Desvenlafaxine XR (brand names: Pristiq, Khedezla, Desfax, Ellefore) is a serotonin-norepinephrine reuptake inhibitor (SNRI) antidepressant. It is the active metabolite of Venlafaxine (Effexor XR). Desvenlafaxine XR is FDA-approved to treat:

• Major Depressive Disorder (MDD) in adults

It is also used off-label for:

• Menopausal hot flashes (vasomotor symptoms)
• Generalized anxiety disorder
• Neuropathic pain
• Fibromyalgia

The recommended dose is 50 mg once daily, taken with or without food. Tablets must be swallowed whole — do not split, chew, crush, or dissolve them. Desvenlafaxine XR should not be stopped abruptly; your doctor will taper the dose gradually to avoid withdrawal symptoms.

Desvenlafaxine XR works by inhibiting the reuptake of two key neurotransmitters in the brain: serotonin and norepinephrine. By blocking the reabsorption of these chemicals back into nerve cells, Desvenlafaxine increases their availability in the brain. This helps regulate mood, reduce feelings of depression, and restore emotional balance. As the active metabolite of Venlafaxine, Desvenlafaxine does not require the same liver enzyme conversion, which may result in more predictable blood levels and fewer drug interactions for some patients.

• Desvenlafaxine Succinate ER Tablets: 25 mg, 50 mg, 100 mg
• Desvenlafaxine Fumarate ER Tablets (Khedezla): 50 mg, 100 mg

Desvenlafaxine XR receives a findability score of 75 out of 100, placing it in the good range. Generic Desvenlafaxine ER tablets (50 mg) are widely manufactured and stocked at most pharmacies across the country, making the standard dose easy to locate. However, less common strengths like 25 mg and 100 mg may occasionally be harder to find at some pharmacies due to lower demand and intermittent generic manufacturer supply chain disruptions. Brand-name Pristiq is also generally available but at a significantly higher cost. If you're having trouble locating your specific dose or formulation, Medfinder can help you search nearby pharmacies with current stock.

Desvenlafaxine XR is most commonly prescribed by:

• Psychiatrists — for major depressive disorder and treatment-resistant depression
• Primary care physicians and family medicine doctors — often the first prescribers for depression
• Internal medicine physicians
• OB/GYNs — particularly for off-label management of menopausal hot flashes
• Pain management specialists — for neuropathic pain and fibromyalgia

Desvenlafaxine XR is also available through telehealth platforms, making it accessible for patients who may not have easy access to a specialist.

No, Desvenlafaxine XR is not a controlled substance. It does not have a DEA schedule classification, which means it can be prescribed with standard refills and does not carry the same regulatory restrictions as medications like benzodiazepines or stimulants. Your doctor can prescribe it freely, and pharmacies can dispense it without additional DEA reporting requirements.

Like all medications, Desvenlafaxine XR can cause side effects. The most commonly reported include:

• Nausea — the most frequent side effect, especially when starting treatment
• Dizziness
• Insomnia
• Constipation
• Excessive sweating (hyperhidrosis)
• Decreased appetite
• Drowsiness or somnolence
• Sexual dysfunction (decreased libido, erectile dysfunction, delayed ejaculation, anorgasmia)
• Dry mouth
• Fatigue

Serious side effects to watch for include serotonin syndrome, increased blood pressure, abnormal bleeding, hyponatremia (low sodium), angle-closure glaucoma, seizures, and mania or hypomania activation. Desvenlafaxine XR carries a boxed warning: antidepressants may increase the risk of suicidal thinking and behavior in children, adolescents, and young adults under 25 years of age. Patients should be monitored closely, especially during the first few months of treatment or when doses change. Contact your doctor immediately if you experience any serious side effects.

If Desvenlafaxine XR isn't the right fit, there are several alternative SNRI and antidepressant medications your doctor may consider:

• Venlafaxine XR (Effexor XR) — The parent compound of Desvenlafaxine. Used for depression, generalized anxiety disorder, social anxiety disorder, and panic disorder. Available in a wider range of doses.
• Duloxetine (Cymbalta) — An SNRI used for depression, anxiety, diabetic neuropathy, fibromyalgia, and chronic musculoskeletal pain. More versatile for pain-related conditions.
• Levomilnacipran (Fetzima) — An SNRI with greater selectivity for norepinephrine reuptake inhibition. Used for major depressive disorder.
• Milnacipran (Savella) — An SNRI primarily approved for fibromyalgia that also has antidepressant properties.

Always discuss alternatives with your prescribing doctor, as the best choice depends on your specific diagnosis, medical history, and treatment goals.

Yes, Desvenlafaxine XR has several important drug interactions:

• MAO inhibitors (Phenelzine, Tranylcypromine, Selegiline) — Do not use within 14 days of an MAOI. Risk of potentially fatal serotonin syndrome.
• Other serotonergic drugs (SSRIs, other SNRIs, Triptans, Tramadol, Lithium, Buspirone, Fentanyl) — Increased risk of serotonin syndrome.
• Linezolid and IV Methylene Blue — Contraindicated due to serotonin syndrome risk.
• Anticoagulants and antiplatelet drugs (Warfarin, Aspirin, NSAIDs) — Increased bleeding risk.
• CYP3A4 inhibitors (Ketoconazole) — May increase Desvenlafaxine levels.
• CYP2D6 substrates (Desipramine, Metoprolol) — Desvenlafaxine may increase their levels.

You should also avoid alcohol, which increases CNS depression and sedation risk, and avoid St. John's Wort and Tryptophan supplements, which increase the risk of serotonin syndrome. Always inform your doctor and pharmacist of all medications and supplements you take.

Desvenlafaxine XR is a well-established SNRI antidepressant that offers a straightforward once-daily dosing regimen at a fixed 50 mg dose for most patients. Generic Desvenlafaxine ER is affordable — as low as $15–$45 per month with a discount card — and is widely available at most pharmacies. As the active metabolite of Venlafaxine, it offers more predictable metabolism for patients who may have difficulty with Effexor XR. While the standard 50 mg strength is easy to find, patients needing 25 mg or 100 mg tablets may occasionally encounter availability issues. If you're having difficulty locating Desvenlafaxine XR at your local pharmacy, Medfinder can help you search pharmacies near you with current availability. Talk to your doctor about whether Desvenlafaxine XR is right for your treatment plan, and never stop taking it abruptly without medical guidance.