IRFANA PARVEEN
By Irfana Parveen

B.Sc (Psychiatry Ward)

23 November 2021
Medically reviewed by
Sumayya Salam
Pharm D
Desvenlafaxine v/s Venlafaxine: Study, Dosage, and Side effects.
Table of Contents

Depression (major depressive disorder) affects more than 16 million adult Americans. Desvenlafaxine and Venlafaxine are two popular drugs prescribed to treat depression, a prevalent mental health disorder. The two medications are similar; Desvenlafaxine is the active metabolite of Venlafaxine. Although they are similar in some ways, they have some differences.

Venlafaxine and desvenlafaxine are serotonin-norepinephrine reuptake inhibitors. These are FDA-approved drugs to treat Major Depressive Disorder. They improve depression symptoms by controlling the reuptake of the neurotransmitters serotonin and norepinephrine in the CNS (central nervous system). These medications help people to tackle their depression and overcome anxiety.

But the question arises- which of them is better Desvenlafaxine or Venlafaxine? To know more, read further. 

What is Venlafaxine?

Venlafaxine is an antidepressant drug and is a part of the drug class named Selective Serotonin and Norepinephrine Reuptake Inhibitors (SSNRI). Venlafaxine hydrochloride is the active ingredient present in Venlafaxine. 

Along with being used as a medication for depression, Venlafaxine also treats mental health problems such as anxiety and panic disorder 

How Does Venlafaxin work?

Venlafaxine is a part of the SSNRI drug class in which the drugs affect the chemicals present in the brain to eradicate mental problems. Venlafaxine is a phenylethylamine derivative. It blocks the presynaptic reuptake of serotonin to promote neurotransmission in the brain. 

Venlafaxine blocks the reuptake of serotonin and norepinephrine in synaptosomes. It is a weak inhibitor of dopamine reuptake. Venlafaxine helps promote the rise of chemical substances such as Norepinephrine and Serotonin by blocking their reuptake, which decreases depression symptoms. It improves the mood and restricts the mind from getting into negative thoughts.

What is Desvenlafaxine?

The active metabolite of venlafaxine is desvenlafaxine, a novel SNRI (Serotonin and Norepinephrine Reuptake Inhibitors) that has received US Food and Drug Administration approval for Major Depressive Disorder. It can be used with other drugs as a combination therapy. Desvenlafaxine is available only in the form of an extended-release tablet. 

How Does Desvenlafaxine Work?

Desvenlafaxine is an active metabolite of Venelafaxine. Desvenlafaxine restricts the uptake of chemicals like Serotonin and Norepinephrine, which increases their level in the brain. These chemicals help to maintain proper mental stability.

Thus, because of Desvenlafaxine, as the level of chemicals increases, it helps to improve the mood and decreases the symptoms of depression. Similar to other SNRIs, there is only a negligible impact on dopamine and its reuptake.

Dosages

Typically, pharmaceutical dosage forms are administered to patients to ensure they receive an effective drug dose. It is a formulation that includes the pharmacological substance and excipients in the amounts and physical forms necessary for the patient's medication to be administered accurately and effectively.

Dosage Of Venlafaxine:

Venlafaxine is an oral medication, and it is available in the form of tablets, capsules, and extended-release capsules. It can be taken with food daily, however, without crushing the capsules and tablets.

For the treatment of GAD, the initial amount of dose can be 75 mg per day. 

The maximum amount of dose of Venlafaxine for GAD is 225 mg per day, and it should not exceed that to prevent further negative consequences.

For treatment of depression, an adult can start medication with an initial dose of 75 mg per day, which can be distributed in two doses of 37.5 mg each or 3 doses of 25 mg each.

The maximum dose for depression depends upon the condition and the stage at which the person faces depression. 

225 mg per day is the maximum dose limit for moderately depressed people, while the dose turns to 375 mg per day if the person is in severe depression.

Purchase Venlafaxine online from a certified online pharmacy. 

Dosage Of Desvenlafaxine

Desvenlafaxine is an oral medication available as a tablet for consumption. Take the dose with or without food. Follow a proper routine for the dosage. It comes in 25-mg, 50-mg, and 100-mg as an extended-release formulation.

An initial adult dosage should be 50 mg once daily. The doctor can increase the dosage to 400 mg if the response is inadequate. It is the maximum daily dose.

The tablets should not be chewed or crushed and must be swallowed as a whole to eliminate the risk of possible side effects.

No. Do not consume alcohol while taking Venlafaxine and Desvenlafaxine because doing so may raise the risk of respiratory depression, sedation, tiredness, and impairment of alertness. Additionally, the combo can make depression and anxiety worse.
The FDA has not authorized desvenlafaxine for anxiety. It is occasionally used as an off-label (unapproved) treatment for panic episodes, generalized anxiety, and social anxiety.
Venlafaxine has the potential to induce severe memory loss and is also anticipated to have other serious cognitive adverse effects. Memory lapses are frequent, annoying, and occasionally frightening, and they can also cause dementia.

Desvenlafaxine v/s Venlafaxine: Which Is More Effective?

Desvenlafaxine and Venlafaxine share some similar features. Although these two medications are different from one another, they each address a specific issue and deliver positive outcomes.
The side effects are the only thing that varies.

Compared to Desvenlafaxine, nausea is more severe in those using Venlafaxine. There are no discernible differences in their efficacy.

The selection of Desvenlafaxine or Venlafaxine entirely depends upon the doctor. 

Desvenlafaxine v/s Venlafaxine: Study Of Comparision

A systematic literature search was conducted to identify all placebo-controlled studies in the treatment of depression using desvenlafaxine and venlafaxine. According to the findings of this indirect meta-analysis, desvenlafaxine is not less effective than venlafaxine for treating depression in the short term at doses that are approved.

Venlafaxine and desvenlafaxine exhibit strong pharmacodynamic suppression of serotonin and noradrenaline reuptake in preclinical models. The findings also imply that desvenlafaxine has a tolerability advantage over venlafaxine in terms of less nausea. 

Two studies compared desvenlafaxine 50 mg and 100 mg daily with a placebo, with the 50 mg dose having a significantly higher remission rate. Only desvenlafaxine 400 mg daily showed a significantly higher remission rate in research comparing desvenlafaxine 100 mg, 200 mg, and 400 mg daily to placebo. 

Things To Note Before Taking Desvenlafaxine:

One should not take Desvenlafaxine if:

  • Allergic to Desvenlafaxine
  • Taking herbal products and OTC vitamins
  • Used MAO in last 14 days
  • Kidney disorders
  • Liver diseases
  • Respiratory system issues
  • Seizures
  • Glaucoma
  • Below the age of 18
  • Pregnant and breastfeeding women (only if allowed by the doctor)

Things To Note Before Taking Venlafaxine:

One should not take Venlafaxine if having:

  • Allergic to Venlafaxine
  • Consumed MAO in last 14 days
  • Liver and kidney diseases
  • Diabetes
  • Glaucoma
  • Thyroid
  • Seizure
  • Bleeding problems
  • Below the age of 18
  • Breastfeeding women. 
  • Venlafaxine can be taken during pregnancy only if recommended by the doctor.

Side Effects Of Desvenlafaxine:

Some serious side effects which one might experience are as follows:

  • Suicidal thoughts
  • Skin allergies or swelling
  • Blurred vision
  • Seizures
  • Breathing problems
  • Rapid heart rate
  • Hallucinations

If observed these side effects, consult the doctor immediately as they can be fatal 

Following are some common side effects after taking Desvenlafaxine:

  • Nausea
  • Loss of appetite
  • Dizziness
  • Loss of sexual interest
  • Problem in sleeping

Side Effects Of Venlafaxine:

Following are some severe side effects that can be experienced after consumption of Venlafaxine and need emergency medical help:

  • Allergic reactions such as skin rash
  • Hallucinations
  • Shivering
  • Stiffness of muscles
  • Imbalance in co-ordination
  • Fast heart rate
  • Agitation

If observed these side effects, consult the doctor immediately as they can be fatal 

Some common side effects faced are:

  • Nausea and vomiting
  • Sleep problems
  • Dry mouth
  • Blurred vision
  • Sexual problems

Side effects Of Venlafaxine and Desvenlafaxine

These are the undesired effects of administering the drug. It often ranges from mild to moderate or severe. Inform your doctor if any of the following appears.

Venlafaxine

Common side effects

Serious side effects

Nausea

Allergic reactions such as skin rash

Vomiting

Hallucination

Sleep problems

Shivering

Dry mouth

Muscle stiffness

Blurred vision

Imbalance in coordination

Sexual problems

Fast heart rate

Dizziness

Agitation

Constipation

Weight gain

Desvenlafaxine

Common side effects

Serious side effects

Nausea, vomiting

Suicidal thoughts

Loss of appetite

Skin allergies or rashes

Dizziness

Blurred vision

Loss of sexual interest

Breathing problems

Sleep problems

Seizure

Dry mouth

Rapid heart rate

Constipation

Hallucination

Blurred vision

Serotonin syndrome

Precautions Of Venlafaxine And Desvenlafaxine

When using prescription medicine, it is crucial to take the advised safety precautions to prevent abuse. When taken according to regimens, accurate doses, and reduced risks, medications can be beneficial for patients. Therefore, follow precautions for the safe use of the drugs.

Precautions Before Taking Venlafaxine

  • Take Venlafaxine as directed.
  • One should not take Venlafaxine if having:
  • Allergic to Venlafaxine
  • Consumed MAO in last 14 days
  • Liver and kidney diseases
  • Diabetes
  • Glaucoma
  • Seizure
  • Bleeding problems 
  • Avoid stopping venlafaxine without first consulting your doctor.
  • Discuss the advantages and dangers of treating depression during pregnancy with your healthcare provider.
  • Venlafaxine can enter breast milk. Talk to your doctor if you are breastfeeding.
  • If you miss a dose, take it as soon as you remember. Do not double the dose for the missed one.
  • Do not drive, operate heavy machinery, or do other dangerous activities until you know how Venlafaxine affects you.
  • Avoid intake of alcohol if you are taking Venlafaxine.

Precautions Before Taking Desvenlafaxine

  • Take Desvenlafaxine exactly as your healthcare provider has told you.
  • Take Desvenlafaxine at about the same time each day.
  • Desvenlafaxine may be taken either with or without food.
  • Swallow Desvenlafaxine tablets whole, with fluid. Do not crush, cut, chew, or dissolve the tablets.
  • One should not take Desvenlafaxine if:
  • Allergic to Desvenlafaxine
  • Taking herbal products and OTC vitamins
  • Used MAO in last 14 days
  • Kidney disorders
  • Liver diseases
  • Respiratory system issues
  • Seizures
  • Glaucoma
  • Pregnant and breastfeeding women (only if allowed by the doctor)
  • Do not stop taking desvenlafaxine or adjust the dosage without consulting your doctor.
  • Take your Desvenlafaxine dose as soon as you remember if you miss one. Skip the missing dose if it is almost time for your next dose. Do not attempt to take two doses to "make up" for the missed dose.
  • Do not take more Desvenlafaxine than your doctor has recommended.
  • Do not drive a car or operate machinery until you know how Desvenlafaxine affects you.
  • Avoid drinking alcohol while taking Desvenlafaxine.

Interactions Of Venlafaxine and Desvenlafaxine

Drug interactions can either increase a medication's effects, potentially leading to a reaction resembling an overdose, or decrease the effect, rendering it ineffective.

Interactions of Venlafaxine

  • Concomitant use of Venlafaxine with antiplatelet drugs, NSAIDs, and blood thinners increase the risk of bleeding.
  • Venlafaxine may interact negatively (and even fatally) with MAO inhibitors.  Do not use MAO inhibitors for two weeks before and at least seven days after treatment with this medication. 
  • Taking other drugs that increase serotonin increases your risk of developing serotonin syndrome or toxicity. Examples include SNRIs like duloxetine tryptophan and SSRIs like fluoxetine/paroxetine.
  • All your medications, including allergy and cold/cough remedies, should have their labels read because they may contain drowsiness-inducing ingredients.
  • When using venlafaxine, avoid taking drugs that contain desvenlafaxine.

Interactions of Desvenlafaxine

  • Avoid concomitant use of Desvenlafaxine with monoamine oxidase inhibitors or within two weeks.
  • Desvenlafaxine may intensify other drugs' bleeding-related side effects (e.g., ibuprofen, warfarin, and aspirin).
  • The use of stimulant drugs with Venlafaxine increases the chance of developing serotonin syndrome. e.g., amphetamine and methylphenidate
  • Concurrent use of Desvenlafaxine with diuretics may increase your risk of a low blood sodium level.

Bottom Line From Practical Anxiety Solutions

Major depressive disorder (MDD) is a widespread, incapacitating illness that causes a significant economic burden. The pharmaceutical drugs venlafaxine and desvenlafaxine are used to treat depression.

Considering that both drugs have similar functions and applications in treatment, some studies refer to venlafaxine as the "parent drug" of desvenlafaxine. In the body, venlafaxine is converted to desvenlafaxine.

Preclinical models show strong inhibition of serotonin and noradrenaline reuptake by venlafaxine and desvenlafaxine. Furthermore, desvenlafaxine has a better tolerability profile of nausea compared to venlafaxine. In case of any adverse event, call your doctor.

  • Preskorn, Sheldon, et al. "Comparison of the pharmacokinetics of venlafaxine extended release and desvenlafaxine in extensive and poor cytochrome P450 2D6 metabolizers." Journal of clinical psychopharmacology 29.1 (2009): 39-43. From https://doi.org10/1097/JCP.0b013e318192e4c1 Obtain on 11/11/2022
  • Liebowitz, Michael R., et al. "Efficacy, safety, and tolerability of desvenlafaxine 50 mg/day and 100 mg/day in outpatients with major depressive disorder." Current medical research and opinion 24.7 (2008): 1877-1890. From https://doi.org/10.1185/03007990802161923 Obtain on 11/11/2022
  • Reddy, S., Fayyad, R., Edgar, C. J., Guico-Pabia, C. J., & Wesnes, K. (2016). The effect of desvenlafaxine on cognitive functioning in employed outpatients with major depressive disorder: a substudy of a randomized, double-blind, placebo-controlled trial. Journal of Psychopharmacology. From https://doi.org/10.1177/0269881116631649 Obtain on 11/11/2022
  • Sansone RA, Sansone LA. Serotonin norepinephrine reuptake inhibitors: a pharmacological comparison. Innov Clin Neurosci. 2014 Mar;11(3-4):37-42. PMID: 24800132; PMCID: PMC4008300.
  •  
    Coleman, Kristina A., et al. "An indirect comparison of the efficacy and safety of desvenlafaxine and venlafaxine using placebo as the common comparator." CNS spectrums 17.3 (2012): 131-141. From https://doi.org/10.1017/S1092852912000648 Obtain on 11/11/2022
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