Is Desvenlafaxine A Tricyclic Antidepressant? (+5)
By
Ivan Kahwa
Author bio
Mr Ivan Kahwa is a chemist and phytopharmaceutical scientist with expertise in chemistry, pharmacology, phytochemistry, and Nanobiotechnology. He writes and reviews content on these topics.
Mr Ivan Kahwa’s Highlights:
Guest Researcher at the University of Leipzig, Senior Research Fellow/Scientist, and Lecturer at the Department of Pharmacy, Faculty of Medicine, Mbarara University of Science and Technology.
Professional Experience:
Mr Ivan joined PHARMBIOTRAC as a research fellow/scientist during his master of science tenure. He contributed to the development of most of the phytopharmaceutical products in the project. Furthermore, he participated in carrying out the pharmacological activities of the developed products in laboratory animals such as mice and rats in order to develop proper doses hence leading to pre-clinical studies.
With the above relevant research experience, Ivan started to work with the University of Leipzig on collaborative projects with Mbarara University to develop the chemistry of Ugandan Medicinal plants and their pharmacological activities. This was coupled with several consultative positions by different German NGOs. Mr. Kahwa is also a supporting in the teaching and learning at the Departments of Pharmacy and Pharmaceutical Sciences, Faculty of Medicine, Mbarara University of Science and Technology.
With the increase in antimicrobial resistance globally, Ivan retooled his thinking towards developing new naturally derived antibiotic regimens from Ugandan propolis with the assistance of nanotechnology to improve their delivery to microbial cells. Kahwa has also published over 28 articles in peer-reviewed journals and he is currently reviewing for many journals.
Education:
2023-2027: PhD in Pharmaceutical Sciences (ongoing) with a focus on Pharmaceutical Microbiology and Nanobiology at Mbarara University of Science and Technology.
2022: 2Msc. in Pharmacognosy and Natural Medicine Science at Mbarara University of Science and Technology.
2018: Bachelor of Science (Chemistry) at Mbarara University of Science and Technology.
Publications:
▪ Iqbal, S., Jabeen, F., Kahwa, I., & Omara, T. 2023. Suberosin Alleviates Thiazolidinedione-Induced Cardiomyopathy in Diabetic Rats by Inhibiting Ferroptosis via Modulation of ACSL4-LPCAT3 and PI3K-AKT Signaling Pathways. Cardiovascular Toxicology. https://doi.org/10.1007/s12012-023-09804-7
▪ Gupta, A. K., Yadav, R., Sharma, S., Sawale, J., & Kahwa, I. 2023. Anti-ageing Activity and Antioxidant Activity of Methanol Extracts of Leaves and Flowers of Salvia officinalis and Rosmarinus officinalis. Journal of Young Pharmacists, 15(3), 448–455. https://doi.org/10.5530/jyp.2023.15.60
▪ Tolo, C.U., Kahwa, I., Nuwagira, U., Weisheit, A. and Ikiriza, H., 2023. Medicinal plants used in treatment of various diseases in the Rwenzori Region, Western Uganda. Ethnobotany Research and Applications, 25, pp.1-16.
https://ethnobotanyjournal.org/index.php/era/article/view/4683
▪ Kahwa, I., Ajayi, C.O., Yadav, R., Chauhan, N.S., Shah, K., Abdelgadir, A.A., Shegena, E.A., Daniel, S., Omara, T., Asiimwe, J.B. and Ikiriza, H., 2023. Pharmacognostic and phytochemical studies as an invaluable approach for correct identification of medicinal plants: The case of Artemisia vulgaris L. substituted for Artemisia annua L. in Western Uganda. TMR Integr Med, 7, p.e23004.
https://doi.org/10.53388/TMRIM202307004
▪ Nalimu, F., Oloro, J., Kahwa, I. and Ogwang, P.E., 2021. Review on the phytochemistry and toxicological profiles of Aloe vera and Aloe ferox. Future Journal of Pharmaceutical Sciences, 7, pp.1-21.
https://doi.org/10.1186/s43094-021-00296-2
▪ Elamin, O.H.S., Ali, M.A., Elgezuli, I.A.A., Bashir, M.A. and Kahwa, I., 2021. Diagnosis of pre-and post-treatment of echinococcus granulosus with counter current immune electrophoresis and bacterial co-agglutination. Journal of Microbiology and Infectious Diseases, 11(02), pp.88-94.
https://doi.org/10.5799/jmid.951600
Published book Chapter
▪ Kahwa, I., Ayesiga, I., Nakalema, S., Alinaiswe, R., Mbabazi, R. and Iqbal, S., 2023. Natural products in the management of onchocerciasis. In Natural Products in Vector-Borne Disease Management (pp. 63-80). Academic Press. Book Chapter.
https://doi.org/10.1016/B978-0-323-91942-5.00012-4
Submitted manuscripts Under Review:
▪ Comparison of the Wound Healing Activity of the Leaf and Leaf Ash Extracts of Vernonia amygdalina in Rats. Journal name: Clinical Phytoscience
▪ Ethnobotanical Survey of Medicinal plants used in the management of cancer in Uganda. Journal name: Journal of Herbal Medicine
▪ Ethnobotanical survey and phytochemical screening of medicinal plants used in treatment of epilepsy by PROMETRA-Uganda Traditional Health Practitioners in Mpigi District, Uganda. Journal name: Journal of Ethnopharmacology
Submitted book chapters under review
1.Book title: Algae as a Natural Solution for Water-Food-Energy Nexus, Section 4: Microalgae and cyanobacteria for food applications, Chapter 4.6: Safety, toxicological and allergenic aspects of using algae for food. Authors: Christine Kyarimpa, Tom Omute, Caroline K. Nakiguli, Alice V. Khanakwa4, Christopher Angiro, Ivan Kahwa, Fortunate Ahumuza, Timothy Omara*. Publisher: Springer Nature Singapore Pte Ltd. 152 Beach Road, #21-01/04 Gateway East, Singapore 189721, Singapore.
2.Book title: Nutraceuticals Inspiring the Contemporary Therapy for Lifestyle Diseases. Chapter: Nutraceutical applications of Seaweeds and their Phytocompounds in Nutrition and Treatment of Diseases. Authors: Ivan Kahwa, Timothy Omara , Innocent Ayesiga , Gael Noel Neh Neba Ambe , Zehbanaz Javidbhai Panwala , Rachel Mbabazi , Shabnoor Iqbal , Christine Kyarimpa , Christine Betty Nagawa , Kamal Shah ,Nagendra Singh Chauhan* Publisher: CRC Press
You can view my works on the following professional sites:
Research Gate: https://www.researchgate.net/profile/Ivan-Kahwa
Google Scholar: https://scholar.google.com/citations?user=tOwrvqoAAAAJ&hl=en
ORCID: https://orcid.org/0000-0002-6440-3437
Linkedin: https://de.linkedin.com/in/ivan-kahwa-865450159
In this article, we will discuss whether desvenlafaxine is a tricyclic antidepressant. We will also discuss how desvenlafaxine differs from tricyclic antidepressants and share some related information.
Is Desvenlafaxine A Tricyclic Antidepressant?
No, desvenlafaxine is not a tricyclic antidepressant (TCA). Desvenlafaxine is a serotonin-norepinephrine reuptake inhibitor (SNRI). TCAs and SNRIs are a class of antidepressants that are FDA-approved to treat major depressive disorder (MDD).
Although desvenlafaxine and TCA drugs are antidepressants, they differ in their mechanism of action, pharmacology, and indications. Additionally, SNRIs like desvenlafaxine are known to have fewer side effects than TCAs.
How Do Desvenlafaxine and TCAs Differ?
Desvenlafaxine and TCAs are different in the following aspects:
Mechanism of Action:
The mechanism of action of desvenlafaxine is to block the reuptake of serotonin and norepinephrine (NE) thereby increasing their concentration in the brain. It is ten times more selective for serotonin and thus, has a stronger affinity for serotonin than NE (1).
TCAs affect 5 neurotransmitter pathways. Like SNRIs, it blocks serotonin and NE reuptake, which elevates their level in the brain. Additionally, they block muscarinic, histamine (H1), and alpha 1 and alpha 2 adrenergic receptors (2).
Indications:
Desvenlafaxine is approved by the FDA to treat MDD (1). It is preferred in patients who have pain disorders along with MDD (3). Off-label, it has been used to manage hot flashes in menopausal women in cases where estrogen can’t be prescribed (1).
TCAs include different drugs and some of them are FDA-approved for MDD. Due to their heightened side effects, TCAs are not the primary choice for MDD. One of the TCAs, clomipramine, is FDA-approved for obsessive-compulsive disorder (2).
TCAs are used off-label to manage a variety of conditions which include (2):
- preventing migraines
- anxiety
- OCD
- insomnia
- neuropathic pain
- fibromyalgia (second-line)
Side effects:
Desvenlafaxine is generally safe and well-tolerated. Unlike TCAs, it does not cause anticholinergic, cardiotoxic, or antihistamine side effects (4). Its common side effects include (1).
- nausea
- dry mouth
- stomach pain
- reduced appetite
- headache
- dizziness
- sweating
As TCAs affect different neurotransmitters, they cause several adverse effects (2).
| Anticholinergic effects | blurry vision, increased heart rate, confusion, urinary retention, constipation, and xerostomia |
| Antihistamine effects | sedation, increased appetite, increased weight, and confusion |
| Antiadrenergic effects | orthostatic hypotension and dizziness |
Additionally, TCAs can also lead to heart-related side effects, especially in individuals with ischemic heart disease. They include QT prolongation, irregular heart rhythms, and sudden cardiac death (2).
Metabolism and Elimination:
Desvenlafaxine is metabolized in the liver and eliminated through the kidney. In its metabolism, CYP enzymes are not majorly involved thus drug-drug interactions are not a major concern. 45% of the drug remains unchanged when excreted (1).
TCAs are metabolized in the liver through the major involvement of CYP enzymes. It is excreted through the kidneys and only 5% of the drug is eliminated unchanged. Drug-drug interactions are a concern with TCAs (2).
Dosage Forms:
Desvenlafaxine is only available as tablets and taken orally. It comes as an extended-release (ER) formulation and the available strengths include 25 mg, 50 mg, and 100 mg (1).
The standard route of administration for TCAs is the oral route although IV and topical administration have been studied as well. It comes in the form of tablets, capsules, and solutions (2).
Can You Take Desvenlafaxine and TCAs Together?
Taking Desvenlafaxine and TCAs together is not recommended due to the increased risk of serotonin syndrome. Serotonin syndrome is a rare condition but its risk is elevated with the concomitant use of these drugs (1).
Serotonin syndrome is dangerous and has a high mortality rate. Symptoms of serotonin syndrome include (1)
- increased heart rate
- excessive saliva production
- hyperactive bowel sounds
- pupil dilation
- hyperthermia
- excessive sweating
Desvenlafaxine or TCA: Which one is more safe?
Although the safety and tolerability of a drug varies depending on the individual responses, desvenlafaxine is considered safer than TCA as it produces fewer side effects and has a lesser chance of drug-drug interactions.
Literature suggests that desvenlafaxine is effective at doses ranging from 50 mg to 400 mg. When used alone, it is rarely lethal (1) and generally safe and well-tolerated (5). Its side effects gradually reduce after the first week of treatment (5).
TCAs have a narrow therapeutic index and the chance of drug overdose is higher in these drugs. TCAs are associated with significant drug-drug interactions. They cause various adverse effects and close monitoring of patients is needed (2).
Thus, desvenlafaxine is considered safer than TCAs. SNRIs like desvenlafaxine and SSRIs (selective serotonin reuptake inhibitors) are considered primarily for the treatment of MDD. TCAs are considered as a secondary or alternative option (2).
It is important to remember that the choice of drug is made by your healthcare provider based on individual symptoms, medical history, and individual needs. Therefore you must communicate with your healthcare provider to discuss the treatment options.
In my understanding, desvenlafaxine is not a tricyclic antidepressant. It is a serotonin-norepinephrine reuptake inhibitor and differs significantly from TCAs in terms of mechanism of action, side effects, pharmacology, and safety profile. Desvenlafaxine is generally well-tolerated and considered safer than TCAs due to its fewer side effects.
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References
1.-
Naseeruddin R, Rosani A, Marwaha R. Desvenlafaxine. [Updated 2023 Jul 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK534829/
2.-
Moraczewski J, Awosika AO, Aedma KK. Tricyclic Antidepressants. [Updated 2023 Aug 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557791/
3.-
Bains N, Abdijadid S. Major Depressive Disorder. [Updated 2023 Apr 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559078/
4.-
Westenberg HG. Pharmacology of antidepressants: selectivity or multiplicity? J Clin Psychiatry. 1999;60 Suppl 17:4-8; discussion 46-8. PMID: 10446734.
5.-
Liebowitz MR, Tourian KA. Efficacy, safety, and tolerability of Desvenlafaxine 50 mg/d for the treatment of major depressive disorder:a systematic review of clinical trials. Prim Care Companion J Clin Psychiatry. 2010;12(3):PCC.09r00845. doi: 10.4088/PCC.09r00845blu. PMID: 20944767; PMCID: PMC2947544.
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