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Pristiq (Desvenlafaxine) Side Effects, Withdrawal and FAQs

Pristiq (desvenlafaxine) is an FDA approved SNRI drug in extended release, oral pill form for treating depression.
Pristiq acts aggressively on blocking serotonergic receptors at a ratio of ten to one over norepinephrine receptors. Stopping the drug suddenly carries certain risks to health.

Pristiq (desvenlafaxine) was initially approved for sale by the FDA in 2007 for the treatment of depression disorders. Because of the statistics relating to suicidality which have been well documented during many clinical trials both before and after the drug was first approved, Pristiq is not approved to be prescribed for children, teens, or young adults under the age of 25 due to increased risk of suicidality, i.e., suicidal thinking and behavior. (5)

Other risks are associated with Pristiq and other SNRI type antidepressant drugs and these should be carefully monitored, such as SEROTONIN SYNDROME and STEVENS-JOHNSON SYNDROME (see below for more detailed information) which are both extremely severe, though relatively rare reactions associated with Pristiq and other SNRI medications.

There are a wide range of additional side effects associated with Pristiq (desvenlafaxine) which you will find listed further down in this article. Not everyone who takes Pristiq suffers extreme side effects, and some people will experience none at all. However, some adverse reactions are life threatening and require medical intervention.

Where lingering and troublesome side effects occur these can lead to wanting to discontinue taking the drug. FDA guidelines are to reduce the drug as rapidly as possible, but not so quickly as to cause intolerable withdrawal symptoms. Doctors in the main are not well-prepared in helping their patients to taper off drugs as unfortunately there is little to no training on this subject given in medical school.

Where a person elects to stop taking an SNRI medication, or any medication, it is always wise to seek as much information as possible before beginning the process. We can provide much information on request which may help greatly in planning a safe and even relatively comfortable withdrawal from Pristiq. More information is given below on these and other related topics.

What is Pristiq (Desvenlafaxine) Used For?

Desvenlafaxine is the generic name for Pristiq, which is approved for the treatment of adult depression disorders.

The drug is also prescribed for a number of women’s health issues in particular, such as hot flashes associated with menopause, and for women who experience particularly difficult symptoms relating to the menstrual cycle.

Pristiq is considered to be a “non-hormonal” treatment where an alternative hormone treatment is sought to address vasomotor (relating to the muscles and nerves that regulate dilation and constriction of blood vessels) conditions relating to a woman’s menstrual cycle.

Pristiq (desvenlafaxine) is also prescribed for reducing pain associated with Fibromyalgia, however only a minority of Fibromyalgia patients continue SNRI drug treatment due to the  severity of side effects that outweigh any perceived benefits.  (1)

Pristiq (Desvenlafaxine) Alternative Names and Slang

Desvenlafaxine is the drug’s generic name. Brand names include:

  • Pristiq
  • Ellefore
  • Khedezia
  • Defaxin ER
  • Deslafax
  • Dvenjoy XR
  • Zyven OD

Pristiq is not known to be a popularized street drug, but has been found in relatively uncommon pharmaceutical drug diversion cases as with other antidepressants. Sometimes called “poor mans cocaine”, certain antidepressant prescription drugs are crushed and snorted or injected for a rush similar to other stimulant drugs like cocaine or crack. However, such practices often lead to a trip to the nearest hospital for emergency medical care.

Due to Pristiq’s extended release structure, it is less subject to abuse than immediate-release antidepressant drugs. Perhaps viewed by some as a deterrent, fillers used in prescription pills may be toxic to the skin when injected, leading to create very deep abscesses that are prone to infection, especially where neglect and poor hygiene can quickly escalate infection and lead to loss of life.

Pristiq (Desvenlafaxine) Side Effects

Severe side effects can occur with any SNRI drug, requiring medical intervention for the safety of the patient. It is important to be aware of these while taking an SNRI. Some of the most severe adverse reactions to be aware of are listed here:

  • SEROTONIN SYNDROME: When too much serotonin has been activated in the body this can result in a set of life-threatening symptoms including sudden fever, chills, depressed respiration, coma, unconsciousness and death.
  • STEVENS-JOHNSON SYNDROME: This is a severe hive-like reaction of the skin caused by certain medications such as Pristiq, which also targets moist tissues of the mouth, eyes, throat, airways, anus, etc. First presents with fever and flu-like symptoms, followed by the skin erupting into blisters that darken and peel away leaving raw painful tissue. Dehydration, sepsis, pneumonia, multiple organ failure associated with this condition can lead to death.
  • INCREASED SUICIDALITY: Pristiq causes suicidality in children, teens and young adults especially under the age of 25 and is therefore not prescribed. However, trials and statistics also show increased suicidality risk in older populations. (2)

Other common side effects include:

  • Nausea
  • Increased depression
  • Thoughts of self-harm
  • Unusual bleeding or bruising
  • Mydriasis (dilated pupils)
  • Headache
  • Tachycardia (rapid heart rate even at rest)
  • Irregular heartbeat, pounding heartbeat
  • Trouble speaking clearly
  • Chills
  • Cold sweats
  • Cognitive impairment, confusion
  • Swelling
  • Numbness
  • Shaking, tremor
  • Vomiting
  • Fatigue
  • Insomnia
  • Drowsiness
  • Sexual dysfunction
  • Anxiety
  • Hyperhidrosis (excessive sweating)
  • Constipation
  • Xerostomia (dry mouth due to dysfunctional saliva glands)

 

Pristiq (Desvenlafaxine) Withdrawal Symptoms

Never abruptly stop taking Pristiq, as according to the FDA and other regulatory bodies rapid or abrupt cessation can be extremely difficult to endure, and sometimes life-threatening.

Withdrawal symptoms from Pristiq (desvenlafaxine) even when tapering slowly can be extremely hard to tolerate, and therefore need to be closely monitored. Some persons will have an easier time if tapering is done in an inpatient style program that can offer enough support and adjunctive therapies to significantly reduce the discomfort that can otherwise accompany cessation.

Some common withdrawals include:

  • dizziness
  • headache
  • insomnia
  • vivid dreams and nightmares
  • weakness
  • irritability
  • nausea
  • vomiting
  • prickling sensations on the skin
  • depression and anxiety.

Discontinuing/Quitting Pristiq (Desvenlafaxine)

Because Pristiq (desvenlafaxine) is a timed-release medication, it may be prudent in some cases to consider cross-tapering. Clinical expertise is essential for this method of tapering to be done correctly, but choosing this option may ultimately prove to be considerably easier on the patient.

Cross-tapering should only be done in an inpatient setting where close monitoring is possible. In this way one can avoid any risks that can be associated with incorrect dosages, inappropriate drug interactions, or switching medications too abruptly.

It is recommended that a center be chosen that has demonstrated competence and familiarity with how to successfully negotiate through the cessation process so the withdrawals can be significantly mitigated. Done well, correct and exact tapering supplemented with neurobiophysical and social support, can be surprisingly mild.

Pristiq (Desvenlafaxine) FAQs

Below are some of the most common questions regarding Pristiq (desvenlafaxine).

If you have other questions, more information is freely available on request if you need further knowledge on these or other topics.

What does Pristiq do to your brain?

It is thought that an SNRI drug affects two types of chemicals that act as messengers within the brain and central nervous system. One of these is serotonin, a neurochemical that is responsible for regulating things like mood, sexual function, digestion, memory and other functions of health. Serotonin is an inhibitory agent that allows us to relax the fight or flight responses, so that these activities are possible.

The other neurochemical that SNRI drugs affect is norepinephrine, which is a direct precursor to adrenaline, the fight or flight response neurotransmitter. Norepinephrine is associated with mental focus and learning, yet too much of it clinically demonstrates as anxiety.

SNRI drugs keep serotonin and norepinephrine suspended in the nerve synapses, instead of allowing them to be reabsorbed into the nerve pathway. When these agents accumulate, they act more intensely, sometimes with unpredictable results.

However, these natural chemicals will eventually degrade and become inactive, instead of being reabsorbed and recycled ready to be used again. This may result in a deficiency as Pristiq does not create more serotonin or norepinephrine, only a health body can do that. This is another mechanism for drugs to have diminished efficacy. (3)

Is Pristiq Different Than Effexor?

Pristiq and Effexor are similar drugs, but are not exactly the same.

Similarities: Pristiq is a time-release drug, and EffexorXR is also a time-release drug. Both drugs share similar side effects.  Both drugs have a black box warning regarding suicide and other risks. Because they are both SNRI drugs they share the mechanism of action on serotonin and norepinephrine, almost identically.  Effexor immediate-release is no longer marketed in the US, but is available in some other countries.

Differences: Pristiq is prescribed for MDD (major depression disorder); Effexor is prescribed for various depression disorders as well as anxiety disorders such as SAD, PD (panic disorder), and anxiety GAD (generalized anxiety disorder). Another difference is that at a lower than 75mg dose, Effexor acts more primarily as an SSRI.  Pristiq has no similar dose-response relationship and acts as an SNRI whether taken in 50mg or 100mg doses. (4)

Does Pristiq Increase Blood Pressure?

Yes. Pristiq (desvenlafaxine) can increase blood pressure. If you already have high blood pressure, you should make sure it is well under control before you start taking a prescription of desvenlafaxine.

Symptoms of high blood pressure can be completely non-existent, even thought the condition exists. So it is wise to have this checked especially before taking medications that can increase hypertension.

Where symptoms of HBP are noticeable, they can include severe headaches, pounding in the chest, ears or in the neck area, confusion, shortness of breath, fatigue, irregular heartbeat, blood in urine, vision problems and pain in chest area. Uncontrolled high blood pressure can lead to serious health risks such as internal tissue damage, stroke or kidney failure.

Treatment for Pristiq (Desvenlafaxine) Abuse and Addiction?

When deciding to come off a drug such as Pristiq, one would be well-advised to choose to work with medical professionals who are familiar with methods and procedures which can mitigate withdrawal adverse effects to have the best chance of success with cessation.

If the taper is too fast, there is a high risk for relapse, and lengthening the overall process. If the taper is too difficult, even if slowly done, and no other guidance or support of any kind is offered, it can be extremely hard to carry through as the symptoms can be intolerable.

However, Pristiq withdrawal can be made much easier to tolerate by choosing inpatient treatment, where constant monitoring is routine, and minute changes to dosage may be helpful within a taper schedule designed to fit the unique and most pertinent needs of an individual.

Our center uses lab testing to help prepare the body for the taper. If vitamin or mineral deficiencies are present, these can be corrected through supplementation and carefully planned diet for maximizing the body’s ability to normalize neurochemistry after prescription drugs have created changes that altered or compromised it.

The presence of neurotoxic materials can have a detrimental effect on the central nervous system. Such symptoms as insomnia, depression and anxiety are linked to certain toxic substances found in heavy metals, pesticides, chemicals in foods, and many other sources. These, however prevalent in our modern lifestyles, can be isolated and gently purged, as a very effective way to prepare for a smooth taper.

Much more information is available on request on our center’s safe methods, therapies, diet, nutrition, and many more helpful techniques that can significantly ease the withdrawal process.


This content has been reviewed, and approved by a licensed physician.

Dr. John Motl, M.D.

Dr Motl is currently certified by the American Board of Psychiatry and Neurology in Psychiatry, and Board eligible in Neurology and licensed in the state of Arizona.  He holds a Bachelor’s of Science degree with a major in biology and minors in chemistry and philosophy. He graduated Creighton University School of Medicine with a Doctor of Medicine.  Dr. Motl has studied Medical Acupuncture at the Colorado School of Traditional Chinese Medicine and at U.C.L.A.

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