AdultPediatricDosage Forms & Strengths tablet, extended release Pristiq 25mg (contains 38 mg of desvenlafaxine succinate) 50mg (contains 76 mg of desvenlafaxine succinate) 100mg (contains 152 mg of desvenlafaxine succinate) Major Depressive Disorder 50 mg PO qDay Higher dosages, up to 400 mg/day, have been used but no additional benefit was demonstrated at doses >50mg/day; increased side effects have been reported Assess periodically to determine need for continued treatment Dosage Modifications Renal impairment Mild (CrCl ≥50 mL/min): Dosage adjustment not necessary Moderate (CrCl 30-50 mL/min): Not to exceed 50 mg/day Severe (CrCl <30 mL/min) and ESRD, requiring hemodialysis: Not to exceed 25 mg PO once qDay or 50 mg PO every other day Do not administer supplemental dose after hemodialysis Hepatic impairment Moderate-to-severe (Child-Pugh score 7-15): 50 mg PO qD; dosages >100 mg/day not recommended Dosing Considerations Gradually reduce dose rather than stopping therapy abruptly whenever possible; if intolerable effects still occur, resume therapy at previously prescribed dosage and then decrease even more gradually Switching from other antidepressants to desvenlafaxine Discontinuation symptoms have been reported when switching patients from other antidepressants Tapering of initial antidepressant may be necessary to minimize discontinuation symptoms Switching to or from a monoamine oxidase inhibitor (MAOI) to treat psychiatric disorders Wait at least 14 days between discontinuance of monoamine oxidase inhibitor (MAOI) and initiation of desvenlafaxine Wait at least 7 days between discontinuance of desvenlafaxine and initiation of MAOI Periodically reassessed to determine the need for continued treatment Using desvenlafaxine with other MAOIs such as linezolid or methylene blue Do not start desvenlafaxine if patient is treated with linezolid or IV methylene blue; patients who require more urgent treatment of a psychiatric condition, other interventions, including hospitalization, should be considered If acceptable alternatives are unavailable and the potential benefits of linezolid or IV methylene blue treatment outweigh the risks of serotonin syndrome in a particular patient, promptly discontinue desvenlafaxine, and linezolid or IV methylene blue can be administered Safety and efficacy not establishedInteraction CheckerEnter a drug name and desvenlafaxineNo Results No Interactions Found Interactions FoundContraindicatedSerious - Use AlternativeSignificant - Monitor CloselyMinorAll Interactions Sort By: SeverityName Contraindicated (11)iobenguane I 123desvenlafaxine decreases effects of iobenguane I 123 by pharmacodynamic antagonism. Contraindicated. If clinically appropriate, discontinue drugs that decrease uptake of NE for at least 5 half-lives; may cause false-negative imaging results.isocarboxazidisocarboxazid and desvenlafaxine both increase serotonin levels. Contraindicated. At least 14 days should elapse between discontinuation of MAOIs and initiation of treatment with a serotonergic druglinezolidlinezolid and desvenlafaxine both increase serotonin levels. Contraindicated. Linezolid may increase serotonin as a result of MAO-A inhibition. If linezolid must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last linezolid dose or after 2 weeks of monitoring, whichever comes firstmethylene bluemethylene blue and desvenlafaxine both increase serotonin levels. Contraindicated. Methylene blue may increase serotonin as a result of MAO-A inhibition. If methylene blue must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last methylene blue dose or after 2 weeks of monitoring, whichever comes firstphenelzinephenelzine and desvenlafaxine both increase serotonin levels. Contraindicated. At least 14 days should elapse between discontinuation of MAOIs and initiation of treatment with a serotonergic drugprocarbazineprocarbazine and desvenlafaxine both increase serotonin levels. Contraindicated. At least 14 days should elapse between discontinuation of MAOIs and initiation of treatment with a serotonergic drugrasagilinerasagiline and desvenlafaxine both increase serotonin levels. Contraindicated. At least 14 days should elapse between discontinuation of MAOIs and initiation of treatment with a serotonergic drugsafinamidedesvenlafaxine, safinamide. Either increases toxicity of the other by serotonin levels. Contraindicated. Concomitant use could result in life-threatening serotonin syndrome.selegilineselegiline and desvenlafaxine both increase serotonin levels. Contraindicated. At least 14 days should elapse between discontinuation of MAOIs and initiation of treatment with a serotonergic drugselegiline transdermalselegiline transdermal and desvenlafaxine both increase serotonin levels. Contraindicated. At least 14 days should elapse between discontinuation of MAOIs and initiation of treatment with a serotonergic drugtranylcyprominetranylcypromine and desvenlafaxine both increase serotonin levels. Contraindicated. At least 14 days should elapse between discontinuation of MAOIs and initiation of treatment with a serotonergic drugSerious - Use Alternative (74)alfentanildesvenlafaxine and alfentanil both increase serotonin levels. Avoid or Use Alternate Drug. May cause serotonin syndromealmotriptanalmotriptan and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.amitriptylineamitriptyline and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.amoxapineamoxapine and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.apixabandesvenlafaxine and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.buspironebuspirone and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.citalopramcitalopram and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.clomipramineclomipramine and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.cocaine topicalcocaine topical and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.cyclobenzaprinedesvenlafaxine and cyclobenzaprine both increase serotonin levels. Avoid or Use Alternate Drug.desipraminedesipramine and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.dexfenfluraminedexfenfluramine and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.dextroamphetaminedextroamphetamine and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.dextromethorphandextromethorphan and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.dihydroergotaminedihydroergotamine and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.dolasetrondolasetron, desvenlafaxine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.doxepindoxepin and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.duloxetineduloxetine and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.eletriptaneletriptan and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.ergotamineergotamine and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.escitalopramescitalopram and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.fentanyldesvenlafaxine and fentanyl both increase serotonin levels. Avoid or Use Alternate Drug. May cause serotonin syndromefluoxetinefluoxetine and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.fluvoxaminefluvoxamine and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.frovatriptanfrovatriptan and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.granisetrongranisetron, desvenlafaxine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.imipramineimipramine and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.iobenguane I 131desvenlafaxine will decrease the level or effect of iobenguane I 131 by Other (see comment). Avoid or Use Alternate Drug. Based on the mechanism of action of iobenguane, drugs that reduce catecholamine uptake or that deplete catecholamine stores may interfere with iobenguane uptake into cells, and thus, reduce iobenguane efficacy. Discontinue interfering drugs for at least 5 half-lives before administration of either the dosimetry or an iobenguane dose. Do not administer these drugs until at least 7 days after each iobenguane dose.isoniazidisoniazid and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.L-tryptophanL-tryptophan and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.levodopalevodopa and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.levomilnacipranlevomilnacipran and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.levorphanoldesvenlafaxine and levorphanol both increase serotonin levels. Avoid or Use Alternate Drug. May cause serotonin syndromelithiumlithium and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.lonafarnibdesvenlafaxine will increase the level or effect of lonafarnib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration of lonafarnib (a sensitive CYP3A substrate) with weak CYP3A inhibitors is unavoidable, reduce to, or continue lonafarnib at starting dose. Closely monitor for arrhythmias and events (eg, syncope, heart palpitations) since lonafarnib effect on QT interval is unknown.lorcaserindesvenlafaxine and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.lsdlsd and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.maprotilinemaprotiline and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.meperidinemeperidine and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.metoclopramidemetoclopramide and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug. Additive effects; increased risk for serotonin syndrome, neuroleptic malignant syndrome, dystonia, or other extrapyramidal reactionsmetoclopramide intranasaldesvenlafaxine, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.milnacipranmilnacipran and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.mirtazapinemirtazapine and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.morphinemorphine and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.nalbuphinedesvenlafaxine and nalbuphine both increase serotonin levels. Avoid or Use Alternate Drug. May cause serotonin syndromenaratriptannaratriptan and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.nefazodonenefazodone and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.netupitant/palonosetronnetupitant/palonosetron, desvenlafaxine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.nortriptylinenortriptyline and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.olopatadine intranasaldesvenlafaxine and olopatadine intranasal both increase sedation. Avoid or Use Alternate Drug. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment. ondansetronondansetron, desvenlafaxine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.opium tincturedesvenlafaxine and opium tincture both increase serotonin levels. Avoid or Use Alternate Drug. May cause serotonin syndromeozanimodozanimod increases toxicity of desvenlafaxine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Because the active metabolite of ozanimod inhibits MAO-B in vitro, there is a potential for serious adverse reactions, including hypertensive crisis. Therefore, coadministration of ozanimod with drugs that can increase norepinephrine or serotonin is not recommended. Monitor for hypertension with concomitant use.palonosetronpalonosetron, desvenlafaxine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.paroxetineparoxetine and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.pentazocinepentazocine and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.protriptylineprotriptyline and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.pseudoephedrinedesvenlafaxine increases effects of pseudoephedrine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug.remifentanildesvenlafaxine and remifentanil both decrease serotonin levels. Avoid or Use Alternate Drug. May cause serotonin syndromerizatriptanrizatriptan and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.ropeginterferon alfa 2bropeginterferon alfa 2b and desvenlafaxine both increase Other (see comment). Avoid or Use Alternate Drug. Narcotics, hypnotics or sedatives can produce additive neuropsychiatric side effects. Avoid use and monitor patients receiving the combination for effects of excessive CNS toxicity.SAMeSAMe and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.sertralinesertraline and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.St John's WortSt John's Wort and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.sufentanildesvenlafaxine and sufentanil both decrease serotonin levels. Avoid or Use Alternate Drug. May cause serotonin syndromesumatriptansumatriptan and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.sumatriptan intranasalsumatriptan intranasal and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.tedizolidtedizolid, desvenlafaxine. Either increases effects of the other by Mechanism: pharmacodynamic synergism. Avoid or Use Alternate Drug. both increase serotonin levels; increased risk of serotonin syndrome.tramadoltramadol and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.trazodonetrazodone and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.trimipraminetrimipramine and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.vilazodonedesvenlafaxine, vilazodone. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug. Concomitant therapy should be discontinued immediately if signs or symptoms of serotonin syndrome emerge and supportive symptomatic treatment should be initiated. .vortioxetinedesvenlafaxine, vortioxetine. Either increases effects of the other by serotonin levels. Avoid or Use Alternate Drug.zolmitriptanzolmitriptan and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.Monitor Closely (96)aripiprazoledesvenlafaxine will increase the level or effect of aripiprazole by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Desvenlafaxine inhibits CYP2D6; with higher desvenlafaxine doses (ie, 400 mg) decrease the CYP2D6 substrate dose by up to 50%; no dosage adjustment needed with desvenlafaxine doses <100 mgatazanaviratazanavir increases levels of desvenlafaxine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity. .atogepantdesvenlafaxine will increase the level or effect of atogepant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.atomoxetinedesvenlafaxine will increase the level or effect of atomoxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Desvenlafaxine inhibits CYP2D6; with higher desvenlafaxine doses (ie, 400 mg) decrease the CYP2D6 substrate dose by up to 50%; no dosage adjustment needed with desvenlafaxine doses <100 mgavapritinibdesvenlafaxine will increase the level or effect of avapritinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.axitinibdesvenlafaxine increases levels of axitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.benzhydrocodone/acetaminophendesvenlafaxine will increase the level or effect of benzhydrocodone/acetaminophen by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Hydromorphone (<3% of the circulating parent hydrocodone [benzhydrocodone