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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by bearfan on April 19, 2009, at 5:06:45
Now out for over a year, what is the generally consensus of Pristiq? I've heard/read mixed results from it. Is it truly an advance or just a 'Me too' Effexor?
Posted by Larry Hoover on April 19, 2009, at 8:30:04
In reply to Has Pristiq proven to be clinically useful?, posted by bearfan on April 19, 2009, at 5:06:45
> Now out for over a year, what is the generally consensus of Pristiq? I've heard/read mixed results from it. Is it truly an advance or just a 'Me too' Effexor?
Just like any antidepressant, individual differences determine whether there will be a benefit, or not. It's no more nor no less effective than any other antidepressant in general use.
I wish the idea that this is a patent extender would go away. Desvenlafaxine is a specific active metabolite of venlafaxine. It's believed to be responsible for the bulk of the antidepressant effect of venlafaxine. The side effects are mostly produced by other metabolites. In simplified terms.
Desvenlafaxine is produced by the liver enzyme 2D6. Many people have impaired activity at that enzyme. Some have none at all. The last time I checked, 118 genetic variants of that enzyme had been identified, with the majority of those leading to poor or no activity.
So, for those individuals, Pristiq offers an opportunity for treatment success that could not have been provided by Effexor. And, the theory is that it will be easier to withdraw from than Effexor, which is notorious for being difficult in that regard.
Time will tell. We don't have a lot of experiential data yet.
Lar
Posted by TriedEveryDrug on April 19, 2009, at 10:31:01
In reply to Re: Has Pristiq proven to be clinically useful? » bearfan, posted by Larry Hoover on April 19, 2009, at 8:30:04
Larry,
Do you know if Desvenlafaxine inhibits 2d6 at all? I know it is metabolized by 3A4.
in addition to being metabolized by 2d6, venlafaxine itself had an inhibitory effect, for instance desipramine AUC is raised 4.5 fold by 75mg of venlafaxine.
I've been interested in a desipramine/venlafaxine combo, but the decreased metabolism of desipramine had me worried. Maybe pristiq is the ticket.
Though epocrates claims there is an interaction. Maybe their data are wrong.
Thanks
>
> I wish the idea that this is a patent extender would go away. Desvenlafaxine is a specific active metabolite of venlafaxine. It's believed to be responsible for the bulk of the antidepressant effect of venlafaxine. The side effects are mostly produced by other metabolites. In simplified terms.
>
> Desvenlafaxine is produced by the liver enzyme 2D6. Many people have impaired activity at that enzyme. Some have none at all. The last time I checked, 118 genetic variants of that enzyme had been identified, with the majority of those leading to poor or no activity.
>
> So, for those individuals, Pristiq offers an opportunity for treatment success that could not have been provided by Effexor. And, the theory is that it will be easier to withdraw from than Effexor, which is notorious for being difficult in that regard.
>
> Time will tell. We don't have a lot of experiential data yet.
>
> Lar
>
>
Posted by linkadge on April 19, 2009, at 10:52:35
In reply to Re: Has Pristiq proven to be clinically useful? » bearfan, posted by Larry Hoover on April 19, 2009, at 8:30:04
I disagree. Some antidepressants are less effecive than others, and pristiq is a patent extender (but, thats not to say it won't be effective for you)
Linkadge
Posted by Zana on April 19, 2009, at 10:57:08
In reply to Re: Has Pristiq proven to be clinically useful? » Larry Hoover, posted by TriedEveryDrug on April 19, 2009, at 10:31:01
Pristiq had been really good for me so far. I've only been on it a couple of weeks. But I have been on Effexor and every other SSRI and they all either pooped out or made me agitated. I can't even tell I'm Prisiq except that I am not really depressed right now and I'm anorgasm- major drag. I'm hoping that is due to low estrogen levels. I wouldn't know for sure until I've increased my estrogen for a few weeks.
I think Pristiq is worth a try. I am taking it with a lot of other stuff, like remeron and seroquel and klonopin and provigi. It's possible the remeron or the seroquel are keeping me from getting agitated. Won't know until I try decreasing them. But I'm not sure what to do next. I'm kind of feeling "if it's not broke don't fix it." On the other hand, I am still feeling more anxiety than I would like and I'd like to be taking less meds, especially seroquel because of the long term side effects.
Hope this helps.Zana
Posted by Phillipa on April 19, 2009, at 12:28:31
In reply to Re: Has Pristiq proven to be clinically useful?, posted by Zana on April 19, 2009, at 10:57:08
Anyone got a magic wand the perfect pill or none at all? I'm sorry I'm in panic mode at the moment got to keep my fingers busy. Phillipa
Posted by sowhysosad on April 19, 2009, at 13:46:22
In reply to Re: Has Pristiq proven to be clinically useful? » bearfan, posted by Larry Hoover on April 19, 2009, at 8:30:04
Yeah, there are clearly people benefitting from Pristiq that couldn't tolerate Effexor. Just because it's a patent-extending, profit-maximising exercise by Wyeth, it doesn't necessarily follow that the resulting product is worthless or of dubious quaity.
Perhaps "capitalist business practices = EVIL" in some people's minds. Sure, the quest for profit does lead to some unethical behaviour amongst the drug companies, but it drives innovation too.
As I mentioned elsewhere, the UK health service (so they don't have to subsidise an on-patent drug) claim that there's no qualitative difference between citalopram and escitalopram, but escitalopram is obviously better for many people. The subtext is "oh it's a patent-extender so it must be bogus".> I wish the idea that this is a patent extender would go away. Desvenlafaxine is a specific active metabolite of venlafaxine. It's believed to be responsible for the bulk of the antidepressant effect of venlafaxine. The side effects are mostly produced by other metabolites. In simplified terms.
Posted by Larry Hoover on April 19, 2009, at 15:13:46
In reply to Re: Has Pristiq proven to be clinically useful? » Larry Hoover, posted by TriedEveryDrug on April 19, 2009, at 10:31:01
> Larry,
>
> Do you know if Desvenlafaxine inhibits 2d6 at all? I know it is metabolized by 3A4.Yes. It must inhibit it, as it's a substrate for the enzyme. Products of enzymatic reactions are by definition substrates for the reverse reaction. So, there would be some production of venlafaxine from desvenlafaxine. The limiting factors are the low affinity of desvenlafaxine for the 2D6 enzyme, and variable activity of that enzyme.
> in addition to being metabolized by 2d6, venlafaxine itself had an inhibitory effect, for instance desipramine AUC is raised 4.5 fold by 75mg of venlafaxine.
>
> I've been interested in a desipramine/venlafaxine combo, but the decreased metabolism of desipramine had me worried. Maybe pristiq is the ticket.There happens to be a study that looks directly at the simultaneous use of desvenlafaxine and desipramine. Preskorn concludes the effect is low-risk.
Even extensive metabolizers at 2D6 produced very little venlafaxine.
http://www.ncbi.nlm.nih.gov/pubmed/19057238
> Though epocrates claims there is an interaction. Maybe their data are wrong.
>
> ThanksYou're welcome.
Lar
Posted by ihatedrugs on April 22, 2009, at 22:55:54
In reply to Re: Has Pristiq proven to be clinically useful? » TriedEveryDrug, posted by Larry Hoover on April 19, 2009, at 15:13:46
It seems to be working for me so far. Less side effects except for some initial loss of appetite.
Wyeth is offering to pay 50 percent of your copay for the length of time you take the drug. My dr. gave me a package with cd card where you register. That and the fact that is working is worth try. I believe you have 90 days from the time is prescribed and the promotion ends in a couple months.
good luck
Posted by Amelia_in_StPaul on April 24, 2009, at 18:28:57
In reply to Re: Has Pristiq proven to be clinically useful?, posted by Zana on April 19, 2009, at 10:57:08
Zana, it's good to know your experience! I have never heard of or experienced that kind of transparency, where you can't tell a med is in your system.
Larry, thanks for the information from a 2D6 perspective. Lots of poor and intermediate metabolizers out there--makes the SSRIs frustrating, to say the least!
Posted by West on June 21, 2009, at 9:52:48
In reply to Re: Has Pristiq proven to be clinically useful?, posted by sowhysosad on April 19, 2009, at 13:46:22
I just checked the prices and teva's rodomel xl 75mg capsules are the same price as wyeth's efexor ones - £22.50. So I'm being given a generic purely for the sake of it. Thanks NHS.
> Yeah, there are clearly people benefitting from Pristiq that couldn't tolerate Effexor. Just because it's a patent-extending, profit-maximising exercise by Wyeth, it doesn't necessarily follow that the resulting product is worthless or of dubious quaity.
>
> Perhaps "capitalist business practices = EVIL" in some people's minds. Sure, the quest for profit does lead to some unethical behaviour amongst the drug companies, but it drives innovation too.
>
> As I mentioned elsewhere, the UK health service (so they don't have to subsidise an on-patent drug) claim that there's no qualitative difference between citalopram and escitalopram, but escitalopram is obviously better for many people. The subtext is "oh it's a patent-extender so it must be bogus".
>
> > I wish the idea that this is a patent extender would go away. Desvenlafaxine is a specific active metabolite of venlafaxine. It's believed to be responsible for the bulk of the antidepressant effect of venlafaxine. The side effects are mostly produced by other metabolites. In simplified terms.
This is the end of the thread.
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