Effects of desvenlafaxine on the pharmacokinetics of desipramine in healthy adults

Int Clin Psychopharmacol. 2013 Mar;28(2):99-105. doi: 10.1097/YIC.0b013e32835c1f49.

Abstract

The results of two single-center, two-period, open-label trials that evaluated the effects of multiple doses of desvenlafaxine on the pharmacokinetics of desipramine, a cytochrome P450 (CYP) 2D6 enzyme substrate, are presented. Healthy individuals aged 18-45 years were administered a single oral dose of 50 mg desipramine with and without 100 mg daily (n=34) or 400 mg daily (n=23) desvenlafaxine for 5 days. After coadministration of 100 mg desvenlafaxine, desipramine exposure, measured by peak plasma concentration (C(max)) and total area under the plasma concentration-versus-time curve (AUC), showed minimal increases of 25 and 17%, respectively; coadministration of 400 mg desvenlafaxine resulted in a 52% increase in desipramine C(max) and a 90% increase in AUC. For the 100 mg dose, the geometric least squares mean ratios and 90% confidence intervals (CIs) for desipramine AUC (117%; 90% CI 110-125%), 2-hydroxydesipramine AUC (114%; 90% CI 110-119%), and C(max) (110%; 90% CI 104-116%) were all within the 80-125% interval, showing the bioequivalence for AUC between desipramine administered alone and in combination with 100 mg desvenlafaxine. These results indicate that desvenlafaxine is a relatively weak inhibitor of CYP2D6 and that desvenlafaxine 100 mg, twice the recommended therapeutic dose of 50 mg, is unlikely to cause drug-drug interactions with CYP2D6 substrates.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Antidepressive Agents / administration & dosage
  • Antidepressive Agents / adverse effects*
  • Antidepressive Agents, Tricyclic / adverse effects
  • Antidepressive Agents, Tricyclic / blood
  • Antidepressive Agents, Tricyclic / pharmacokinetics*
  • Antidepressive Agents, Tricyclic / urine
  • Biological Availability
  • Cyclohexanols / administration & dosage
  • Cyclohexanols / adverse effects*
  • Cytochrome P-450 CYP2D6 / genetics
  • Cytochrome P-450 CYP2D6 / metabolism
  • Cytochrome P-450 CYP2D6 Inhibitors
  • Desipramine / adverse effects
  • Desipramine / analogs & derivatives
  • Desipramine / blood
  • Desipramine / pharmacokinetics*
  • Desipramine / urine
  • Desvenlafaxine Succinate
  • Dose-Response Relationship, Drug
  • Drug Interactions
  • Enzyme Inhibitors / administration & dosage
  • Enzyme Inhibitors / adverse effects
  • Female
  • Half-Life
  • Humans
  • Male
  • Metabolic Clearance Rate
  • Metabolic Detoxication, Phase I
  • Middle Aged
  • Neurotransmitter Uptake Inhibitors / administration & dosage
  • Neurotransmitter Uptake Inhibitors / adverse effects*
  • Polymorphism, Genetic
  • Young Adult

Substances

  • Antidepressive Agents
  • Antidepressive Agents, Tricyclic
  • Cyclohexanols
  • Cytochrome P-450 CYP2D6 Inhibitors
  • Enzyme Inhibitors
  • Neurotransmitter Uptake Inhibitors
  • Cytochrome P-450 CYP2D6
  • Desipramine
  • 2-hydroxydesipramine
  • Desvenlafaxine Succinate