*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.
Common Pristiq side effects include nausea, insomnia, excessive sweating, and sexual dysfunction. Serious side effects require medical attention such as a risk of suicidal thoughts, symptoms of mania, and allergic reactions.
One of the most common reasons people want to stop taking a medication is the occurrence of side effects. If Pristiq side effects persist beyond the first few weeks, a prescriber can help you determine next steps, which may include a change in dosage, timing of dosage, or to a different medication.
If you are considering Pristiq or want to discuss your current medication treatment with a provider, online psychiatry platforms, such as Talkiatry and Brightside Health are a good place to start. Their providers offer assessments and prescription consultation, and can answer any questions you have about Pristiq’s side effects.
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
Common Pristiq side effects can impact your digestive system, appetite, and sexual functioning. There is also a risk of serious side effects that require medical attention.
If Pristiq side effects persist longer than a few weeks, your provider can help you determine next steps, which may include a change in dosage, timing of dosage, or medication.
There are several ways to cope with Pristiq side effects, including self care practices, medication adjustments, and therapy.
If you are considering Pristiq or an alternative, 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.
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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
- Bruising or unusual bleeding
- Symptoms of mania or hypomania
- Heart palpitations
- Blurred vision
- Worsened anxiety
- 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 which 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 to understand the potential side effects and benefits of any medication.
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.
*This is not a comprehensive list of all warnings and precautions for Pristiq. You should talk with your doctor about any questions you have and to understand the potential warning and precautions of any medication.
Important Things to Know About Taking Pristiq
Before starting Pristiq, it’s important to understand what to expect during your first weeks of treatment. Your prescriber will discuss your dosage, how to take your medication, precautions for the medication, potential side effects you may experience, and what to do if side effects become a problem.
How Long Does It Take for Pristiq to Work?
Pristiq can take about 4-8 weeks to become fully effective, but some individuals may start to feel better after the first week or two. Each person may have a different response time based on how their body absorbs and processes the medication.
Can Pristiq Make You Feel Worse at First?
Yes, some people starting Pristiq may 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, contact your provider immediately.
What Happens If I Miss a Dose?
If you forget to take your Pristiq dose, take it as soon as you remember. If your next dose is due soon, skip the missed one and take your next scheduled dose. Never take two doses at once, and continue taking your medication as prescribed unless your prescriber directs you to do otherwise.1
Who Experiences Side Effects More?
Some patients may experience side effects from Pristiq more than others. While predicting who will respond poorly is difficult, 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.
Adolescent patients and their parents should be aware of the risk of increased suicidal ideation when starting Pristiq. It is essential to discuss your health conditions with your physician to 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
- Susceptibility to nausea and vomiting
- High blood pressure
- Liver problems
- Kidney problems
- Suicidal ideations
- A history of serotonin syndrome
- 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 breastfeeding
- A history of bipolar disorder, symptoms of mania or hypomania
- Prior allergic reactions to desvenlafaxine
- Prior vision issues such as glaucoma
- A history of seizures
How to Cope With Common Pristiq Side Effects
There are ways to cope with the most common Pristiq side effects*. Many may go away on their own during the first few weeks. Contact your provider if side effects persist or worsen.
Digestive Symptoms
Taking Pristiq can cause digestive side effects such as nausea, constipation, and vomiting. To reduce these, follow meal timing recommendations for Pristiq. Also, drink plenty of water, eat smaller, more frequent meals, and avoid spicy foods. You may also try ginger or peppermint teas, but talk with your healthcare provider before taking any prescription or over-the-counter medicine or using supplements such as tea.
Sexual Side Effects
Men taking Pristiq may experience erectile dysfunction, decreased sex drive, and delayed ejaculation. Women may have problems with orgasms and decreased sex drive.1 These effects may go away after the first few weeks. Scheduling sexual activity before taking a dose may also reduce the risk or impact of sexual side effects. If these effects are bothersome or persistent, your provider may consider a change of dosage or medication.
*All medications, including Pristiq, can cause side effects which 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 to understand the potential side effects and benefits of any medication.
More Ways to Manage Pristiq Side Effects
Here are more ways to cope with and reduce the impact of Pristiq side effects.
Practice Good Sleep Hygiene
Following good sleep hygiene practices can help you feel rested while your body adjusts to the medication. Try to wake up and go to bed about the same time each day, and make sure your sleeping environment is relaxing and comfortable to you. If you experience drowsiness, avoid doing activities that require alertness, such as driving or operating machinery.
Healthy Lifestyle Activities
Eating well, sleeping enough, and getting adequate exercise are all parts of a healthy lifestyle. These activities are important for all aspects of your physical and mental health and can help you endure the impact of side effects.
Follow a Daily Routine
Following your normal routine is important whether or not the medication is working yet. Doing your regular daily activities can keep life more predictable and reduce stress as you adjust to the medication. Also, be sure you are taking your medication as prescribed and at a consistent time each day.
Consider Therapy
Psychotherapy can support you by addressing the impact of side effects and helping you develop strategies to manage them. For in-person treatment, your primary care provider or insurance company can provide a referral, or you may get one from family or friends.
To find an online therapist, an online therapist directory is a great starting point. Many online psychiatry platforms, such as Talkiatry and Brightside Health, also offer therapy services.
Should I Stop Taking Pristiq If I Start Feeling Side Effects?
Do not stop taking Pristiq unless you have been advised to do so by your provider. Doing so can cause uncomfortable symptoms, including dizziness, fatigue, irritability, and nausea. For some people who have been taking antidepressants over a long course of time, abruptly stopping Pristiq can lead to antidepressant discontinuation syndrome, also known as antidepressant withdrawal.
If you are experiencing side effects from your medication, tell your provider. They will help you determine the best course for continued treatment, which may include changing your dosage, the time for your dosage, or your medication. If your doctor determines discontinuing your medication is the best option, they will provide a plan for stopping your medication gradually, which can minimize your risk of developing withdrawal symptoms.
When Should I Call My Doctor About Pristiq Side Effects?
Side effects are one of the most common reasons people choose to stop taking medication. While some effects can be managed and may fade away, some do not go away unless a person stops taking the medication. Side effects can occur even if you are taking your medication correctly.
Contact your provider as soon as possible if side effects persist or become hard to tolerate so you can consider other treatment options. While not common, some people taking Pristiq may experience serious side effects. These effects often require immediate medical care and some may be life-threatening. If you notice any of the serious side effects listed above, seek medical care immediately.
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When Should I Seek an Alternative to Pristiq Due to Side Effects?
Pristiq’s initial side effects typically subside after a few weeks. If after some time you are looking to change your medication due to continued side effects, work with a doctor to find an alternative. There are many Pristiq alternatives available. All classes of antidepressants can help reduce depression symptoms, though potential risks and benefits can vary.
Other SNRIs and SSRIs are usually the first antidepressants considered as Pristiq alternatives because of their safety and effectiveness.
Atypical antidepressants work differently to improve symptoms and don’t fit into a formal category. Tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) are older medications with more side effects. However, they may be helpful for those who need to avoid or can’t tolerate other types of antidepressants.
How to Get a Prescription for Pristiq or Alternative Medications
To get a prescription for Pristiq or an alternative 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 Pristiq alternatives should be included in your treatment plan.
To get an online prescription for a Pristiq alternative, 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.
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 are available with convenient access to mental health care for depressive conditions. Individuals may even change prescribers and get a mental health evaluation, diagnosis, and personalized treatment plan.
Questions to ask your care team about Pristiq side effects may 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?
- If I’m not able to tolerate the side effects, are there Pristiq alternatives to consider?
- How should I cope with side effects?
- What to do if the side effects do not disappear after the first few weeks?
- Can I skip or lower a dose to avoid the side effects?
- Can I switch the drug if the side effects last longer or get worse?
- What to do if I have serious side effects?
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.
- Limit alcohol while taking Pristiq and eat a balanced diet to minimize sexual dysfunction and ensure your body can experience and enjoy sex. This is because drinking alcohol can make it hard for your brain to send and receive signals to feel different parts of your body during sex. It can also make it harder for men and women to reach orgasm when having sex. Your healthcare provider can help to determine what is a safe amount of alcohol for you to drink and the best-balanced diet for you.
- 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. This is because they are processed by the same gut enzymes, cytochrome P450 (CYPs). These interactions can lead to unwanted side effects or reduce the effectiveness of your prescription medication.2
Frequently Asked Questions
What Is Pristiq (Vortioxetine) & What Is It Used to Treat?
Pristiq (desvenlafaxine) is an antidepressant in the serotonin norepinephrine reuptake inhibitors (SNRI) drug class. It is FDA-approved to treat major depression disorder in adults only.1
What Does Pristiq Do?
Pristiq is a serotonin norepinephrine reuptake inhibitor 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.
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.
Do Pristiq Side Effects Vary Based on the Dosage?
Side effects may be more likely to occur the higher the Pristiq dosage you take. Also, it has been shown that there is no added benefit for doses of 100 mg or higher, but the risk of side effects increases.3 Your doctor may start you on 25 mg or 50 mg once daily, but the recommended dose is 50 mg once daily with or without food.
Does Pristiq Cause Weight Changes?
Yes, weight changes from Pristiq are possible. This side effect was not reported in clinical trials. But Pristiq can cause reduced appetite, and when treating your depression symptoms your appetite or desire to exercise may change.
Which Antidepressants Cause the Fewest Side Effects?
SNRIs and SSRIs are antidepressants that cause the fewest side effects. These are newer classes of antidepressants and are often preferred for their milder side effects.
Which Antidepressants Cause the Most Side Effects?
Monoamine oxidase inhibitors (MAOIs), tetracyclic, and tricyclic antidepressants (TCAs) cause the most side effects. These are older classes of medication and are not first-line treatments for depression because they have more side effects than newer antidepressants.
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.
What’s the Number One Most Common Side Effect of Pristiq?
The most commonly reported side effect of Pristiq is nausea.1
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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Pristiq extended release – desvenlafaxine succinate tablet, extended release. (January 10, 2025). DailyMed.nlm.nih.gov. Retrieved from https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm
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Marken, P. A., & Munro, J. S. (2000). Selecting a Selective Serotonin Reuptake Inhibitor: Clinically Important Distinguishing Features. Primary Care Companion to the Journal of Clinical Psychiatry. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC181142/
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Liebowitz, M. R., Manley, A. L., Padmanabhan, S. K., Ganguly, R., Tummala, R., & Tourian, K. A. (2008). Efficacy, safety, and tolerability of desvenlafaxine 50 mg/day and 100 mg/day in outpatients with major depressive disorder. Current medical research and opinion, 24(7), 1877–1890. Retrieved from https://doi.org/10.1185/03007990802161923
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. Moved “Interactions With Pristiq”, “Pristiq Withdrawal”, and “Allergic Reactions” sections into new “What Are the Warnings & Risks for Pristiq” feature. Revised “Severe Side Effects of Trintellix” and “Other Warnings & Precautions For Taking Pristiq” to become the new “Warnings & Risks” feature. Added new section “How to Cope With Common Trintellix Side Effects” and “More Ways to Manage Pristiq Side Effects”, “Should I Stop Taking Pristiq If I Start Feeling Side Effects?”, “When Should I Seek an Alternative to Pristiq Due to Side Effects?”, “How to Get a Prescription for Pristiq or Alternative Medications” and all included subsections. Retitled “Questions to Ask Your Health Team” to “Questions to Ask Your Provider”. Replaced “Final Thoughts” with “Prescriber’s Tips” feature. Removed “For Further Reading”, Added FAQs.
Author: Christin Black, PharmD
Medical Reviewer: Dena Westphalen, PharmD
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