*An off-label use of a medication is a use that is not FDA-approved. Prescribers can decide to use a medication off-label because, in their professional judgment, they believe it may offer a benefit to someone.
Pristiq, with the active ingredient desvenlafaxine, is an antidepressant medication. Pristiq is FDA-approved to treat symptoms of major depressive disorder in adults and is in the serotonin and norepinephrine reuptake inhibitor (SNRI) drug class.
Common side effects of Pristiq may include nausea, insomnia, excessive sweating, and sexual dysfunction. While it is considered a safe and effective treatment for major depression, there are risks and it may not be a suitable treatment for some individuals.
If you’re considering Pristiq, online psychiatry platforms such as Talkiatry and Brightside Health can connect you with a provider quickly. They offer assessments and can provide a prescription if they determine Pristiq or another medication may help your symptoms.
Boxed Warning: Desvenlfaxine (Pristiq) – Risk of suicidal thoughts and behaviors in certain people
Desvenlafaxine, the active ingredient in Pristiq, has a black box warning. These are the most serious types of warnings from the Food and Drug Administration (FDA). Desvenlafaxine can increase the risk of suicidal thoughts and behaviors in children, adolescents, and young adults. Regardless of your age, you should talk with your doctor about serious risks with desvenlafaxine and any other medications before starting treatment.
Key Takeaways
Pristiq is a prescription antidepressant medication used to treat major depression in adults only.
Pristiq, with the active ingredient desvenlafaxine, is a serotonin norepinephrine reuptake inhibitor (SNRI).
If you are considering Pristiq, a good place to start is with an evaluation from a medical provider. Many online psychiatry platforms offer online assessments and medication management, such as Talkiatry or Circle Medical.
Personalized Treatment for Depression
Talkiatry can match you with an actual psychiatrist. Talkiatry psychiatrists can evaluate you for depression and other issues that may be impacting your mood then implement a personalized treatment plan. Insurance accepted. Get started with a short online assessment.
What Is Pristiq (Desvenlafaxine)?
Pristiq is a brand name SNRI antidepressant medication. It is FDA-approved for treating major depression in adults only.1 Pristiq is available as the generic medication desvenlafaxine with the same risks and treatment benefits as the branded form.
How Does Pristiq Work?
Pristiq is thought to work by affecting the levels of two chemical messengers in the body, serotonin and norepinephrine.1 Increased amounts of these two chemicals may help the communication between brain cells, potentially improving mood and other symptoms of depression.
What Is Pristiq Used to Treat?
A provider may prescribe an SNRI like Pristiq in someone’s treatment for depression when other treatments, such as SSRI antidepressants, have been ineffective in managing depressive symptoms or cause intolerable side effects.
Pristiq is commonly used as an FDA-approved medication to treat:1
- Major depression in adults
Off-Label (Non-FDA-Approved) Uses of Pristiq
Pristiq can also be used off-label (non-FDA-approved) for several conditions. This means that a provider may prescribe it if they determine it may be beneficial for a patient.
Pristiq may also be used off-label as a treatment for:2, 3, 4
- Anxiety
- Social anxiety
- Panic disorder
How Effective Is Pristiq?
Multiple short- and long-term studies have shown Pristiq to be an effective treatment for major depression. Short-term studies included hundreds of patients taking various dosages and compared them to those treated with a placebo.
In all studies, depression symptoms were significantly improved after 8 weeks of treatment with Pristiq. A long-term study of more than 24 weeks demonstrated that Pristiq can reduce the rate of symptom relapse by up to half when compared to patients receiving a placebo.1
Initial studies also showed that any doses higher than 50 mg once daily were not more helpful, and only increased the risk of negative side effects.1 Pristiq is a serotonin- norepinephrine reuptake inhibitor (SNRI) and works at different places in the body than selective serotonin reuptake inhibitors (SSRIs). There has been evidence that shows a small but significantly better response to treatment with SNRIs when compared to SSRIs.5
How Long Does it Take for Pristiq to Work?
Pristiq can take about 4-6 weeks to become fully effective, but some individuals may start to feel better after the first week or two.1 Each person may have a different response time based on how their body absorbs and processes the medication.
How Long Do I Need to Keep Taking Pristiq?
The length of treatment with Pristiq will vary from patient to patient and will be based on each person’s response to the medication. Pristiq has been studied and shown to be effective long term, and some patients may continue to use it for months to years.
The decision to end treatment will depend on how effective Pristiq is, any side effects experienced, or other medications started or stopped during the course of treatment. Always follow the directions of your prescriber when taking Pristiq.1
Common Pristiq Side Effects
Individuals taking Pristiq may experience common side effects that impact their digestive system and sexual functioning. Some may require medical attention but many often resolve on their own.
Common side effects of Pristiq may include:*1
- Nausea
- Constipation
- Decreased appetite
- Dizziness
- Anxiety
- Drowsiness
- Insomnia
- Excessive sweating
- Delayed ejaculation
- Reduced sex drive
- Problems having an orgasm
*All medications, including Pristiq, can cause side effects that can be mild or serious. This is not a comprehensive list of all possible side effects. You should talk with your doctor about any questions you have and understand the potential side effects and benefits of any medication.
Serious Pristiq Side Effects
There is a risk for side effects to be severe or persistent. If these side effects appear, it is important to seek immediate medical attention.
Serious side effects of Pristiq that require immediate medical attention include:*1
- Suicidal thoughts or actions, worsened anxiety
- Bruising or unusual bleeding
- Symptoms of mania or hypomania
- Blurred vision or eye pain
- Elevated blood pressure
- Hyponatremia (low sodium levels in the blood)
- Lung disorders including interstitial lung disease and eosinophilic pneumonia
- Seizures or convulsions
- Allergic reactions
- Muscle rigidity, tremors, fever, and/or seizures (Could be a sign of serotonin syndrome)
*All medications, including Pristiq, can cause side effects that can be mild or serious. This is not a comprehensive list of all possible side effects. You should talk with your doctor about any questions you have and understand the potential side effects and benefits of any medication.
What Are The Long-term Effects of Taking Pristiq?
Taking Pristiq long term can cause serious side effects in some people. In long-term studies, the most common side effect reported was vomiting. However, there are other reports of less common side effects such as sexual dysfunction, changes in heart function or health, and the development of anxiety.1 It is important to keep all follow up appointments and ensure proper monitoring of your treatment. If you notice any changes in health, be sure to contact your provider immediately.
Personalized Treatment for Depression
Talkiatry can match you with an actual psychiatrist. Talkiatry psychiatrists can evaluate you for depression and other issues that may be impacting your mood then implement a personalized treatment plan. Insurance accepted. Get started with a short online assessment.
What Are the Risks & Warnings for Pristiq?
Suicidal Ideation & Behavior
Desvenlafaxine, the active ingredient in Pristiq, can cause suicidal thoughts and behaviors in children and adolescents. This calls for immediate medical attention. Regardless of your age, you should talk with your doctor about serious risks with desvenlafaxine and any other medications before starting treatment.
Triggering Manic Episodes
People with symptoms of bipolar disorder or mania are discouraged from taking Pristiq as the medication can cause manic episodes.
Seizures
Patients with a history of seizure disorder are discouraged from taking Pristiq as it can cause seizure episodes.
Bleeding Problems
If you have bleeding problems, you should not take Pristiq with advice from your healthcare provider, as the drug increases the risk of bleeding.
Breastfeeding & Pregnancy
Pregnant and lactating women are discouraged from taking Pristiq as the medication can cause severe health effects to an infant and also cause premature labor and miscarriage.
Interactions With Alcohol
Taking Pristiq and alcohol together is not encouraged as the drug can cause worsening symptoms of depression, such as dizziness and headaches.
Allergic Reactions
Anyone can have an allergic reaction to medication, including Pristiq. If you experience symptoms such as swelling, inflammation, breathing problems, hives, or a rash, seek immediate medical help as this reaction may be life threatening.
Antidepressant Discontinuation Syndrome
People discontinuing Pristiq abruptly may have symptoms of Pristiq withdrawal, also called antidepressant discontinuation syndrome. Because of this, it is always recommended to taper the dose of medication as instructed by your provider. Do not stop taking Pristiq or adjust your dosage on your own.
Common symptoms of Pristiq withdrawal include dizziness, nausea, fatigue, anxiety, sweating, seizures, and electric shock sensations.
Drug Interactions
Taking certain medications or supplements with Pristiq may increase the risk of side effects or impact how well it works. Before making any changes, talk to your doctor to ensure your treatment remains safe and effective.
Substances you should avoid using while taking Prozac include:
- Monoamine oxidase inhibitors (MAOIs)
- Other drugs that impact serotonin levels
- Medications that affect blood clotting
- Medications broken down by the liver enzyme CYP2D6
This is not a comprehensive list of all possible drug interactions for Prozac. Be sure to talk with your doctor or pharmacist about any prescription or over the counter medications you take, as well as supplements, herbs, and teas.
Who Should Not Take Pristiq?
Some patients may experience side effects from Pristiq more than others. While predicting who may not respond well to Pristiq can be challenging, specific patient populations should be cautious with Pristiq. Patients taking other serotonin norepinephrine reuptake inhibitors (SNRIs), selective serotonin reuptake inhibitors (SSRIs), or medications that increase serotonin in the brain should avoid Pristiq due to the risk of serotonin syndrome.
Always discuss your health conditions with your provider so they can select the medication that is the most suitable for you.
Populations who are at an increased risk for experiencing side effects include those who are or have:1
- High blood pressure
- Liver problems
- Kidney problems
- Suicidal thoughts or behaviors
- A history of heart conditions
- A history of stroke or other cerebrovascular problems
- Low sodium levels in the blood
- A history of bleeding problems
- Pregnant or plan to become pregnant
- Breastfeeding or who plan to breastfeed
- A history of bipolar disorder, symptoms of mania or hypomania
- Prior allergic reactions to desvenlafaxine
- A history of seizures
Drug Interactions With Pristiq
Taking certain medications or supplements with Pristiq may increase the risk of side effects or impact how well it works. Before making any changes, talk to your doctor to ensure your treatment remains safe and effective.
Substances you should avoid using while taking Pristiq include:
- Monoamine oxidase inhibitors (MAOIs)
- Other drugs that impact serotonin levels (SSRIs, SNRIs, TCAs, triptans, etc)
- Medications that affect blood clotting
- Medications broken down by the liver enzyme CYP2D6
This is not a comprehensive list of the possible interactions with Pristiq. You should talk with your provider and your pharmacist about all prescription and over-the-counter medications, herbs, and supplements you take before starting Pristiq.
Pristiq Withdrawal
People who stop taking Pristiq abruptly may have symptoms of Pristiq withdrawal, also called antidepressant discontinuation syndrome. Because of this, it is always recommended to taper the dose of medication as instructed by your provider. Do not stop taking Pristiq or adjust your dosage on your own.
Common symptoms of Pristiq withdrawal include dizziness, nausea, fatigue, anxiety, sweating, seizures, and electric shock sensations.
Pristiq Dosages for FDA-Approved Treatment
The typical Pristiq dosage ranges from 50 to 100 mg daily. However, their prescriber may recommend a dosage above 100 mg once daily for some patients. Pristiq dosages can vary for each individual based on several factors such as age, weight, and medical history. Dosage may also be adjusted as needed throughout treatment.
How Should I Take Pristiq?
Pristiq can be taken orally with or without food. It should be swallowed with water without crushing, breaking, or chewing. Also, it’s recommended to take the medication at approximately the same time each day. Always take your medications as prescribed by your provider.
What Happens If I Miss a Dose of Pristiq?
In case you miss a dose of Pristiq, take it as soon as you remember it. However, if it is too close to your next dose, skip the missed dose and go back to your normal dosing schedule. Do not try to catch up with extra doses. Also, do not abruptly stop taking Pristiq. Instead, consult your doctor about a plan to safely stop taking the medication.
Can You Overdose on Pristiq?
Yes, you can overdose on Pristiq. A Pristiq overdose can be potentially life-threatening. It can occur if you take higher amounts of Pristiq dosage than the recommended or prescribed by your provider. The signs and symptoms of a Pristiq overdose can include dizziness, drowsiness, agitation, confusion, and persistent headaches.
What Should You Do If You Take Too Much Pristiq?
If you believe you or some you know have taken too much Pristiq, seek immediate medical care or call 9-1-1. Have important information with you such as basic medical history, when the Pristiq dosage was taken, and the amount taken.
How to Get a Prescription for Pristiq
To get a prescription for Pristiq in person, start with an evaluation for your symptoms. Your primary care provider, who may be a physician, nurse practitioner, or physician assistant, can help you get the process started. They may make a referral to a psychiatrist or specialist to determine if a prescription for Pristiq should be included in your treatment plan.
Can I Get Pristiq Prescribed Online?
To get an online prescription for Pristiq, you will also start by getting evaluated by an online psychiatric provider. We have thoroughly reviewed platforms like Talkiatry or Circle Medical that prescribe non-controlled substances such as antidepressants.
Personalized Treatment for Depression
Talkiatry can match you with an actual psychiatrist. Talkiatry psychiatrists can evaluate you for depression and other issues that may be impacting your mood then implement a personalized treatment plan. Insurance accepted. Get started with a short online assessment.
Questions to Ask Your Provider
It is important to discuss the potential side effects of Pristiq with your doctor, psychiatrist, or therapist you may experience immediately after starting the treatment. Ask them whether these side effects will go away on their own or if any intervention is needed.
Also, many online psychiatry services make access to mental health care for depressive conditions convenient. Individuals may even change prescribers and get a mental health evaluation, diagnosis, and personalized treatment plan.
Questions to ask your care team about Pristiq include:
- How long will it take for me to adjust to taking Pristiq?
- How quickly can Pristiq cause side effects?
- What are the first days of Pristiq side effects like?
- What is the best dosage to ensure fewer side effects, especially in the first week?
- When should I reach out to you if I am experiencing side effects?
- Is there anything I should tell my therapist about my new Pristiq prescription?
- How often should I come for medical check ups?
- What should I do if I have a history of allergic reactions?
- Is my Pristiq dose safe if I am breastfeeding or pregnant?
- What should I do if I miss the Pristiq doses?
Prescriber’s Tips
Your prescriber will share important information about your Pristiq prescription. They will explain how to take and store your medication, what to avoid when taking it, and what to do about side effects. Follow these tips for safe and effective use of Pristiq.
- Take your medication as prescribed, do not change your dose or stop taking it unless your prescriber tells you to. Keeping a consistent dosing schedule reduces the chance of unwanted side effects. When taking antidepressants, this approach can prevent withdrawal symptoms such as dizziness, brain zaps, and flu-like symptoms.1
- Take your medication at the same time each day. Doing so can help you remember to take it, making it as effective as possible. Your healthcare provider can help determine the optimal timing based on your sleep patterns and initial medication response.
- Avoid alcohol while taking Pristiq.
- Tell your prescriber right away if you or your child have any worsening mental health symptoms. Antidepressants have a boxed warning for increased risk of suicidal thoughts and behaviors in children under age 18 and young adults.
- Tell your prescriber about all medications and supplements you take, including over-the-counter treatments. Many over-the-counter medications and supplements can interact with prescription medications.
Frequently Asked Questions
Can Pristiq Be Used During Pregnancy?
It’s not known if Pristiq is safe to take during pregnancy. Talk with your provider about risks and benefits when considering treatment with Pristiq while pregnant.
Can Pristiq Be Used While Breastfeeding?
Pristiq can pass into breast milk and the risks to a nursing baby are unclear. Talk with your provider about the possible risks and benefits of taking Pristiq while breastfeeding.
Is it Safe to Drive While Taking Pristiq?
Pristiq may cause you to feel sleepy. Avoid driving or operating dangerous equipment, at least until you find out how the medication affects your judgment or reaction times.
Is It OK to Drink Alcohol While Taking Pristiq?
No. Drinking alcohol while taking Pristiq is not recommended. Taking Pristiq and alcohol together may cause worsening symptoms of depression, and may increase side effects such as dizziness, headaches, drowsiness and difficulty concentrating.
What Are Common Side Effects of Pristiq?
Common side effects of Pristiq include nausea, constipation, anxiety, and drowsiness.
How Long Will Pristiq Side Effects Last?
Side effects are one of the most common reasons people choose to stop taking Pristiq. While some effects can be managed and may fade away after the first few weeks, some do not go away unless a person stops taking the medication.
Can Pristiq Make You Feel Worse at First?
Yes, some people starting Pristiq may feel worse at first. Some experience uncomfortable side effects such as increased nausea and constipation.1 Pristiq can also increase the risk of suicidal thoughts and behaviors in some people. If you experience worsened symptoms or side effects of any kind while taking this medication, contact your provider immediately.
How Does Pristiq Make You Feel During the First Week?
During the first week of taking Pristiq, the medication is building up in your body. This may trigger side effects for some people. It takes several weeks for Pristiq to start working and you may not notice any difference in your symptoms yet.
Should I Stop Taking Pristiq If I Experience Side Effects?
Do not stop taking Pristiq unless you have been advised to do so by your provider. Doing so can lead to antidepressant discontinuation syndrome, also known as antidepressant withdrawal. This can cause uncomfortable symptoms, including dizziness, fatigue, irritability, and nausea.
ChoosingTherapy.com strives to provide our readers with mental health content that is accurate and actionable. We have high standards for what can be cited within our articles. Acceptable sources include government agencies, universities and colleges, scholarly journals, industry and professional associations, and other high-integrity sources of mental health journalism. Learn more by reviewing our full editorial policy.
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Pristiq extended-release – desvenlafaxine succinate tablet, extended release. (December 19, 2024). DailyMed.nlm.nih.gov. Retrieved from https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm
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Tourian, Karen A., et al. “Analysis of the Effect of Desvenlafaxine on Anxiety Symptoms Associated with Major Depressive Disorder: Pooled Data from 9 Short-Term, Double-Blind, Placebo-Controlled Trials.” CNS Spectrums, vol. 15, no. 3, Mar. 2010, pp. 187–193. Retrieved from https://doi.org/10.1017/s1092852900027450
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Liebowitz, Michael & Salmán, Ester & Johnson, Ann & Hanover, Rita. (2015). A 12-Week Double-Blind, Placebo-Controlled, Flexible-Dose Trial of Desvenlafaxine Extended-Release Tablets in Generalized Social Anxiety Disorder. Journal of Depression and Anxiety. Retrieved from https://www.researchgate.net/publication/281945699_A_12-Week_Double-Blind_Placebo-Controlled_Flexible-Dose_Trial_of_Desvenlafaxine_Extended-Release_Tablets_in_Generalized_Social_Anxiety_Disorder
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Bradwejn J, Ahokas A, Stein DJ, Salinas E, Emilien G, Whitaker T. (2005). Venlafaxine extended-release capsules in panic disorder: flexible-dose, double-blind, placebo-controlled study. The British Journal of Psychiatry. Retrieved from https://pubmed.ncbi.nlm.nih.gov/16199795/
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Lieberman, D. Z., & Massey, S. H. (2010). Desvenlafaxine in major depressive disorder: an evidence-based review of its place in therapy. Core evidence, 4, 67–82. Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC2899788/
We regularly update the articles on ChoosingTherapy.com to ensure we continue to reflect scientific consensus on the topics we cover, to incorporate new research into our articles, and to better answer our audience’s questions. When our content undergoes a significant revision, we summarize the changes that were made and the date on which they occurred. We also record the authors and medical reviewers who contributed to previous versions of the article. Read more about our editorial policies here.
Author: No Change
Reviewer: No Change
Primary updates: Added “Key Takeaways” feature. Edited for clarity and reorganized. Added sections titled “How Effective Is Pristiq?”, “How Long Does it Take Pristiq to Work?”, “How Long Do I Need to Keep Taking Pristiq?”, “What Are the Long-term Effects of Pristiq?”. Revised and retitled “Pristiq Dosage” section to “Pristiq Dosages for FDA-Approved Treatment”, consolidated with Pristiq Forms & Strengths. Consolidated “Pristiq Warnings & Precautions” and “Allergic Reactions to Pristiq” into new “Risks” feature. Added “How to Get a Prescription for Pristiq”. Retitled “Questions to Ask Your Health Provider About Pristiq” to “Questions to Ask Your Provider”. Removed “For Further Reading” section, added FAQs. Replaced “Final Thoughts” with “Prescriber’s Tips” feature.
Author: Diana Rangaves, PharmD, RPh
Medical Reviewer: Heidi Moawad, MD
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