Pristiq (Desvenlafaxine)

The recommended daily dose is 50 mg, taken with or without food. There is no evidence that a dose greater than this provides any additional benefits.

Tablets should be taken whole. Do not divide, crush, chew or dissolve.

For patients with moderately impaired kidney function, the recommended dose is 50 mg. The recommended dose for those with severe or end-stage kidney disease is 50 mg every other day. The dosage should not be increased in these patients.

For patients with impaired liver function, it is not recommended that dosing exceed 100 mg/day.

Do not take Pristiq with a monoamine oxidase inhibitor (MAOI) or within 14 days of stopping an MAOI. Wait seven days after stopping Pristiq to start an MAOI.

• Kidney Disease: Dosage adjustment is recommended in those with severe or end-stage kidney disease. The dose should not be raised in these patients.
• The Elderly: In determining the dose for older patients, it should be taken into consideration that this population may need alterations in dosing due to reduced renal clearance. It should also be kept in mind that there is a greater risk for orthostatic hypotension in these patients.
• Pregnant/Breastfeeding Mothers: Pristiq should only be given to pregnant or breastfeeding women if the expected benefits outweigh the risks.

• Patients should be monitored for worsening depression or suicidality, especially at the beginning of treatment or when dosage changes occur.
• Serotonin syndrome or neuroleptic malignant syndrome-like reactions may occur when Pristiq is taken with certain other medications. You should tell your doctor if you are taking any of the following: triptans, St. John's wort, MAOIs, tryptophan, sibutramine, tramadol or any type of antidepressant.
• Elevated blood pressure may occur while using Pristiq. You should make sure that your blood pressure is under control prior to starting this medication and continue to have it monitored while you are taking it.
• The risk of abnormal bleeding may be increased, especially if other drugs that affect blood clotting, such as NSAIDs and aspirin, are being used.
• Mydriasis has occurred with Pristiq. Patients with raised intraocular pressure or who at risk for angle-closure glaucoma should be monitored.
• Pristiq may activate mania or hypomania in bipolar patients.
• Use cautiously in patients with cerebro- or cardiovascular disease.
• Pristiq may raise cholesterol or triglyceride levels.
• Patients should taper off their dose gradually in order to avoid discontinuation syndrome.
• Renal impairment reduces the clearance of Pristiq from the body. Your doctor will need to lower your dosage if you have impaired kidney function.
• Pristiq should be used cautiously in patients with seizure disorder.
• Blood sodium levels may potentially drop dangerously low while using Pristiq. Tell your doctor if you experience headache, difficulty concentrating, memory changes, confusion, weakness or unsteadiness on your feet. In severe or sudden cases, symptoms may also include hallucinations, fainting, seizures and coma. If left untreated, this condition can be fatal.
• Do not use other drugs containing desvenlafaxine or venlafaxine with Pristiq.
• Interstitial lung disease and eosinophilic pneumonia can occur while using Pristiq.

_Source:

_{Prescribing Information - Pristiq. Wyeth Pharmaceuticals Inc. Accessed: Dec. 21, 2009. http://www.pristiq.com}