired platelet aggregation INTEG: Photosensitivity, hyperhidrosis, diaphoresis, rash SYST: Serotonin syndrome, neuroleptic malignant syndrome–like symptoms, toxic epidermal necrolysis, Stevens- Johnson syndrome, erythema multiforme, angioedema; neonatal abstinence syn- drome (fetal exposure)
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INTERACTIONS Increase: serotonin syndrome, neuroleptic malignant syndrome–like reactions— SSRIs, other SNRIs, serotonin receptor ago- nists (almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, SUMAtriptan, ZOL- Mitriptan), tricyclics, traZODone, sibutra- mine, ergots, lithium, nefazodone, meperidine, phentermine, MAOIs, dextro- methorphan, linezolid, promethazine, methylphenidate, dexmethylphenidate, mir- tazapine, pentazocine, tryptophan, methy- lene blue IV; do not administer concurrently Increase: bleeding risk—salicylates, thrombolytics, NSAIDs, platelet inhibi- tors, anticoagulants Increase: CNS depression—alcohol, opi- oids, antihistamines, sedatives/hypnotics Increase: hallucinations, delusions, disorientation—zolpidem Drug/Herb Increase: desvenlafaxine action—kava, valerian Drug/Lab Test Increase: cholesterol, triglycerides False positive: amphetamine, phencyclidine Decrease: sodium
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DOSAGE AND ROUTES Major depressive disorder • Adult: PO Initially, 50 mg/day; max 400 mg/day with adjustments as needed Reduction of hot flash frequency/ severity in women with natural or medically induced menopause (unlabeled) • Adult: PO 25-150 mg/day, max 200 mg/day Renal/hepatic dose • Adult: PO CCr 30-50 mL/min 50 mg daily; CCr <30 mL/min or end-stage renal disease 50 mg every other day; moderate to severe hepatic disease, max 100 mg/ day
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Available forms: Extended-release tab- lets 25, 50, 100 mg
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Administer: • Without regard to food; food may minimize GI symptoms • Extended-release tablet: do not crush, break, or chew • Store at room temperature
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Assess:
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Evaluate: • Decreased depression, increased sense of well-being, renewed interest in activities
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To take as directed, not to double or skip doses; if a dose is missed, take as soon as remembered unless close to next dose; do not discontinue abruptly, de- crease gradually
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PHARMACOKINETICS Protein binding 30%, elimination half- life 11 hr; elimination half-life is increased (hepatic/renal disease) D
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• Adult: PO Initially, 50 mg/day; max 400 mg/day with adjustments as needed Reduction of hot flash frequency/ severity in women with natural or medically induced menopause (unlabeled)
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• Adult: PO 25-150 mg/day, max 200 mg/day Renal/hepatic dose
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• Adult: PO CCr 30-50 mL/min 50 mg daily; CCr <30 mL/min or end-stage renal disease 50 mg every other day; moderate to severe hepatic disease, max 100 mg/ day
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