Desvenlafaxine

Desvenlafaxine

Systematic (IUPAC) name
4-[2-dimethylamino-1-(1-hydroxycyclohexyl) ethyl]phenol
Clinical data
Trade names	Pristiq, Desfax
AHFS/Drugs.com	monograph
MedlinePlus	a608022
License data	US FDA: Desvenlafaxine
Pregnancy category	AU: B2 US: C (Risk not ruled out)
Routes of administration	Oral
Legal status
Legal status	AU: S4 (Prescription only) CA: ℞-only US: ℞-only
Pharmacokinetic data
Bioavailability	80%
Protein binding	Low (30%)
Metabolism	CYP3A4, (CYP2D6 is not involved)
Biological half-life	11 h
Excretion	45% excreted unchanged in urine
Identifiers
CAS Number	93413-62-8
ATC code	N06AX23 (WHO)
PubChem	CID 125017
IUPHAR/BPS	7158
DrugBank	DB06700
ChemSpider	111300
UNII	NG99554ANW
KEGG	D07793
ChEBI	CHEBI:83527
ChEMBL	CHEMBL1118
Chemical data
Formula	C16H25NO2
Molar mass	263.38 g/mol
SMILES OC2(C(c1ccc(O)cc1)CN(C)C)CCCCC2
InChI InChI=1S/C16H25NO2/c1-17(2)12-15(13-6-8-14(18)9-7-13)16(19)10-4-3-5-11-16/h6-9,15,18-19H,3-5,10-12H2,1-2H3 Key:KYYIDSXMWOZKMP-UHFFFAOYSA-N
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Desvenlafaxine (brand name: Pristiq, Desfax), also known as O-desmethylvenlafaxine, is an antidepressant of the serotonin-norepinephrine reuptake inhibitor (SNRI) class developed and marketed by Wyeth (now part of Pfizer). Desvenlafaxine is a synthetic form of the major active metabolite of venlafaxine (sold under the brand names Effexor and Efexor). It is being targeted as the first non-hormonal based treatment for menopause.^[1]

Medical uses

Desvenlafaxine's primary use in medicine is the treatment of major depressive disorder.^[2]

Adverse effects

Adverse effect incidence^[2][3][4]

Very common (>10% incidence) adverse effects include:

• Nausea
• Headache
• Dizziness
• Dry mouth
• Hyperhidrosis
• Diarrhea
• Insomnia
• Constipation
• Fatigue

Common (1-10% incidence) adverse effects include:

• Tremor
• Blurred vision
• Mydriasis
• Decreased appetite
• Sexual dysfunction
• Insomnia
• Anxiety
• Elevated cholesterol and triglycerides
• Proteinuria
• Vertigo
• Feeling jittery
• Asthenia
• Nervousness
• Hot flush
• Irritability
• Abnormal dreams
• Urinary hesitation
• Yawning
• Rash

Uncommon (0.1-1% incidence) adverse effects include:

• Hypersensitivity
• Syncope
• Depersonalisation
• Hypomania
• Withdrawal syndrome
• Urinary retention
• Epistaxis
• Alopecia (hair loss)
• Orthostatic hypotension
• Peripheral coldness

Rare (<0.1% incidence) adverse effects include:

• Hyponatraemia (low blood sodium)
• Seizures
• Extrapyramidal side effects
• Hallucinations
• Angioedema
• Photosensitivity reaction
• Stevens-Johnson syndrome

Unknown frequency adverse effects include:

• Abnormal bleeding (e.g. gastrointestinal bleeds)
• Narrow-angle glaucoma
• Mania
• Interstitial lung disease
• Eosinophilic pneumonia
• Hypertension
• Suicidal behaviour & thoughts
• Serotonin syndrome

Pharmacology

Desvenlafaxine is a synthetic form of the isolated major active metabolite of venlafaxine, and is categorized as a serotonin-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.^[5] It works by blocking the "reuptake" transporters for key neurotransmitters affecting mood, thereby leaving more active neurotransmitters in the synapse. The neurotransmitters affected are serotonin (5-hydroxytryptamine) and norepinephrine (noradrenaline). It is approximately 10 times more potent at inhibiting serotonin uptake than norepinephrine uptake.^[6]

The molecule resembles hordenine with additions.

Transporter	Ki[nM][7]
SERT	61.4
NET	2953

Approval status

United States

Pristiq 50 mg tablets (US)

Wyeth announced on 23 January 2007 that it received an "approvable" letter from the Food 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's Guayama, Puerto Rico facility, where the drug is to be manufactured;
• several postmarketing 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.^[8]

The FDA approved the drug for antidepressant use in February 2008, and was to be available in US pharmacies in May 2008.^[9]

Canada

On February 4, 2009, Health Canada approved use of desvenlafaxine for treatment of depression in Canada.^[10] Pristiq is now available in Canadian pharmacies.

European Union

In 2008, Wyeth withdrew its application for Ellefore, the product under review for treatment of major depressive disorder in the European Union. In 2012, Pfizer received authorization in Spain to market Pristiq for the disorder in 50mg and 100mg tablets. ^[11][12][13]

Clinical efficacy

In clinical trials, desvenlafaxine demonstrated a significant superiority to placebo both in changes from baseline in the HAM-D17 score^[14] and in measures of well being such as the Sheehan Disability Scale (SDS) and 5-item World Health Organization Well-Being Index (WHO-5).^[15]

See also

• Ansofaxine

References

1. "Wyeth Receives Approvable Letter From FDA for PRISTIQ for the Treatment of Vasomotor Symptoms Associated With Menopause" (Press release). Wyeth. 2007-07-24. Retrieved 2007-07-31.
2. "PRODUCT INFORMATION PRISTIQ® desvenlafaxine (as succinate)" (PDF). TGA eBusiness Services. Pfizer Australia Pty Ltd. 10 December 2012. Retrieved 8 November 2013.
3. "DESVENLAFAXINE tablet, extended release [Ranbaxy Pharmaceuticals Inc.]". DailyMed. Ranbaxy Pharmaceuticals Inc. March 2013. Retrieved 9 November 2013.
4. "desvenlafaxine (Rx) - Pristiq, Khedezla". Medscape Reference. WebMD. Retrieved 9 November 2013.
5. Lemke, Thomas L.; Williams, David A. (2012). Foye's Principles of Medicinal Chemistry. Lippincott Williams & Wilkins. p. 609. ISBN 978-1-60913-345-0.
6. Deecher, DC; Beyer, CE; Johnston, G; Bray, J; Shah, S; Abou-Gharbia, M; Andree, TH (August 2006). "Desvenlafaxine succinate: A new serotonin and norepinephrine reuptake inhibitor" (PDF). The Journal of Pharmacology and Experimental Therapeutics 318 (2): 657–665. doi:10.1124/jpet.106.103382. PMID 16675639.
7. Roth, BL; Driscol, J (12 January 2011). "PDSP K_i Database". Psychoactive Drug Screening Program (PDSP). University of North Carolina at Chapel Hill and the United States National Institute of Mental Health. Retrieved 9 November 2013.
8. "Wyeth Receives Approvable Letter From FDA For Pristiq (Desvenlafaxine Succinate) For The Treatment Of Major Depressive Disorder" (Press release). 2007-01-23. Retrieved 2007-04-04.
9. "FDA Approves Pristiq" (Press release). Wyeth. 2008-02-29. Retrieved 2008-02-29.
10. Health Canada Notice of Compliance - Pristiq. February 4, 2009, retrieved on March 9, 2009.
11. http://www.aemps.gob.es/cima/especialidad.do?metodo=verPresentaciones&codigo=75561
12. http://www.aemps.gob.es/cima/especialidad.do?metodo=verPresentaciones&codigo=75560
13. https://www.pfizer.es/sobre_pfizer/medicamentos/pristiq.html
14. 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 Spectr 14 (3): 144–54. PMID 19407711.
15. 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". J Clin Psychiatry 70 (10): 1365–71. doi:10.4088/JCP.09m05133blu. PMID 19906341.

External links

• Pfizer's Pristiq site for U.S. residents