Hot flashes, or vasomotor symptoms (VMS), are the most common symptom of perimenopause.1 During the menopausal transition, women experience fluctuations in sex hormones produced by the ovaries including estrogen, progesterone, and testosterone. While the exact pathophysiology of hot flashes is still unclear, the proposed mechanism is decreased levels of neurotransmitters in the thermoregulatory center of the hypothalamus. Estrogen withdrawal induces production of hypothalamic norepinephrine and serotonin, which lowers the thermoregulatory threshold and causes greater sensitivity to changes in core body temperature. A small rise in temperature can cause hot flashes: sudden feelings of warmth, perspiration, increased heart rate, and anxiety.1,2
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Desvenlafaxine reaches peak plasma concentrations in 7.5 hours with 80% bioavailability after oral administration. Taking desvenlafaxine with food, especially if high in calorie content, can increase maximal drug concentration (Cmax) by 16% with similar area under the curve (AUC). Its distributive properties include low plasma protein binding (30%) and a volume of distribution of about 3.4 L/kg. Dose adjustments should be made in patients with renal function impairment because elimination of desvenlafaxine is significantly correlated with creatinine clearance. The recommended maximum dose of desvenlafaxine is 100 mg/day for moderate to severe hepatic impairment because there is minor metabolism by the liver via CYP3A4. The approximate half-life elimination is 10 to 11 …show more content…
Like other SNRI antidepressants, there is a black box warning on desvenlafaxine’s package insert stating the medication can increase risk of suicidal ideation. All patients should be closely monitored for changes in these behaviors and development of suicidal thoughts. Desvenlafaxine is rated FDA pregnancy category C with suggestive risk of drug crossing the placenta in animal studies.5 There is also some evidence that desvenlafaxine is excreted in breast milk. Common adverse reactions for desvenlafaxine are nausea, dry mouth, hyperhidrosis, dizziness, and insomnia.5,6 Because SNRIs may impair platelet aggregation due to platelet serotonin depletion, drug interactions may occur when taking desvenlafaxine with antiplatelet agents or SSRIs. Co-administration with other drugs with serotonergic properties may enhance toxic effects and increase risk of serotonin
Desvenlafaxine reaches peak plasma concentrations in 7.5 hours with 80% bioavailability after oral administration. Taking desvenlafaxine with food, especially if high in calorie content, can increase maximal drug concentration (Cmax) by 16% with similar area under the curve (AUC). Its distributive properties include low plasma protein binding (30%) and a volume of distribution of about 3.4 L/kg. Dose adjustments should be made in patients with renal function impairment because elimination of desvenlafaxine is significantly correlated with creatinine clearance. The recommended maximum dose of desvenlafaxine is 100 mg/day for moderate to severe hepatic impairment because there is minor metabolism by the liver via CYP3A4. The approximate half-life elimination is 10 to 11 …show more content…
Like other SNRI antidepressants, there is a black box warning on desvenlafaxine’s package insert stating the medication can increase risk of suicidal ideation. All patients should be closely monitored for changes in these behaviors and development of suicidal thoughts. Desvenlafaxine is rated FDA pregnancy category C with suggestive risk of drug crossing the placenta in animal studies.5 There is also some evidence that desvenlafaxine is excreted in breast milk. Common adverse reactions for desvenlafaxine are nausea, dry mouth, hyperhidrosis, dizziness, and insomnia.5,6 Because SNRIs may impair platelet aggregation due to platelet serotonin depletion, drug interactions may occur when taking desvenlafaxine with antiplatelet agents or SSRIs. Co-administration with other drugs with serotonergic properties may enhance toxic effects and increase risk of serotonin