Pristiq

Pristiq (desvenlafaxine) is an SNRI antidepressant approved by the FDA to treat MDD (Major Depressive Disorder) in adults. It works by enhancing the levels of norepinephrine & serotonin in the brain, chemicals that help regulate mood and emotional balance. Pristiq is available in extended-release tablets of 25 mg, 50 mg, and 100 mg strengths. While effective for depression, it can cause side effects such as nausea, dizziness, and insomnia. It’s essential to follow your doctor’s dosage instructions and discuss any other medications or supplements you’re taking to avoid interactions. Pristiq is not suitable for everyone, especially those with certain medical conditions.

Pristiq (desvenlafaxine) is classified as a serotonin-norepinephrine reuptake inhibitor (SNRI), a group of antidepressants that function by increasing the levels of serotonin & norepinephrine in the brain. These neurotransmitters are crucial in regulating mood, anxiety, and overall emotional balance, making SNRIs effective in treating major depressive disorder (MDD) in adults. Pristiq is administered as an extended-release tablet & is available in 3 strengths- 25 mg, 50 mg, & 100 mg. The recommended starting dosage for treating MDD is 50 mg once daily, with a maximum allowable dose of 400 mg per day.

Higher doses do not necessarily increase effectiveness and are more likely to cause side effects such as nausea, dizziness, insomnia, and sexual problems. Therefore, adhering to the prescribed Pristiq dosage and duration is essential, and any adjustments should be made under medical supervision. Pristiq is contraindicated in individuals with allergies to desvenlafaxine, venlafaxine, or any excipients in the medication. It should also be avoided by those who have taken MAOIs in the past 14 days or are currently being treated with linezolid or methylene blue due to the chance of serotonin syndrome. Other contraindications include a history of high blood pressure, heart disease, stroke, seizures, bipolar disorder, and certain metabolic conditions.

Interactions with other medications, especially other antidepressants, diuretics, lithium, and specific pain medications, can increase the chance of serotonin syndrome or other serious side effects. Therefore, discussing all medications & supplements with a healthcare provider is crucial. Additionally, Pristiq can pass into breast milk, and its safety during pregnancy is not well-established, necessitating thorough consultation with a doctor. Proper storage and disposal of Pristiq are also important to prevent accidental ingestion and environmental harm.

• Pristiq is approved to treat adults with major depressive disorder (MDD), commonly referred to as simply depression or clinical depression.
• Pristiq can be used off-label for the following conditions:
• To treat menopausal symptoms
• To treat anxiety and social anxiety disorder
• To treat OCD (obsessive-compulsive disorder)
• To treat bipolar disorder
• To treat some types of pain, include fibromyalgia & nerve pain

Dosage

It comes in the form of extended-release tablets and has three strengths:

• Pristiq 25 mg tablets
• Pristiq 50 mg tablets
• Pristiq 100 mg tablets

Recommended Dosage for Different Patients

Dosage for Major Depressive Disorder Using Pristiq

• Recommended Starting Dosage: The initial dose for treating major depressive disorder with Pristiq is 50 mg taken orally once daily.
• Consistency in Dosing: It is advisable to take your dose at the same time each day to maintain levels of medication in your body consistently.
• Duration of Treatment: Continue taking 50 mg each day as long as prescribed by your doctor.
• Maximum Dosage: The maximum allowable dose of Pristiq is 400 mg per day. However, if you have liver or kidney issues, your doctor may prescribe a lower maximum dosage.

Dosages higher than 50 mg daily have not shown increased effectiveness in treating depression. Moreover, higher dosages are more likely to cause side effects.

[Note: Remember that the above recommendations may vary from person to person. It is important to discuss it with your doctor, and they’ll customize your Pristiq dosage accordingly.]

• Take Pristiq once each day.
• You can take it at any time of the day but try to take it at the same time every day.
• Set a reminder on your phone or use a medication timer to help ensure you don’t miss a dose.
• Swallow Pristiq tablets whole with a glass full of water. Do not crush, break, chew, or dissolve the tablets.
• Pristiq is an extended-release tablet designed to release medication slowly. Damaging the tablet (by splitting, crushing, chewing, or dissolving) will interfere with this mechanism.
• Pristiq is designed to be used as a long-term medication for managing depression.
• After your depression symptoms improve, it’s recommended to continue taking your antidepressant for 4 to 9 months to help prevent a relapse.
• Continuing treatment with Pristiq can significantly lower the risk of your depression returning.
• Some individuals, especially those with multiple past episodes of depression or a history of mental health issues, are more susceptible to recurrent depression.
• If you are at higher risk, it may be beneficial to use antidepressants for an extended period before considering discontinuation.
• If Pristiq proves safe and effective for you, your doctor may recommend that you continue taking it for the long term.
• The decision of the doctor will be based on a careful assessment of your personal health history and ongoing response to the medication.

[Note: Your doctor will decide the accurate amount of Pristiq for you based on your condition, following guidelines & studies on the drug. They’ll adjust it as needed over time.]

Pristiq belongs to a class of antidepressants known as serotonin-norepinephrine reuptake inhibitors (SNRIs). This class of medication is a group of drugs that works in a similar manner. SNRIs work by increasing the levels of serotonin and norepinephrine in the brain. These neurotransmitters are chemical substances that regulate your mood. By increasing their levels, SNRIs can gradually improve symptoms of depression.

It’s important to understand that Pristiq is not designed to change your personality or make you feel instantly happy. Instead, its purpose is to gradually correct the chemical imbalances in the human brain that contribute to depression. This process takes time, and Pristiq is meant to work slowly and steadily to alleviate your symptoms. Generally, it can take between two to four weeks for Pristiq to begin showing effects and for you to start feeling better. During this period, you might notice improvements in specific areas such as appetite, sleep, and concentration before observing significant changes in your overall mood. These early signs are an indication that the medication is beginning to take effect.

Common side effects of Pristiq may include:

• Sexual Problems include difficulty achieving an erection, a reduced sex drive, and problems having an orgasm.
• Nausea
• Fatigue
• Dry Mouth
• Dizziness
• Constipation
• Sweating
• Reduced Appetite
• Insomnia
• Sleepiness (avoid driving or operating heavy machinery)
• Anxiety

Serious side effects of Pristiq may include:

• Seizures symptoms may consist of the following:
  • Sudden eye movements
  • Loss of bowel or bladder control
  • Uncontrolled muscle spasms
  • Drooling
  • Loss of consciousness
• Serotonin syndrome symptoms may consist of the following:
  • Nausea or vomiting
  • Seizures
  • Diarrhea
  • Stiff muscles
  • Flushing
  • Coma
  • Tremor or twitching
  • Sweating
  • Dizziness
  • Agitation
  • Hallucinations (hearing or seeing things that are not real)
  • Fast heartbeat
  • Loss of coordination
• Suicidal thoughts & behaviors in children & young adults symptoms may consist of the following:
  • New or worsening anxiety or panic attacks
  • Thoughts about dying or harming yourself
  • Acting on impulses without thinking much about the severe consequences
  • Being irritable, angry, or aggressive
  • New or worsening insomnia
  • Extreme levels of excitement & activity or talking very fast may all be considered symptoms of mania
  • Attempting suicide
  • Worsening depression
  • Feeling very agitated, restless, or unable to be still
• Bleeding more easily than usual. Symptoms may consist of the following:
  • Nosebleeds
  • Bloody stools
  • Black-colored stools, which may look like tar
  • Vomiting up blood, which can look red or pink in color
  • Bruising easily
• New or worsened high blood pressure symptoms may consist of the following:
  • Chest pain
  • Headache
• Closed-angle glaucoma symptoms may consist of the following:
  • Sudden severe headache
  • Nausea
  • Eye pain or redness
  • Blurred vision
  • Seeing halos around lights
• Lung problems symptoms may consist of the following:
  • Cough
  • Trouble breathing
  • Chest discomfort
• The low sodium level in your blood symptoms may consist of the following:
  • Hallucinations
  • Seizures
  • Feeling weak & unsteady, which could lead to falls
  • Headache
  • Confusion
  • Trouble concentrating
  • Fainting
  • Problems with your memory
• Severe allergic reactions

[Note: This list may not cover all side effects of Pristiq. Always consult with your doctor or healthcare giver for medical advice about side effects.]

• Stopping Pristiq Suddenly and Withdrawal Symptoms: It’s important not to stop taking Pristiq abruptly due to the risk of withdrawal symptoms. Your doctor can recommend tapering off the medication slowly over several months to minimize these symptoms. In some instances, stopping Pristiq can lead to severe symptoms, including suicidal thoughts and behaviors. These severe reactions have been reported post-approval of the drug. If you and your doctor decide it’s time to stop taking Pristiq, doing so gradually will help manage and potentially prevent withdrawal symptoms. Your doctor will provide specific guidelines or instructions on how to reduce your dosage step-by-step to ensure a safer discontinuation process. Examples of withdrawal symptoms from sudden discontinuation of Pristiq include:
  • Sensations of pins & needles or electric shocks
  • Sweating
  • Confusion
  • Anxiety
  • Low energy levels, physically or mentally
  • Abnormal dreams
  • Headache
  • Insomnia
  • Seizures
  • Tinnitus (ringing or other various noises in the ears)
  • Mood changes
  • Dizziness
  • Diarrhea
  • Tremor
  • Nausea
  • Irritability or agitation

Pristiq Boxed Warning

FDA Warning of Suicidal Thoughts and Actions: Pristiq carries a boxed warning, the most serious warning issued by the FDA. This warning is meant to alert both healthcare providers and patients to the potential risks of dangerous side effects.

• Increased Risk for Young People: Antidepressants like Pristiq can increase the risk of suicidal thoughts & actions in children, teenagers, and young adults under the age of 25. This risk is especially heightened during the initial months of treatment or following any changes in dosage.
• Age Restrictions: Pristiq is not approved for use in children under 18 years of age.

Be vigilant for any signs that your depression is becoming more severe. Immediately report any abrupt changes in behaviors, mood, thoughts, or feelings to your doctor. Alert your doctor right away if you have thoughts of harming yourself or if you attempt suicide. This FDA warning underscores the importance of careful monitoring and communication with your healthcare provider while taking Pristiq, especially if you fall within the age group at higher risk.

Before starting Pristiq, it’s important to discuss your health history with your doctor, as Pristiq may not be suitable for everyone, especially if you have certain medical conditions or health factors. Here are some key considerations:

• High Blood Pressure: Pristiq can raise blood pressure. If you have high blood pressure, you may need to manage it with medication before starting Pristiq. Regular blood pressure monitoring will be necessary, and dosage adjustments may be required if blood pressure remains elevated.
• Allergy to Venlafaxine or Desvenlafaxine: If you are allergic to desvenlafaxine (the active ingredient in Pristiq) or venlafaxine (Effexor), you should not take Pristiq. Inform your doctor about any medication allergies before beginning Pristiq.
• Heart Disease: Elevated blood pressure from Pristiq can worsen existing heart conditions. Your doctor will check your blood pressure & review your heart health history before prescribing Pristiq.
• Bipolar Disorder, Mania, or Hypomania: Pristiq tablets may not be safe for those with a history of these conditions as they can trigger manic episodes in people with bipolar disorder. Discuss any mental health history with your doctor.
• Stroke or Mini-Stroke: A history of strokes may increase the risk of a stroke when taking Pristiq due to its potential to raise blood pressure. Regular blood pressure monitoring will be required.
• Epilepsy or Seizure Conditions: Pristiq has not been studied in people with a history of seizures. If you have epilepsy or seizures, your doctor will determine if Pristiq is appropriate and will monitor your condition closely.
• Low Sodium Levels: Pristiq can lower sodium levels, especially in older adults and those taking diuretics. Inform your doctor if you have a history of low sodium levels or if you are taking diuretics.
• Bleeding Problems: Pristiq can increase bleeding risks. Discuss any history of bleeding issues with your doctor.
• High Cholesterol or Triglycerides: Pristiq can raise cholesterol or triglyceride levels. If you already have high levels, you may need regular blood tests during treatment to monitor this.
• Liver Problems: Similarly, liver issues can impact Pristiq metabolism. If you have moderate to severe liver problems, your dosage may need to be adjusted. Talk to your doctor about any liver conditions.
• Kidney Problems: Reduced kidney function can affect how Pristiq is cleared from your body. Dosage adjustments will be necessary for moderate to severe kidney issues. Discuss any kidney conditions with your doctor.

Other Important Precautions

• • Alcohol: It’s advisable to avoid drinking alcohol while taking Pristiq. Alcohol can heighten the risk of experiencing side effects from Pristiq, including experiencing sexual problems, feeling sleepy or drowsy, and dizziness. Additionally, drinking alcohol can exacerbate the symptoms of depression, potentially undermining the effectiveness of your treatment with Pristiq. If you currently drink alcohol, it’s important to discuss this with your doctor. They can advise whether it is safe for you to continue consuming alcohol while on this medication and help you understand the possible risks involved.
• Risks of Using Pristiq During Pregnancy
• • Increased Risk of Preeclampsia: Research indicates that individuals taking venlafaxine during pregnancy may face a higher risk of developing preeclampsia, a condition characterized by high blood pressure that can arise during or shortly after pregnancy.
  • Increased Risk of Bleeding: There is also an elevated risk of bleeding during and after delivery for those who take venlafaxine close to their delivery date.
  • Potential Neonatal Complications: Newborns whose birthing parents have taken venlafaxine or Pristiq may face several complications, including issues with:
    • Breathing
    • Feeding
    • Maintaining body temperature
    • Regulating blood sugar
  • Considering Untreated Depression: It’s crucial to balance these risks against the consequences of untreated depression during pregnancy, which can also lead to serious outcomes for both the pregnant individual and the baby. Untreated depression can affect the ability to care for oneself during pregnancy and impact postpartum bonding and care.
• Birth Control: Since it’s not well-established whether Pristiq is safe during pregnancy if you are sexually active and there’s a possibility of pregnancy, it’s crucial to have a conversation with your doctor or healthcare professional about effective birth control options while using Pristiq. This is important to prevent an unintended pregnancy during treatment, given the uncertainties surrounding the medication’s safety for pregnant individuals.
• Breastfeeding: Pristiq is known to pass into breast milk, albeit in small amounts. Although one small study did not find any significant adverse effects in children breastfed by individuals taking Pristiq, the data from this study are not enough to conclusively determine the safety of Pristiq during breastfeeding. Larger, more comprehensive studies are needed to better understand the potential impacts.

Pristiq should not be used in individuals who:

• Have an allergy to venlafaxine, desvenlafaxine, or any of the excipients in Pristiq.
• Have taken a monoamine oxidase inhibitor for psychiatric indications in the last 14 days.
• Are being treated with medications like linezolid or methylene blue.

• If you forget to consume a dose of Pristiq tablet at your usual time, take it as soon as you remember.
• If it’s almost time for your next scheduled Pristiq dose, you can skip the missed dose. Do not double up; simply continue with your regular dosing schedule.
• Never take more than one dose at a time to compensate for a missed one. This can increase your chances of experiencing severe side effects.
• Use your phone to set a reminder that aligns with your dosing schedule.
• Consider using a medication timer as a backup to ensure you don’t miss your doses of Pristiq.

[Note: If you have missed a Pristiq dose and are unsure about when to take the next dose, immediately consult your doctor or pharmacist.]

Taking more than the recommended dosage of Pristiq can result in serious & potentially life-threatening side effects. If you or someone else has overdosed on Pristiq, it is crucial to recognize the symptoms and respond promptly. Symptoms of a Pristiq overdose may include:

• Fast heartbeat
• Larger-than-normal pupils
• Vomiting
• Unusual sleepiness or drowsiness
• Seizures
• Heart rhythm changes
• Low blood pressure
• Dizziness
• Muscle aches and pains
• Coma

If you suspect an overdose of Pristiq, contact your doctor immediately for guidance. In cases where symptoms are severe, such as seizures or loss of consciousness, you can call 911 or go to the nearest emergency room without delay. Quick medical intervention is essential in managing the effects of an overdose.

[Note: If you consumed or taken more than the recommended dose of Pristiq, get medical help quickly or call the Poison Help line at 1-800-222-1222.]

• Store at room temperature.
• Keep in a tightly sealed container.
• Protect from light.
• Do not store Pristiq at temperatures above 86°F (30°C).
• Avoid storing in damp or wet areas, such as bathrooms.
• Dispose of leftover medication safely.
• Prevent accidental ingestion by pets, children, or others.
• Help save the environment by ensuring proper disposal.

[Note: Discuss with your healthcare professional or doctor about the proper disposal of unused medicine & any questions you may have regarding its storage.]

Pristiq can interact with a variety of other medications and supplements, potentially affecting how well it works or increasing the likelihood of side effects.

Interactions Between Pristiq and Other Medications

Discuss all medications, both prescription & over-the-counter, as well as any supplements and herbs you are taking, with your doctor and pharmacist. This discussion will help avoid potentially harmful interactions. If you have any specific concerns or queries about drug interactions that might affect you, make sure to raise these with your healthcare provider. Being proactive about communicating with your healthcare providers and informing them of all substances you take can help manage your treatment effectively and safely.

Interactions with Other Antidepressants: Taking Pristiq in combination with certain other antidepressants can significantly increase your risk of having serotonin syndrome, a serious condition characterized by excessively high levels of the neurotransmitter serotonin in the brain. Antidepressants that may also increase the risk of serotonin syndrome when taken with Pristiq include:

• Other Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) besides Pristiq, such as:
  • Effexor XR (venlafaxine)
  • Cymbalta (duloxetine)
• Selective Serotonin Reuptake Inhibitors (SSRIs) such as:
  • Paxil (paroxetine)
  • Prozac (fluoxetine)
  • Zoloft (sertraline)
  • Pexeva (paroxetine)
  • Brisdelle (paroxetine)
• Tricyclic Antidepressants (TCAs) such as:
  • Norpramin (desipramine)
  • Amitriptyline
  • Tofranil (imipramine)

Additionally, taking SSRIs or other SNRIs with Pristiq can also raise your risk of bleeding problems due to the enhanced effects of platelet aggregation.

Interactions with Diuretics: Taking diuretic medications with Pristiq may increase the risk of hyponatremia, a condition characterized by a lower level of sodium in the blood. Both diuretics and Pristiq can cause sodium levels to drop, which can lead to various symptoms. Examples of diuretic medications that can increase your risk for hyponatremia include:

• Lasix (furosemide)
• Naturetin (bendroflumethiazide)
• Hydrochlorothiazide

If you are using a diuretic, discuss this with your doctor before beginning treatment with Pristiq. It may be necessary to conduct blood tests to monitor your sodium levels. Be vigilant for any symptoms of low blood sodium, which can include:

• Difficulty concentrating
• Headaches
• Memory issues
• Weakness or unsteadiness
• Confusion

Interactions with Lithium: Combining Pristiq with lithium (Lithobid) can elevate your risk of developing serotonin syndrome. Both Pristiq and lithium work to increase serotonin levels, which can lead to potentially life-threatening outcomes if they become too high. If you are currently taking lithium, it is important to discuss this with your doctor before starting Pristiq. Your doctor might suggest alternative treatments or closely monitor you for signs of serotonin syndrome if combining these medications is deemed necessary.

Interactions with Linezolid or Methylene Blue: Do not take Pristiq if you are being treated with linezolid (Zyvox) or methylene blue (Provayblue). Using Pristiq in conjunction with these medications can greatly increase your risk of developing serotonin syndrome. This condition, characterized by dangerously high levels of the neurotransmitter serotonin in the brain, can be life-threatening. 

Both Pristiq and these medications individually elevate serotonin levels. When taken together, they can cause an excessive increase in serotonin. If you require treatment with linezolid or methylene blue, you will need to discontinue Pristiq. You should only resume Pristiq 24 hours after the last dose of methylene blue or linezolid, under close medical supervision, for any signs of serotonin syndrome.

Interactions with MAOI Antidepressants: Similarly, combining Pristiq with any monoamine oxidase inhibitor (MAOI) can lead to a high risk of serotonin syndrome. MAOIs are a class of antidepressants that also increase serotonin levels in the brain, just like Pristiq. It is crucial not to take Pristiq if you have taken an MAOI within the past 14 days. Conversely, you should not start an MAOI until at least 7 days have elapsed since stopping Pristiq. Examples of MAOIs that should not be combined with Pristiq include:

• Emsam (selegiline)
• Nardil (phenelzine)
• Marplan (isocarboxazid)
• Parnate (tranylcypromine)

Interactions with Buspirone: Similarly, taking Pristiq with Buspirone, which is often prescribed for anxiety, also increases the risk of serotonin syndrome due to both drugs raising serotonin levels. If you are taking buspirone, make sure to consult with your doctor before beginning treatment with Pristiq. Depending on your medical history & current condition, your doctor may recommend a different medication for treating your anxiety to avoid the risk of serotonin syndrome.

Interactions with Certain Pain Medications: Similarly, taking Pristiq with certain pain medications like tramadol (Ultram, ConZip) or fentanyl (Subsys, Duragesic, Actiq, & others) also increases the risk of serotonin syndrome, as these medications also elevate serotonin levels. If you are taking tramadol or fentanyl for pain management, it is crucial to consult your doctor before starting Pristiq. Your doctor might suggest switching to a different pain medication that does not interact with Pristiq in the same way.

Interactions with Triptan Medications for Migraine: Taking Pristiq in conjunction with triptan medications, which are used to treat migraines and cluster headaches, can significantly increase your risk of developing serotonin syndrome. This condition results from excessively high levels of serotonin in the brain and can be life-threatening. Examples of triptan medications that can increase your risk of serotonin syndrome when taken with Pristiq include:

• Relpax (eletriptan)
• Maxalt (rizatriptan)
• Axert (almotriptan)
• Zomig (zolmitriptan)
• Imitrex (sumatriptan)
• Amerge (naratriptan)
• Frova (frovatriptan)

If you are currently taking any triptan medications, discuss this with your doctor before starting Pristiq. Your doctor may recommend alternative medications to manage your migraines or headaches to avoid the risk of serotonin syndrome.

Interactions with Amphetamine Drugs: Combining Pristiq with amphetamine drugs, including Adderall, can increase your risk of a serious condition called serotonin syndrome. This dangerous condition arises when levels of the neurotransmitter serotonin become excessively high in the body. Both Pristiq and amphetamines contribute to increased serotonin levels. Examples of amphetamine drugs that can elevate your risk of serotonin syndrome when used with Pristiq include:

• Adderall (amphetamine and dextroamphetamine)
• Desoxyn (methamphetamine)
• Dexedrine (dextroamphetamine)
• Mydayis (amphetamine and dextroamphetamine)
• Evekeo (amphetamine)
• Adzenys (amphetamine)
• Dynavel (amphetamine)

If you are currently taking any amphetamine drugs, it’s crucial to consult your pharmacist before starting Pristiq. Your healthcare professional might suggest an alternative medication that does not have the same risk of increasing serotonin levels.

Interactions with Anticoagulant Drugs: Anticoagulants are used to treat or prevent blood clots. Taking Pristiq with anticoagulant drugs can significantly increase your risk of bleeding. Examples of anticoagulant drugs that may increase your risk of bleeding when taken with Pristiq include:

• Xarelto (rivaroxaban)
• Pradaxa (dabigatran)
• Eliquis (apixaban)
• Savaysa (edoxaban)
• Coumadin (warfarin)

If you are taking any anticoagulant medication, it is important to talk with your healthcare professional before starting Pristiq. Your doctor may recommend extra monitoring for signs of abnormal bleeding. Report any unusual bruising or severe bleeding to your doctor immediately.

Interactions with Anti-Inflammatory Drugs: Taking nonsteroidal anti-inflammatory drugs (NSAIDs) with Pristiq can also increase your risk of bleeding, particularly in the stomach & intestines. Examples of NSAIDs that may raise your risk of bleeding when taken with Pristiq include:

• Motrin (ibuprofen)
• Aleve (naproxen)
• Zorvolex (diclofenac)
• Advil (ibuprofen)
• Ibu-tab (ibuprofen)
• Zipsor (diclofenac)
• Naprosyn (naproxen)
• Ketoprofen

If you’re taking any NSAIDs, discuss this with your doctor prior to starting treatment with Pristiq. Depending on your health profile and the necessity of NSAID therapy, your doctor may suggest different pain management options. If you do take NSAIDs while on Pristiq, be vigilant for any signs of unusual bruising or bleeding. Contact your doctor quickly if you are experiencing blood in your vomit or stools, as these can be signs of serious bleeding issues.

Interactions Between Pristiq & Herbs or Supplements

When taking Pristiq, it’s important to consider how herbs and supplements might interact with this medication. Certain natural products can influence the effectiveness of Pristiq or increase the risk of side effects. Always discuss any supplements or herbal remedies you are considering or currently taking with your doctor or pharmacist.

• Interactions with Tryptophan: Similarly, tryptophan supplements should be avoided while taking Pristiq. Tryptophan is an amino acid that works as a precursor to serotonin. Supplementing with tryptophan while on Pristiq can also lead to excessive serotonin levels and increase the risk of serotonin syndrome.
• Interactions with St. John’s Wort: St. John’s wort, scientifically known as Hypericum perforatum, should not be taken in conjunction with Pristiq. This herb is commonly used for its antidepressant effects but can dangerously increase serotonin levels when combined with Pristiq, leading to a condition known as serotonin syndrome. Serotonin Syndrome is a potentially life-threatening state where excessive serotonin accumulates in the body, leading to symptoms such as:
  • Diarrhea
  • Confusion
  • Rapid heart rate and high blood pressure
  • Heavy sweating
  • Loss of muscle coordination or twitching muscles
  • Agitation or restlessness
  • Shivering
  • Muscle rigidity
  • Goosebumps
  • Headache
  • Dilated pupils

If you are using any herbs or supplements, particularly those known to affect serotonin levels, discuss these with your healthcare provider before starting Pristiq. Your doctor may suggest alternatives or closely monitor you for any signs of adverse reactions. This careful management helps prevent interactions and ensures the safe use of your medications.

[Note: This isn’t a complete list of interactions, and there could be other drugs that interact with Pristiq. Make sure to tell your doctor or healthcare professional about any prescription, over-the-counter medicines, and herbal products you’re taking.]

• Trazodone
• Tofranil (imipramine)
• Abilify (aripiprazole)
• Wellbutrin SR
• Pristiq (desvenlafaxine)
• Eldepryl (selegiline)
• Cymbalta (duloxetine) SNRI
• Paxil (paroxetine)
• Serzone (nefazodone)
• Lexapro (escitalopram)
• Amitriptyline HCl
• Nardil (phenelzine)
• Zoloft (sertraline)
• Viibryd (vilazodone)
• Trintellix (vortioxetine)
• Pamelor (nortriptyline)
• Norpramin (desipramine)
• Surmontil (trimipramine)
• Remeron (mirtazapine)
• Anafranil (clomipramine)
• Parnate (tranylcypromine)
• Celexa (citalopram)
• Protriptyline HCl

[Note: Your doctor or healthcare professional will choose what’s best for you. Don’t use any of these alternative medications of Pristiq without consulting your doctor. Taking them by yourself may cause severe side effects.]

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