Table 14: Select non-SSRI Antidepressant Dosage Modifications in Renal Impairment – Serotonin and Norepinephrine Reuptake Inhibitors

Drug Name Dosage in Renal Impairment 
Desvenlafaxine
  • Moderate renal impairment (CrCl 30-50 ml/min):
    • 50 mg/day
  • Severe renal impairment (CrCl less than 30 ml/min), ESRD:
    • 25 mg once daily or 50 mg every other day
Duloxetine
  • Mild to moderate renal impairment:
    • start with lower dose, titrate gradually
  • Severe renal impairment, ESRD:
    • not recommended
Levomilnacipran
  • Moderate renal impairment (CrCl 30-59 ml/min):
    • 80 mg/day
  • Severe renal impairment (CrCl 15-29 ml/min):
    • 40 mg/day
  • ESRD:
    • not recommended
Milnacipran
  • Moderate renal impairment (CrCl 30-49 ml/min):
    • use cautiously
  • Severe renal impairment (CrCl 5-29 ml/min):
    • reduce dose by 50% to 25-50 mg twice daily (based on response and tolerability)
  • ESRD:
    • not recommended
Venlafaxine
  • Mild to moderate renal impairment (CrCl 30-89 ml/min):
    • IR:  reduce total daily dose by 25%
    • ER:  reduce total daily dose by 25% to 50%
  • Severe renal impairment (CrCl less than 30 ml/min) and hemodialysis:
    • reduce total daily dose by 50%
  • Adjust doses based on response and tolerability due to variability in renal clearance

Legend:

  • CrCl = creatinine clearance
  • ESRD = end-stage renal disease
  • ER = extended-release
  • IR = immediate-release