Desvenlafaxine, sold under the brand namePristiq among others, is a medication used to treatdepression.[4] It is anantidepressant of theserotonin-norepinephrine reuptake inhibitor (SNRI) class and is taken by mouth.[4] It is recommended that the need for further treatment be occasionally reassessed.[4] It may be less effective than its parent compoundvenlafaxine,[5] although some studies have found comparable efficacy.[6]
Desvenlafaxine was approved for medical use in theUnited States in 2008.[4] In Europe its application for use was denied in 2009.[5] In 2022, it was the 208th most commonly prescribed medication in the United States, with more than 1million prescriptions.[9][10]
Desvenlafaxine is primarily used as a treatment formajor depressive disorder.[11] Use has only been studied up to 8 weeks.[4] It may be less effective thanvenlafaxine,[5] although some studies have found comparable efficacy with a lower rate of nausea.[6]
Doses of 50 to 400 mg/day appear effective for major depressive disorder, although no additional benefit was demonstrated at doses greater than 50 mg/day, and adverse events and discontinuations were more frequent at higher doses.[12]
Desvenlafaxine improves theHAM-D17 score[13] and measures of well-being such as the Sheehan Disability Scale (SDS) and 5-itemWorld Health Organization Well-Being Index (WHO-5).[14]
Desvenlafaxine is a synthetic form of the isolated major active metabolite ofvenlafaxine, and is categorized as aserotonin-norepinephrine reuptake inhibitor (SNRI). When most normal metabolizers take venlafaxine, approximately 70% of the dose is metabolized into desvenlafaxine, so the effects of the two drugs are expected to be very similar.[17] It works by blocking the"reuptake" transporters for keyneurotransmitters affecting mood, thereby leaving more active neurotransmitters in thesynapse. The neurotransmitters affected areserotonin (5-hydroxytryptamine) andnorepinephrine (noradrenaline). It is approximately 10 times more potent at inhibitingserotonin uptake thannorepinephrine uptake.[18]
Wyeth announced on 23 January 2007 that it received anapprovable letter from theFood and Drug Administration for desvenlafaxine. Final approval to sell the drug was contingent on a number of things, including:
A satisfactory FDA inspection of Wyeth'sGuayama, Puerto Rico facility, where the drug is to be manufactured;
Severalpostmarketing surveillance commitments, and follow-up studies on low-dose use, relapse, and use in children;
Clarity by Wyeth around the company's product education plan for physicians and patients;
Approval of desvenlafaxine's proprietary name, Pristiq.[20]
The FDA approved the drug for antidepressant use in February 2008, and was to be available in US pharmacies in May 2008.[21]
In March 2017, the generic form of the drug was made available in the US.[citation needed]
In 2009, an application to market desvenlafaxine formajor depressive disorder in the European Union was declined.[5] In 2012, Pfizer received authorization in Spain to market desvenlafaxine for the disorder.[24][25] In August 2022, following a 14-year approval process, desvenlafaxine was brought to the market for the disorder in Germany.[26]
Desvenlafaxine is classified as a schedule 4 (prescription only) drug in Australia. It was listed on the Pharmaceutical Benefits Scheme (PBS) in 2008 for the treatment of major depressive disorders.[27]
^abColeman KA, Xavier VY, Palmer TL, Meaney JV, Radalj LM, Canny LM (September 2012). "An indirect comparison of the efficacy and safety of desvenlafaxine and venlafaxine using placebo as the common comparator".CNS Spectrums.17 (3):131–141.doi:10.1017/S1092852912000648.PMID22883424.S2CID35165334.
^Perry R, Cassagnol M (June 2009). "Desvenlafaxine: a new serotonin-norepinephrine reuptake inhibitor for the treatment of adults with major depressive disorder".Clinical Therapeutics.31 (Pt 1):1374–1404.doi:10.1016/j.clinthera.2009.07.012.PMID19698900.
^Thase ME, Kornstein SG, Germain JM, Jiang Q, Guico-Pabia C, Ninan PT (March 2009). "An integrated analysis of the efficacy of desvenlafaxine compared with placebo in patients with major depressive disorder".CNS Spectrums.14 (3):144–154.doi:10.1017/s1092852900020125.PMID19407711.S2CID32901068.
^Soares CN, Kornstein SG, Thase ME, Jiang Q, Guico-Pabia CJ (October 2009). "Assessing the efficacy of desvenlafaxine for improving functioning and well-being outcome measures in patients with major depressive disorder: a pooled analysis of 9 double-blind, placebo-controlled, 8-week clinical trials".The Journal of Clinical Psychiatry.70 (10):1365–1371.doi:10.4088/JCP.09m05133blu.PMID19906341.
^Lemke TL, Williams DA (2012).Foye's Principles of Medicinal Chemistry. Lippincott Williams & Wilkins. p. 609.ISBN978-1-60913-345-0.
^abcDeecher DC, Beyer CE, Johnston G, Bray J, Shah S, Abou-Gharbia M, et al. (August 2006). "Desvenlafaxine succinate: A new serotonin and norepinephrine reuptake inhibitor".The Journal of Pharmacology and Experimental Therapeutics.318 (2):657–665.doi:10.1124/jpet.106.103382.PMID16675639.S2CID15063064.
^Roth BL, Driscol J (Dec 2012)."PDSP Ki Database".Psychoactive Drug Screening Program (PDSP). University of North Carolina at Chapel Hill and the United States National Institute of Mental Health. Retrieved7 July 2018.
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