The Pharmacokinetic Profile of PRISTIQ

• Drug is readily available to the systemic circulation — 80% oral bioavailability
• Predictable pharmacokinetic profile regardless of CYP2D6 metabolizer status
• Free (unbound) drug availability to cross the blood-brain barrier — 30% protein binding²
• Neither a substrate nor an inhibitor of P-glycoprotein transporter

PRISTIQ Metabolism

PRISTIQ has a low potential for CYP2D6-mediated drug-drug interactions^2,15

Potential Drug-Drug Interactions with PRISTIQ

• Monoamine oxidase inhibitors (MAOIs) (Contraindicated)

– Do not use with an MAOI or within 14 days of stopping an MAOI.

Allow 7 days after stopping PRISTIQ before starting an MAOI

• Central Nervous System (CNS) active agents; serotonergic agents, antipsychotics, or other dopamine antagonists
• The risk of using PRISTIQ in combination with other CNS-active drugs has not been systematically evaluated. Consequently, caution is advised when PRISTIQ is taken in combination with other CNS-active drugs
• Drugs that may interfere with homeostasis (NSAIDs, aspirin, warfarin, anticoagulants)

– PRISTIQ may increase the risk of bleeding events. Patients should be cautioned about the risk of bleeding associated with the concomitant use of PRISTIQ and NSAIDs, aspirin, or other drugs that affect coagulation

Impact of CYP2D6 status

The Metabolism of PRISTIQ is Independent of the CYP2D6 Pathway
in the Liver²

Data from an open-label, 2-period, parallel-group, crossover study evaluating single doses of
PRISTIQ 50 mg in healthy subjects who are extensive or poor CYP2D6 substrate metabolizers
(N=14). The primary objective was to determine the difference in the pharmacokinetics of
PRISTIQ when influenced by CYP2D6 polymorphism.³

• Each PRISTIQ tablet contains 76 or 152 mg desvenlafaxine succinate equivalent to 50 or 100 mg of desvenlafaxine²
• PRISTIQ has high bioavailability (80%) of the active drug²
• Metabolism primarily by conjugation in the liver and, to a minor extent, through oxidative metabolism²
• PRISTIQ 50 mg delivered predictable desvenlafaxine concentrations regardless of CYP2D6 metabolizer status^2,3
• Desvenlafaxine levels after administration of PRISTIQ were largely unaffected by genetic variability in CYP2D6 metabolism^2,3

Next: Patient Profiles

Please see Full Prescribing Information including Boxed Warning & Medication Guide

PRISTIQ Extended-Release Tablets are indicated for the treatment of major depressive disorder in adults.

Important Safety Information for PRISTIQ

Contraindications

• PRISTIQ is contraindicated in patients with a known hypersensitivity to PRISTIQ or venlafaxine.
• PRISTIQ must not be used concomitantly with an MAOI or within 14 days of stopping an MAOI.  Allow 7 days after stopping PRISTIQ before starting an MAOI.

Warnings and Precautions

• All patients treated with antidepressants should be monitored appropriately and observed closely for clinical worsening, suicidality, and unusual changes in behavior, especially during the first few months of treatment and when changing the dose. Consider changing the therapeutic regimen, including possibly discontinuing the medication, in patients whose depression is persistently worse or includes symptoms of anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia, hypomania, mania, or suicidality that are severe, abrupt in onset, or were not part of the patient's presenting symptoms. Families and caregivers of patients being treated with antidepressants should be alerted about the need to monitor patients. 
• Development of a potentially life-threatening serotonin syndrome or Neuroleptic Malignant Syndrome-like reactions have been reported with SNRIs and SSRIs alone, including PRISTIQ treatment, but particularly with concomitant use of serotonergic drugs, including triptans, with drugs that impair the metabolism of serotonin (including MAOIs), or with antipsychotics or other dopamine antagonists. If concomitant use with a triptan is clinically warranted, careful observation of the patient is advised, particularly during treatment initiation and dose increases. Concomitant use of PRISTIQ with serotonin precursors is not recommended.
• Patients receiving PRISTIQ should have regular monitoring of blood pressure since increases in blood pressure were observed in clinical studies. Pre-existing hypertension should be controlled before starting PRISTIQ. Caution should be exercised in treating patients with pre-existing hypertension or other underlying conditions that might be compromised by increases in blood pressure. Cases of elevated blood pressure requiring immediate treatment have been reported. For patients who experience a sustained increase in blood pressure, either dose reduction or discontinuation should be considered.
• SSRIs and SNRIs, including PRISTIQ, may increase the risk of bleeding events. Concomitant use of aspirin, NSAIDs, warfarin, and other anticoagulants may add to this risk.
• Mydriasis has been reported in association with PRISTIQ; therefore, patients with raised intraocular pressure or those at risk of acute narrow-angle glaucoma (angle-closure glaucoma) should be monitored.
• PRISTIQ is not approved for use in bipolar depression. Prior to initiating treatment with an antidepressant, patients should be adequately screened to determine the risk of bipolar disorder.
• As with all antidepressants, PRISTIQ should be used cautiously in patients with a history or family history of mania or hypomania, or with a history of seizure disorder.
• Caution is advised in administering PRISTIQ to patients with cardiovascular, cerebrovascular, or lipid metabolism disorders. Increases in blood pressure and small increases in heart rate were observed in clinical studies with PRISTIQ. PRISTIQ has not been evaluated systematically in patients with a recent history of myocardial infarction, unstable heart disease, uncontrolled hypertension, or cerebrovascular disease.
• Dose-related elevations in fasting serum total cholesterol, LDL (low density lipoprotein) cholesterol, and triglycerides were observed in clinical studies. Measurement of serum lipids should be considered during PRISTIQ treatment.
• On discontinuation, adverse events, some of which may be serious, have been reported with PRISTIQ and other SSRIs and SNRIs. Abrupt discontinuation of PRISTIQ has been associated with the appearance of new symptoms. Patients should be monitored for symptoms when discontinuing treatment. A gradual reduction in dose rather than abrupt cessation is recommended whenever possible.
• The recommended dose in patients with severe renal impairment or end-stage renal disease (ESRD) is 50 mg every other day. The dose should not be escalated in patients with moderate or severe renal impairment or ESRD.
• Products containing desvenlafaxine and products containing venlafaxine should not be used concomitantly with PRISTIQ.
• Hyponatremia may occur as a result of treatment with SSRIs and SNRIs, including PRISTIQ. Discontinuation of PRISTIQ should be considered in patients with symptomatic hyponatremia.
• Interstitial lung disease and eosinophilic pneumonia associated with venlafaxine (the parent drug of PRISTIQ) therapy have been rarely reported.

Adverse Reactions

• The most commonly observed adverse reactions in patients taking PRISTIQ vs placebo for MDD in short-term fixed-dose premarketing studies (incidence ≥5% and at least twice the rate of placebo in the 50-mg dose group) were nausea (22% vs 10%), dizziness (13% vs 5%), hyperhidrosis (10% vs 4%), constipation (9% vs 4%), and decreased appetite (5% vs 2%).

PQP00126