The Effect of Dose Titration and Dose Tapering on the Tolerability of Desvenlafaxine in Women with Vasomotor Symptoms Associated with Menopause

Gallagher, J. Christopher; Strzinek, Robert A.; Cheng, Ru Fong J.; Ausmanas, M. K.; Astl, Dorothea; Seljan, Palma

doi:10.1089/jwh.2011.2764

Cited by 19 publications

(19 citation statements)

References 20 publications

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“…Comparisons of Different Discontinuation Methods Two studies evaluated the tolerability of different discontinuation methods after treatment of major depression [7] and vasomotor symptoms in healthy postmenopausal women [36]. After the RCT phase, all treatments were interrupted and a follow-up evaluation was done to evaluate discontinuation symptoms (online suppl.…”

Section: Single Drug At Different Doses Comparisonsmentioning

confidence: 99%

Withdrawal Symptoms after Serotonin-Noradrenaline Reuptake Inhibitor Discontinuation: Systematic Review

Fava

Benasi

Lucente

et al. 2018

Psychother Psychosom

163

146

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Background: Serotonin-noradrenaline reuptake inhibitors (SNRI) are widely used in medical practice. Their discontinuation has been associated with a wide range of symptoms. The aim of this paper is to identify the occurrence, frequency, and features of withdrawal symptoms after SNRI discontinuation. Methods: PRISMA guidelines were followed to conduct a systematic review. Electronic databases included PubMed, the Cochrane Library, Web of Science, and MEDLINE from the inception of each database to June 2017. Titles, abstracts, and topics were searched using a combination of the following terms: “duloxetine” OR “venlafaxine” OR “desvenlafaxine” OR “milnacipran” OR “levomilnacipran” OR “SNRI” OR “second generation antidepressant” OR “serotonin norepinephrine reuptake inhibitor” AND “discontinuation” OR “withdrawal” OR “rebound.” Only published trials in the English language were included. Results: Sixty-one reports met the criteria for inclusion. There were 22 double-blind randomized controlled trials, 6 studies where patients were treated in an open fashion and then randomized to a double-blind controlled phase, 8 open trials, 1 prospective naturalistic study, 1 retrospective study, and 23 case reports. Withdrawal symptoms occurred after discontinuation of any type of SNRI. The prevalence of withdrawal symptoms varied across reports and appeared to be higher with venlafaxine. Symptoms typically ensued within a few days from discontinuation and lasted a few weeks, also with gradual tapering. Late onset and/or a longer persistence of disturbances occurred as well. Conclusions: Clinicians need to add SNRI to the list of drugs potentially inducing withdrawal symptoms upon discontinuation, together with other types of psychotropic drugs. The results of this study challenge the use of SNRI as first-line treatment for mood and anxiety disorders.

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Section: Single Drug At Different Doses Comparisonsmentioning

confidence: 99%

Withdrawal Symptoms after Serotonin-Noradrenaline Reuptake Inhibitor Discontinuation: Systematic Review

Fava

Benasi

Lucente

et al. 2018

Psychother Psychosom

163

146

View full text Add to dashboard Cite

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“…One study found symptoms considered to represent withdrawal in 45% of subjects being treated for panic disorder after 2 or more weeks of discontinuing a variety of SRIs, though without a comparison group involving abrupt or rapid discontinuation [40]. Another trial evaluated withdrawal symptoms after discontinuing desvenlafaxine in older women treated for menopausal vasomotor instability, with randomization to abrupt discontinuation or to various stepwise reductions of doses over 2 weeks; the findings supported a reduction of risk of withdrawal symptoms with more gradual discontinuation [41]. A third study of anxiety disorder patients found that antidepressants could be discontinued, even very slowly over 4 months, in only 37%, and that two-thirds became newly anxious [42].…”

Section: Withdrawal Reactionsmentioning

confidence: 99%

Effects of Treatment Discontinuation in Clinical Psychopharmacology

Baldessarini

Tondo

2019

Psychother Psychosom

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“…A recent published well-written review also concluded that desvenlafaxine at doses of 100 mg have not been shown to cause significant side effects [28]. Furthermore, dose titration improved tolerability of desvenlafaxine 100 mg and resulted in a low rate of discontinuations due to adverse effects [14]. The desvenlafaxine dose should be titrated appropriately to minimize the chance of treatment discontinuation.…”

Section: Discussionmentioning

confidence: 99%

“…Several non-hormonal compounds including clonidine, gabapentin, and some of serotonin and serotonin-norepinephrine reuptake inhibitors have been used for relief of VMS. Desvenlafaxine, a novel serotonin norepinephrine reuptake inhibitor, has been shown to be effective for the treatment of moderate to severe hot flashes associated with menopause [11,12,13,14,15,16,17,18]; however, the results have not been entirely consistent [19]. There have been potential cardiovascular risks associated with the use of desvenlafaxine in this patient population [11].…”

Section: Introductionmentioning

confidence: 99%

Efficacy and Safety of Desvenlafaxine Treatment for Hot Flashes Associated with Menopause: A Meta-Analysis of Randomized Controlled Trials

Sun

Yanqing

Zhang³

2013

Gynecol Obstet Invest

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Vasomotor symptoms, such as daytime hot flashes and nighttime awakenings due to hot flashes, are commonly associated with menopausal women. The aim of this study was to assess desvenlafaxine in moderate to severe hot flashes in postmenopausal women. Electronic databases were searched for relevant randomized controlled trials that compared desvenlafaxine to placebo for postmenopausal women affected with hot flashes. The main outcomes were mean differences (MD) or standardized mean differences (SMD) and 95% confidence interval (CI) for change of the hot flashes. Six randomized controlled trials were identified in the meta-analysis. Pooled change of moderate and severe hot flashes frequency reduced SMD of -0.49 (95% CI -0.91 to -0.07) in desvenlafaxine 100 mg and -0.36 (95% CI -0.54 to -0.19) in desvenlafaxine 150 mg at week 12. Desvenlafaxine 100 mg reduced moderate and severe hot flashes frequency SMD of -0.74 (95% CI -1.05 to -0.44) within 26 weeks. There is no evidence for an increased risk of cardiovascular, cerebrovascular, or hepatic events associated with desvenlafaxine 100 mg/day. The meta-analysis suggests that treatment with desvenlafaxine 100 mg/day is associated with a significant reduction of moderate to severe hot flashes in postmenopausal women. Desvenlafaxine appears both safe and effective for treating hot flushes for up to 12 months.

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The Effect of Dose Titration and Dose Tapering on the Tolerability of Desvenlafaxine in Women with Vasomotor Symptoms Associated with Menopause

Abstract: Titration regimens may improve tolerability of desvenlafaxine 100 mg/d in postmenopausal women with VMS. Taper regimens of desvenlafaxine 50 mg/d-placebo or 50/25-mg/d, were better tolerated than abrupt discontinuation or desvenlafaxine 50 mg given every other day taper regimen.

Cited by 19 publications

References 20 publications

Withdrawal Symptoms after Serotonin-Noradrenaline Reuptake Inhibitor Discontinuation: Systematic Review

Withdrawal Symptoms after Serotonin-Noradrenaline Reuptake Inhibitor Discontinuation: Systematic Review

Effects of Treatment Discontinuation in Clinical Psychopharmacology

Efficacy and Safety of Desvenlafaxine Treatment for Hot Flashes Associated with Menopause: A Meta-Analysis of Randomized Controlled Trials

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