Desvenlafaxine succinate (DVS) Controlled-Release Tablets
Educating elderly patients new to DVS: safety guide for Australian Nurses
Class: Serotonin-noradrenaline reuptake inhibitor (SNRI) antidepressant
Brand name: Pristiq®
Indications
Symptomatic treatment of major depressive disorder.1
Pharmacology
Pharmacodynamics (PD): DVS prolongs the action of serotonin (5-HT) and noradrenaline (NA) in the central-nervous-system (CNS) by selectively binding to synaptic reuptake transporters.2-4 (See fig 1).5 5-HT and NA are powerful neurotransmitters that regulate mood and mental wellbeing.3
Pharmacokinetics (PK): Well absorbed in the gastrointestinal tract, metabolised in the liver and excreted in the urine. 1-2,4 The average PK parameters of DVS with once-daily dosing are1,4:
Note: Clearance rates are reduced in elderly patients with renal and/or hepatic dysfunction, resulting in an increased t1/2 and overexposure to DVS1-4,6 (see Dosage Considerations and Adverse Effects).
Dosage
• 50 mg once daily, swallowed whole with water. Not to be crushed, cut, dissolved or chewed, as this will modify the timed-release mechanism, reducing efficiency and causing adverse effects.
• To be taken at the same every day to sustain a therapeutic steady state (devise a routine that works best with the patient as to maintain compliance e.g. after brushing teeth at night).
Dosage Considerations
• Abruptly increasing or decreasing dose causes adverse effects, due to slow CNS
Dosages of the drug vary from one extreme to another based upon the patients needs.
That is, a minimum of 2 capsules should be taken with meal and enough water, according to its manufacturer. This should be up to a 6 months course for best results.
For adults and children 12 years of age and older, the recommended dosage is 0.63 mg three times daily, given every 6 to 8 hours (maximum 1.25 mg three times a day).
It is mixed with about 4 ounces of liquid before you, the person for whom it is prescribed, drink it. The full amount needs to be ingested within two minutes. Because the medication has a rather bitter taste, have a small glass of a delicious tasting liquid handy to cleanse your palate after drinking the entire amount of life-ending medication. (Death With Dignity)
2 times daily with water after meals and 4 capsules each time. No, we recommend you take at least 4 capsules per serving.
This class of medication works by increasing the amount of Serotonin in the brain to help maintain a balance (Preston & et al, 2013).
For adults – take one or two quick release capsules daily, preferably with a meal.
Naltrexone is available in two formulations: a 50 mg daily oral tablet (ReVia®, others) and a 380 mg extended-release once-monthly intramuscular injection (Vivitrol®). Unlike
pill a day. Using that high of a dosage may cause the patient to become addicted. If the patient
The oral dosage would be 6 - 10 mg/kg PO (mixed in cola or other beverage) given 30 minutes before procedure.
After getting accommodated with the drug, 20 mcg may be increased. However, raising the dosage should be gradually done after keenly monitoring the body reactions.
Age plays an important factor when considering prescribing drugs as the very young and the elderly will have difficulty with the metabolism and excretion of drugs. Even the healthiest of the ageing population will have a degree of renal impairment which delays excretion through the kidneys, increasing the duration of action. However when dealing with an acute illness, which are the patients I encounter, a further and rapid reduction in clearance will exacerbate this process. Liver function may also be impaired during acute illness resulting in delayed drug metabolism (Beckworth & Franklin, 2007). Therefore, before any prescribing can take place a diagnosis must be accurately made and underpinned by an understanding of basic pathophysiology eg, a recent review of bloods to assess renal
b.ii. The dosage will depend on the age, weight, and other health issues of the person.
Serotonin (5-hydroxytryptamine, 5-HT) is a neurotransmitter in the brain that has an enormous influence over many brain functions. It is synthesized, from the amino acid L-tryptophan, in brain neurons and stored in vesicles. Serotonin is found in three main areas of the body: the intestinal wall; large constricted blood vessels; and the central nervous system. The most widely studied effects have been those on the central nervous system. The functions of serotonin are numerous and appear to involve control of appetite, sleep, memory and learning, temperature regulation, mood, behavior (including sexual and hallucinogenic behavior), cardiovascular function, muscle contraction, endocrine regulation, and
2000mg/day. If doses >2000mg/day are required, give in 3 divided doses (not to exceed 2500mg/day)