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65 years In children and young adults, initiate only if benefits greatly outweigh risks Monitor closely for changes in behavior, clinical worsening, and suicidal tendencies during initial 1-2 months of therapy and dosage adjustments Patient s family should communicate any abrupt behavioral changes to healthcare provider Worsening behavior and suicidal venlafaxine er capsules vs tablets that are not part of presenting symptoms may necessitate discontinuance of therapy Not approved for use in pediatric patientsHypersensitivity to desvenlafaxine succinate, venlafaxine hydrochloride or to any excipients in the desvenlafaxine formulation Coadministration with MAOIs increases risk of serotonin syndrome Use of MAOIs concomitantly within 14 days before initiating desvenlafaxine or within 7 days after discontinuing desvenlafaxine Symptoms include tremor, myoclonus, diaphoresis, nausea, vomiting, flushing, dizziness, hyperthermia with features resembling neuroleptic malignant syndrome NMS seizures, rigidity, autonomic instability with possible rapid fluctuations of vital signs, and mental status changes that include extreme agitation progressing to delirium and coma Starting desvenlafaxine in patient being treated with linezolid or IV methylene blue is contraindicated because of increased risk of serotonin syndrome If linezolid or IV methylene blue must be administered, discontinue desvenlafaxine immediately and monitor for central nervous system CNS toxicity; therapy may be resumed 24 hours after last linezolid or methylene blue dose or after 2 weeks of monitoring, whichever comes first Suicidality; monitor for clinical worsening and venlafaxine er capsule vs tablets risk especially in children, adolescents, and young adults aged 18-24 years during early phases of treatment and alterations in dosages Neonates exposed to SNRIs or SSRIs late in 3rd trimester of pregnancy have developed complications necessitating prolonged hospitalization, respiratory support, and tube feeding Control hypertension before initiating treatment; monitor blood pressure regularly during treatment; if sustained hypertension is observed, consider dosage reduction or discontinuance Risk of mydriasis; may trigger angle closure attack in patients with angle closure glaucoma with anatomically narrow angles without a patent iridectomy; avoid use of antidepressants, including desvenlafaxine, in patients with untreated anatomically narrow angles Use caution in patients with history of seizure disorders Screen venlafaxine er capsules vs tablets for bipolar disorder; risk of mixed or manic episodes is increased in patients treated with antidepressants May precipitate shift to mania or hypomania in patients with bipolar venlafaxine er capsule vs tablets avoid monotherapy in patients with bipolar disorder; screen for bipolar disorder patients presenting venlafaxine er capsule vs tablets depressive symptoms Cardiovascular, cerebrovascular or lipid metabolism disorders; monitor patients who have history of or are at risk for these disorders Monitor serum lipids periodically; risk of elevations in fasting serum total cholesterol, low-density lipoprotein LDL and triglycerides is increased Hyponatremia due to syndrome of inappropriate antidiuretic hormone SIADH cases of serum sodium 110 mmol/L have been reported; monitor patients who are venlafaxine er capsule vs tablets diuretics or at risk for volume depletion Rare reports of interstitial lung disease and eosinophilic pneumonia; monitor patients for progressive dyspnea, cough, or chest discomfort Risk of mydriasis; may trigger angle closure attack in patients venlafaxine er capsule vs tablets angle closure glaucoma with anatomically narrow angles without a patent iridectomy May impair congnitive abilities; use caution operating heavy machinery A gradual reduction in dosage rather than abrupt cessation recommended; monitor for discontinuation symptoms; adverse reactions after discontinuation of serotonergic antidepressants, particularly after abrupt discontinuation, include: nausea, sweating, dysphoric mood, irritability, agitation, dizziness, sensory disturbances eg, paresthesia, such as electric shock sensations venlafaxine er capsule vs tablets, anxiety, confusion, headache, lethargy, emotional lability, insomnia, hypomania, tinnitus, and seizures Consider risk of serotonin syndrome if administered concomitantly with other serotonergic drugs including triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone, amphetamines, and St.

John s Wort Serotonin syndrome or NMS-like reactions may occur; discontinue and initiate supportive therapy; closely monitor patients concomitantly receiving triptans, antipsychotics, or serotonin precursors Serotonin syndrome signs and symptoms may include mental status changes eg, agitation, hallucinations, delirium, and coma autonomic instability eg, tachycardia, labile blood pressure, dizziness, diaphoresis, flushing, hyperthermia neuromuscular symptoms eg, tremor, rigidity, myoclonus, hyperreflexia, incoordination seizures, and gastrointestinal symptoms eg, nausea, vomiting, diarrhea Neonates exposed to SNRIs or SSRIs late in 3rd trimester of pregnancy have developed complications necessitating prolonged hospitalization, respiratory support, and tube feeding Monitor for the emergence of serotonin syndrome Discontinue treatment with desvenlafaxine and any concomitant serotonergic agents immediately if the above symptoms occur, and initiate supportive symptomatic treatment If concomitant use of desvenlafaxine with other serotonergic drugs is clinically warranted, inform patients of the increased risk for serotonin syndrome and monitor for symptoms See Contraindications Concomitant use of desvenlafaxine venlafaxine er capsules vs tablets peak plasma concentration and AUC of a drug primarily metabolized by CYP2D6 which may increase the risk of toxicity of the CYP2D6 substrate drugs False-positive urine immunoassay screening tests for phencyclidine PCP and amphetamine have been reported in patients taking desvenlafaxine SSRIs and SNRIs may impair platelet aggregation and increase the risk of bleeding events, ranging from ecchymoses, hematomas, epistaxis, petechiae, and GI hemorrhage to life-threatening hemorrhageConcomitant use of aspirin, NSAIDs, warfarin, other anticoagulants, or other drugs known to affect platelet function may add to this riskFor patients taking warfarin, carefully monitor coagulation indices when initiating, titrating, or discontinuing therapy Pregnancy exposure registry venlafaxine er capsules vs tablets pregnancy outcomes in women exposed to antidepressants during pregnancy Healthcare providers are encouraged to register venlafaxine er capsules vs tablets by calling the National Pregnancy Registry for Antidepressants at 1-844-405-6185 No published studies on desvenlafaxine in pregnant women; however published epidemiologic studies of pregnant women exposed to venlafaxine, the parent compound, have not reported a clear association with adverse developmental outcomes Exposure to SNRIs in mid to late venlafaxine er capsule vs tablets may increase the risk for preeclampsia, and exposure to SNRIs near delivery may increase the risk for postpartum hemorrhage Exposure to SNRIs or SSRIs in late venlafaxine er capsule vs tablets may lead to an increased risk for neonatal complications related webpage prolonged hospitalization, respiratory support, and tube feeding; monitor neonates who were exposed to desvenlafaxine in the third trimester of pregnancy for drug discontinuation syndrome Available limited data from published literature show low levels of desvenlafaxine in human milk, and have not shown adverse reactions in breastfed infants There are no data on the effects of desvenlafaxine on milk production Consider the developmental and health benefits of breastfeeding along with the mother s clinical need for desvenlafaxine and any potential adverse effects on the breastfed child from desvenlafaxine or from the underlying maternal conditionA: Generally acceptable.

Controlled studies in pregnant women show no evidence of fetal risk.Little JT, Ketter TA, Kimbrell TA, Dunn RT, Benson BE, Willis MW, Luckenbaugh DA, Post RM. Biol Psychiatry.

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