Pristiq (Desvenlafaxine) is a prescription medication that treats major depression in adults. The recommended starting dose is typically 50 mg, but the dose may vary from 25 to 400 mg. While the timeframe varies for each individual, symptoms often begin improving within two weeks. Some individuals may experience side effects while taking Pristiq.
What Is Pristiq (Desvenlafaxine)?
Pristiq is a serotonin-norepinephrine reuptake inhibitor (SNRI) antidepressant medication. It works by affecting the levels of serotonin and norepinephrine in the brain which may reduce symptoms of depression and anxiety. Because Pristiq use may increase the risk of suicidal thoughts or behaviors in children, teens, and young adults, this drug is typically not recommended for individuals under the age of 24.
What is Pristiq Used to Treat?
Pristiq is used to treat major depressive disorders (MDD) in adults. However, the providers also prescribe it for some off-label (non-FDA-approved) uses. 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.
American Academy of Child and Adolescent Psychiatry (AACAP) recommends off-label Pristiq use in young individuals with depression who have not responded to standard treatment or whose condition is severe and standard treatment is not helpful enough.2
Pristiq is commonly used as an FDA-approved medication to treat:1
- Major depressive disorder (MDD) in adults
Pristiq can also be used off-label for treating:3
- Anxiety
- Menopausal hot flashes
- Panic disorder
- Diabetic neuropathy
- Bipolar disorder
- Fibromyalgia
- Obsessive-compulsive disorder (OCD)
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Pristiq Dosages for FDA-Approved Treatment
FDA is a US federal agency responsible for drug quality, effectiveness, and safety before it is approved for human use. Pristiq is an FDA-approved prescription medication for treating depression in adults. There are recommended standard doses, but individual doses sometimes vary. Doctors consider lower dosages in individuals with serious liver or kidney problems.
Pristiq Forms & Strengths
Pristiq is an oral form of a colored square and pyramid shape tablet. It is available in three strengths (25, 50, and 100 mg). Pristiq is an extended time-release medication formulated to release the tablet contents at regular levels to last for longer periods in your body. Dosages vary if people have serious liver or kidney problems.1
Pristiq is available in the following forms and strengths:
- 25 milligrams (mg): tan, square, and pyramid oral tablet
- 50 mg: light pink, square, and pyramid oral tablet
- 100 mg: reddish-orange, square, and pyramid oral tablet
Pristiq tablets must be swallowed with or without food as directed by their prescribers. Typically, it is taken once a day at the same time for the best result. It is important to continue this medication even if you feel well. If you plan to stop the drug always consult your doctor before discontinuing the drug.
Pristiq Dosages for Adults
Pristiq is typically taken orally at a dosage of 50 mg per day to treat adult depression. However, other factors may influence the dosage, which can range from 50 to 400 mg per day. To ensure maximum effectiveness, it’s crucial to take the tablet whole and at the same time each day. It’s important to note that the tablet has a slow-release formula and should never be crushed or dissolved in liquid.
Pristiq Dosage for Adults with Major Depressive Disorder (MDD)
Pristiq is a prescription medication that’s been approved by the FDA as a treatment for major depression. It comes in the form of an extended-release tablet that slowly releases its contents throughout the day to potentially help improve mood, energy, and overall sense of well-being. While people might notice some improvements in depression symptoms after two weeks, it can take several weeks to experience significant changes.
It’s important to continue taking Pristiq even if you start feeling better. If you need to stop taking Pristiq, your doctor will determine when it’s time to start gradually reducing your dosage before stopping altogether. Fortunately, Pristiq has a low risk for abuse or addiction, and it is easy to take with a straightforward daily dosing schedule.
Here is Pristiq dosage information for depression in adults:4
- Typical starting dosage: 50 milligrams (mg) taken once a day. Your doctor may adjust the dose based on your other health issues.
- Dosage increases: Your doctor may choose to gradually increase Pristiq dosage from your initial dose.
- Maximum dosage: Typically, the highest recommended dose for daily use is 400 mg. However, for individuals with liver disease, the maximum daily dose should not exceed 100 mg, and for those with kidney problems, the maximum dose should not exceed 50 mg per day. If undergoing hemodialysis, the recommended dose is no more than 25 mg per day or 50 mg every other day, and it is important to avoid taking additional doses after hemodialysis.
Pristiq Dosages for Older Adults
Pristiq dosages to treat depression in older adults (65+) are the same as it is for adults. However, older adults who have liver or kidney problems will need a dose adjustment.
Pristiq Dosage for Older Adults with Major Depressive Disorder (MDD)
Pristiq is an FDA-approved, on-label treatment for major depressive disorder in older adults. It can take two to four weeks for the symptoms of depression to subside. Continue taking it even if your symptoms feel better.
Your doctor will determine whether it is appropriate to cut the dosage before quitting Pristiq. The specific time of day does not affect how the medication works. However, for the most effective treatment response, take your medication as consistently as possible. Continue taking your medication as directed without skipping doses.
Here is Pristiq dosage information for depression in older adults:
- Typical starting dosage: A starting dosage is 50 milligrams (mg) taken once a day. Your doctor may adjust the dose based on your other health issues.
- Dosage increases: Your Doctor may choose to gradually increase Pristiq dosage from the initial dosage.
- Maximum dosage: Typically, the highest recommended dose for daily use is 400 mg. However, for individuals with liver disease, the maximum daily dose should not exceed 100 mg, and for those with kidney problems, the maximum dose should not exceed 50 mg per day. If undergoing hemodialysis, the recommended dose is no more than 25 mg per day or 50 mg every other day, and it is important to avoid taking additional doses after hemodialysis.
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Pristiq Dosage for Off-Label Uses
Pristiq is used as an off-label drug to treat certain mental and physical health disorders. For instance, the North American Menopause Society (NAMS) and the American College of Obstetricians and Gynecologists (ACOG) recommend off-label Desvenlafaxine as a viable alternative for women who cannot or do not want to use hormonal therapy to treat hot flashes or other menopause-related vasomotor symptoms.3
Pristiq is also recommended by the AACAP to treat serious depression and obsessive-compulsive disorders in young individuals when other treatments have failed or are inadequate and the severity of the illness is too high.
Pristiq Dosing Considerations
Before taking Pristiq, your doctor will determine the appropriate dosage based on your medical history, including any kidney or liver problems. It’s important to inform your doctor of any high blood pressure, heart problems, bleeding disorders, history of stroke, or seizures.
Additionally, let your doctor know about any other medications, over-the-counter products, vitamins, or supplements, as they may increase your risk of side effects. If you have a history of alcohol or illicit drug use, or if you are planning to conceive pregnant or breastfeeding, it’s important to inform your doctor to avoid any negative effects on your baby.
Conditions that require special Pristiq dosing considerations include:1
- Liver problems: Individuals with moderate to severe hepatic impairment should take 50 mg daily. A daily dose of greater than 100 mg is not recommended.
- Kidney problems: If you are facing kidney issues, the breakdown of Pristiq in your body may be slow. The recommended daily dosage of Pristiq for individuals with moderate kidney problems is 50 mg. For those with severe kidney problems, the daily dosage should not exceed 25 mg or 50 mg every other day.
- Elderly adults: Pristiq has the potential to decrease blood sodium levels in elderly individuals (65+) taking diuretic medications. If taking a diuretic or have had low sodium levels in the past, discuss this with your doctor before starting treatment with Pristiq.
What to Expect When Increasing Pristiq Dosages
It is important to follow your doctor’s prescribed dosage of Pristiq. While taking a dosage may not cause additional side effects for some people, it may elevate the risk in others. Higher doses may result in shortness of breath, chest pain, drowsiness, irregular heartbeat, excessive sweating, dizziness, muscle pain, nausea, constipation, decreased appetite, urge to vomit, trouble sleeping, and extreme fatigue. However, many of these symptoms can go away on their own without treatment after a few days or weeks.
Some people may believe that taking higher doses of Pristiq will provide faster relief and may try this on their own, but this can intensify side effects and is not recommended. A high dosage of Pristiq has the potential to cause serotonin syndrome, a serious life-threatening condition caused by increased serotonin levels. If you experience symptoms of serotonin syndrome, it is crucial to seek immediate medical attention and discontinue Pristiq in a safe and supervised manner.
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What if I Miss a Dose of Pristiq?
If you miss a dose of Pristiq and you are about to take your next dose, do not take extra to make up for the missing dose. If you miss multiple doses or are unsure about what to do, contact your healthcare team immediately. If you have trouble remembering when to take your medication, your pharmacist or physician can provide helpful tips.
Pristiq may be intolerable for some people and have unpleasant side effects, and others find that it doesn’t relieve depression as effectively as they had expected. Because of these reasons, some people may decide to stop taking Pristiq. Don’t stop abruptly and without talking to your doctor about it. Doing so can cause a condition called antidepressant discontinuation syndrome, also called antidepressant withdrawal.
Withdrawal symptoms may range from mild to severe, including nausea, headaches, tiredness, diarrhea, heavy perspiration, disorientation, and irritability. If you have stopped taking Pristiq suddenly, get immediate medical assistance to prevent the onset of these symptoms.
Can You Overdose on Pristiq?
When people take more Pristiq than is prescribed, they risk overdosing. Overdosing may also result from chewing or crushing the tablets, combining them with other psychiatric medications, or taking higher or more frequent doses than advised.
Drowsiness, vomiting, convulsions, chest pain, coughing, irregular heartbeat, or serotonin syndrome can result from a Pristiq overdose. Pristiq should not be taken more than what your doctor has prescribed.
What Should You Do If You Take Too Much Pristiq?
If you believe you have taken an excessive amount of Pristiq dosage and you faint or are having difficulties breathing, call 911 for immediate assistance and go to urgent medical care right away. Additionally, you should reach out to your doctor immediately and you may also contact the poison control center at 1-800-222-1222 if you suspect drug toxicity.
Can You Become Addicted to Pristiq?
In clinical trials, people taking Pristiq did not show any drug-seeking behaviors associated with addiction.
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Questions to Ask Your Health Team About Pristiq Dosage
Ask your doctor before starting Pristiq about the potential side effects, the frequency of visits, and other important questions. Your doctor can talk with you about whether Pristiq would be an effective course of treatment for you.
If you experience life-threatening symptoms while taking Pristiq, immediately call 911 or visit the closest emergency room.
Questions to ask your care team about Pristiq dosages include:
- Is it safe to take Pristiq with my other medications?
- Will Pristiq or desvenlafaxine be covered by my insurance?
- Does my medical history indicate a need to adjust my dosage?
- How long will it take before my symptoms improve?
- Should I let my therapist know I am taking this medication?
- What should I do if I want to stop taking Pristiq?
- Can I continue my substance abuse treatment or talk therapy while taking Pristiq?
- Is my Pristiq dose safe if I am breastfeeding or pregnant?
- What should I do if I miss the Pristiq doses?
- What happens if I overdose on Pristiq?
How to Get a Pristiq Prescription
Pristiq is potentially an effective medication with both FDA-approved and off-label uses, with its only FDA-approved use being to treat major depression in individuals aged 18 and above. Your doctor will assess your psychiatric condition and medical history to determine whether Pristiq is the right solution for you. They may ask you a few questions about your mood and medical history, including the most bothersome symptom and how long you have been experiencing it. Additionally, they will ask about medications you have used in the past for your symptoms and whether they were effective or caused any adverse effects.
Your doctor will carefully consider the benefits of your treatment, taking into account any potential side effects, to determine the appropriate drug dose. The goal of treatment is to improve your condition while minimizing any negative effects. If you are considering treatment, online psychiatry services may be a helpful option to explore.
In My Experience
In my experience, Pristiq has the potential to treat adult depression safely and effectively with fa low risk of side effects or drug interactions. Its once-daily dosage schedule is easily manageable and suitable for long-term compliance. It contains the active component desvenlafaxine succinate, which may help restore a sense of well-being by raising the levels of the brain chemicals serotonin and noradrenaline. Because Pristiq does not have addictive potential, it is not a controlled substance.
Pristiq is widely used off-label for conditions like panic attacks and social anxiety disorders. It is crucial to only use Pristiq as prescribed. When proper medical care coordination combines with transparent information sharing, Pristiq has the potential to effectively reduce depression symptoms while being well-tolerated by patients.
Choosing Therapy 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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National Institutes of Health. (n.d.). DailyMed – PRISTIQ EXTENDED-RELEASE- desvenlafaxine succinate tablet, extended release. U.S. National Library of Medicine. Retrieved from https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm
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AACAP.org. (2012). Facts for Families. Retrieved from Psychiatric Medication for Children and Adolescent Part II – Types of Medications
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Desvenlafaxine – Drug Summary. (n.d.) Prescribers Digital Reference. Retrieved from desvenlafaxine.pdr.net
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Pfizer.com Medication Guide (2021). Pfizer.com Retrieved from https://labeling.pfizer.com/ShowLabeling.aspx?id=497§ion=MedGuide
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