Desvenlafaxine is a biopharmaceutics classification system (BCS) class 1 (high solubility, high permeability) and biopharmaceutical drug disposition classification system (BDDCS) class 3, (high solubility, poor metabolism; implying low permeability) compound. Thus the rate-limiting step for desvenlafaxine absorption (i.e. intestinal dissolution or permeation) is not fully clarified.

The aim of this study was to investigate whether dissolution and/or intestinal permeability rate-limit desvenlafaxine absorption from an immediate-release formulation (IRF) and Pristiq^®, an extended release formulation (ERF).

Semi-mechanistic models of desvenlafaxine were built (using SimCyp^®) by combining in vitro data on dissolution and permeation (mechanistic part of model) with clinical data (obtained from literature) on distribution and clearance (non-mechanistic part of model). The model predictions of desvenlafaxine pharmacokinetics after IRF and ERF administration were compared with published clinical data from 14 trials.

Desvenlafaxine in vivo dissolution from the IRF and ERF was predicted from in vitro solubility studies and biorelevant dissolution studies (using the USP3 dissolution apparatus), respectively. Desvenlafaxine apparent permeability (P_app) at varying apical pH was investigated using the Caco-2 cell line and extrapolated to effective intestinal permeability (P_eff) in human duodenum, jejunum, ileum and colon. Desvenlafaxine pK_a-values and octanol–water partition coefficients (D_o:w) were determined experimentally.

Due to predicted rapid dissolution after IRF administration, desvenlafaxine was predicted to be available for permeation in the duodenum.

Desvenlafaxine D_o:w and P_app increased approximately 13-fold when increasing apical pH from 5.5 to 7.4. Desvenlafaxine P_eff thus increased with pH down the small intestine. Consequently, desvenlafaxine absorption from an IRF appears rate-limited by low P_eff in the upper small intestine, which “delays” the predicted time to the maximal plasma concentration (t_max), consistent with clinical data. Conversely, desvenlafaxine absorption from the ERF appears rate-limited by dissolution due to the formulation, which tends to negate the influence of pH-dependent permeability on absorption.

We suggest that desvenlafaxine P_eff is mainly driven by transcellular diffusion of the unionized form. In the case of desvenlafaxine, poor metabolism does not imply low intestinal permeability, as indicated by the BDDCS, merely low duodenal/jejunal permeability.