PRISTIQ® (desvenlafaxine) Switching patients between Pristiq® and other antidepressants

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Discontinuation symptoms have been reported when switching patients from other antidepressants, including venlafaxine to desvenlafaxine. Tapering of the initial antidepressant followed by a washout period may be necessary to minimise discontinuation symptoms and the possibility of drug-drug interactions from a pharmacokinetic or pharmacodynamic perspective.1

Pfizer does not have any specific recommendations with regards to switching patients between antidepressants, including to/from Pristiq.1

You may wish to refer to tertiary references to assist in your clinical decision. For your reference, an antidepressant changeover guide from the Australian Medicines Handbook2 has been provided below.

Antidepressant Changeover Guide2

© Australian Medicines Handbook 2018

Drug#Recommendation*Rationale
Category A changeover
fluoxetine, phenelzine, tranylcypromine, vortioxetine
  • gradual withdrawal generally unnecessary; withdrawal symptoms very unlikely
  • wait for at least 14 days before starting next antidepressant (may be up to 5 weeks with fluoxetine)
  • consider hospitalisation during washout/changeover if severely depressed
drug (or metabolites) with long half-life or persistent effects
Category B changeover
TCAs, SSRIs (except fluoxetine), mianserin, mirtazapine
  • withdraw gradually to prevent withdrawal symptoms (particularly if higher dose or long-term use); usually reduce dose by 25% per day
  • wait for 2-4 days before starting next antidepressant
  • consider hospitalisation during washout/changeover if severely depressed
  • mianserin: withdrawal symptoms rare
drug (or metabolites) with intermediate half-life of 24-48 hours
Category C changeover
agomelatine, moclobemide, reboxetine, SNRIs
  • SNRIs: withdraw gradually to prevent withdrawal symptoms
  • agomelatine, moclobemide, reboxetine: withdrawal symptoms not reported or rare
  • wait for 1-2 days before starting next antidepressant (agomelatine can be started immediately if switching from an SSRI to SNRI)
drug (or metabolites) with short half-life of <18 hours
# consider any interaction between the drug being stopped and the new drug; this may affect the changeover period
* interval before starting next antidepressant may differ from that recommended by other sources, eg product information

REFERENCES

  1. Pristiq®(desvenlafaxine) Product Information
  2. Antidepressant changeover guide (last modified Jul 2018). Australian Medicines Handbook 2018 [online]. Adelaide: Australian Medicines Handbook Pty Ltd; 2018 July. Available from: https://amhonline.amh.net.au/