Venlafaxine (EFFEXOR) is a serotonin and noradrenaline reuptake inhibitor (SNRI) that is indicated for major depressive disorder (MDD), generalized anxiety disorder, social anxiety disorder, and panic disorder with or without agoraphobia.
Desvenlafaxine (PRISTIQ) meanwhile is a synthetic succinate version of venlafaxine’s major active metabolite, although its approval is limited to MDD.
#venlafaxine #desvenlafaxine #effexor #pristiq #antidepressants
Dr Sanil Rege explains the difference between the two.
1. Venlafaxine sequentially inhibits Serotonin transporter (SERT) and Noradrenaline Transporter (NAT).
2. Venlafaxine has a 30-fold higher affinity for the reuptake of serotonin over noradrenaline whilst desvenlafaxine has a 10-fold affinity
3. Venlafaxine at its minimal effective dose in depression (75 mg/d), venlafaxine acts as a selective 5-HT reuptake inhibitor. In contrast, when administered at higher doses (225 and 375 mg/d), it acts as a dual 5-HT and NE reuptake inhibitor exhibiting dose-dependent pharmacology in relation to efficacy and tolerability.
4. The sequential inhibition of serotonin and NA is reflected in its side effect profile—that initial side effects are predominantly related to serotonin (e.g., headaches, nausea, fatigue, sexual dysfunction). In contrast, subsequent side effects with higher dosing are related to serotonin and norepinephrine (e.g., activation effects, dry mouth, night sweats).
5. Desvenlafaxine, on the other hand, blocks the serotonin and norepinephrine reuptake at starting doses.
Both Venlafaxine and desvenlafaxine have applications in a range of disorders beyond depression and anxiety.
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