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Pristiq Tapering

This entry was posted in Antidepressant on by .
Medically Reviewed Fact Checked

Last Updated on August 3, 2022 by Carol Gillette

Alternative to Meds Editorial Team
Medically Reviewed by Dr Samuel Lee MD

Pristiq tapering, weaning, and titration may need an in-patient setting. For medication-sensitive individuals, it may be more helpful to address root causes for symptoms as well as provide very gentle tapering protocols.

Pfizer’s patent on Pristiq ran out in 2017 but generic versions (desvenlafaxine) of this SNRI drug are still sold.

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Top 10 Reasons for Pristiq Titration

  • The drug no longer provides relief.
  • Planning pregnancy and wish to be drug-free for the safety of the baby.3
  • Concerns about serotonin syndrome.
  • Suicidal thoughts, thoughts of self-harm*
  • Concerns over potential cardiac events.
  • Increased bleeding, and potential gastrointestinal hemorrhage.
  • High blood pressure.
  • Changes in behavior.
  • Potential for seizures.
  • Worsened depression, and other undesirable drug side effects.4

*Pristiq presented a heightened risk to those under the age of 25 in clinical trials, and FDA issued a black box warning prohibiting prescribing the drug to that age range.1

Other adverse effects:  pneumonia, mania, dizziness, nausea, vomiting, blurred vision, and insomnia. These are some of the many side effects that may overshadow any positive effects that a person may have hoped to receive from taking Pristiq.

When these side effects become too harsh to endure, a person may decide that getting off Pristiq is the most logical step to take. In Tourian’s 2011 study, published in the Primary Care Companion for CNS Disorders, the majority who dropped out of the drug trials opted to do so to avoid the harsh adverse effects of Pristiq.4

Pristiq Discontinuation Syndrome

pristiq discontinuation syndromeSNRI drugs manipulate the distribution of certain natural hormones and transmitters. Rantamaki’s research from 2016 concluded that despite a marked deficiency in understanding of what antidepressants do to the CNS and brain chemistry, their therapeutic effects are only temporary.6  Addressing psychosocial, dietary, and other challenges can play a significant role in the treatment of depression or other symptoms.

In addition to lack of efficacy, trying to stop taking SNRI medication can produce what is called discontinuation syndrome when a person stops the drug. The most common symptoms of Pristiq discontinuation syndrome are both physical and mental. Physical symptoms can include nausea, headache, fatigue, diarrhea, profuse sweating, and dizziness. Psychological symptoms include irritability, anxiety, and abnormal dreams. Studies show that discontinuation is associated with these symptoms whether the drug was taken short-term or long-term. 7

Pristiq Tapering Guidelines and Schedule

Never abruptly stop taking an SNRI drug such as Pristiq. Drug-makers and regulatory agencies do not understand how the drug works exactly, and seem to understand even less about stopping them safely.2

The guidance which follows is given in the context of consulting with your prescribing physician before implementing anything here on your own.

Pristiq Tapering Guidelines Include:
  • pristiq tapering guidelinesHave your doctor help with how to cut the dosage which may involve actually cutting the pills. In the case of Pristiq, the lowest dosage is the 25mg tan-colored squares. The tablets can be cut in half when needed providing a 12.5mg option. When these tablets are cut they become no longer extended-release. Desvenlafaxine (immediate-release) has a short half-life of 11 hours,8 but Pristiq is contained in a time-release format designed to release over a 24-hour period. The longer the half-life, the slower the medication will leave your body, which, generally speaking, makes the tapering easier. Also worth noting, if there is hepatic (liver) impairment, the half-life can be 13 or 14 hours. These factors can complicate the withdrawal. Do get medical advice before attempting this on your own.
  • Serotonin syndrome: Be alert for severe adverse reactions from excess serotonin, whether from drug interactions or from other unknown causes. Seek immediate medical help if sudden changes occur such as rash, fever, racing heart, a sudden increase in blood pressure, confusion, difficulty breathing, agitation, anxiety, muscle stiffness, and diarrhea. Untreated, serotonin syndrome can be life-threatening.9,11
  • You can cut the 25mg pills in half for smaller dosing. You can even try to cut them into quarters if truly necessary. A half pill would be 12.5mg and a quarter would be 6.75mg. This will lose the time-released attribute and so the half-life will be even shorter than the expected 11 hours.
  • Tapering should be gradual, say 10% or 25% depending on tolerance, and monitor sensitivity. Adjust as needed. Withdrawals will generally appear 1 to 3 days after each dosage reduction.
  • Withdrawal symptoms generally emerge within the drug’s half-life range. In this case, the elimination half-life is about 11 hours depending on individual variability and the format of the medication itself.8 Onset of Pristiq withdrawal after making a cut may be felt within the first 24 hours and may escalate the following 2 days after. Talk to your medical practitioner if withdrawals seem to go on too long or too intensely at any cut.
  • A gradual taper would allow time so that each cut can settle out before the next one, say 2, 3, or 4 weeks, depending on personal sensitivity.
  • Generally, the cuts should become smaller as the taper process rolls out.
  • Keep a notebook or similar log so you can keep track of your progress, and have an idea of what to expect with the next cut.

Some persons experience what is termed protracted withdrawal which is best addressed in an in-patient setting or at the very least, under the care of a doctor familiar with tapering Pristiq.

Prozac Crossover Method for Pristiq Weaning

The short half-life of Pristiq and the fact that it is an SNRI may warrant considering a crossover to Prozac, and then tapering off the Prozac due to its longer half-life. Pristiq is acting on both serotonin and norepinephrine levels. Prozac only addresses serotonin. So the crossover will involve a dip in norepinephrine support and Prozac will likely provide the serotonin support. In our experience, a sudden norepinephrine drop is much more tolerable than a sudden serotonin drop.

Methods described here including the below need to be talked about with a prescriber sensitive to your situation prior to attempting.

Prozac Crossover Methods Should take into account:
  • Medication-sensitive persons may have difficulty switching to a different medication. Stay in close touch with your prescribing physician to avoid complications.
  • Before weaning down off Pristiq, your physician may want to induct a small dosage of Prozac to test your tolerance, for example, by cutting the 10mg green elliptical in half to get 5mg.
  • Your prescriber may advise you to start 5mg Prozac for one week (one-half tablet) while still taking Pristiq.
  • The dosing ranges for Prozac and Pristiq are not equivalent so some guidance from a medical professional is needed to get your situation mapped out. But an example might be if you are taking 50mg Pristiq, drop to 25mg Pristiq, and go up to a total of 10-15mg Prozac.
  • You can gauge how long to do this step, by how symptomatic you are after one week or two weeks, etc. If you are still symptomatic, discuss this with your doctor who may advise you to continue for another week at this step.
  • Consult with your physician and If the above was tolerated, then discuss if your doctor feels you are ready to convert over to all Prozac (in the example this would be 20-30mg). This would be followed by another rest period of 1-2 weeks before any changes.
  • From here, look at the Prozac tapering page with your doctor and ask them to use those instructions for your guide
  • Your doctor may advise putting you back on your original Pristiq dose if the above is not tolerated. The physician would generally just do a straight taper off the Pristiq in this case.
  • Be aware that by switching over to Prozac, you are going from an SNRI to an SSRI. Your physician may agree that generally, Prozac withdrawal is easier to manage than Pristiq as it does not carry the norepinephrine aspect (stimulatory) of Pristiq. This may result in fatigue. But your doctor may advise that Prozac may mitigate harsh effects such as brain zaps that are more associated with Pristiq.

Is Pristiq Prescribed Only to Women?

Although Pristiq (desvenlafaxine) was originally marketed mostly to target women for menstrual or menopausal issues like “hot flashes,” with its pretty-sounding name and cute commercials featuring wind-up dolls, lots of soft pink and pastel colors, and gentle music, prescribing the drug today is not limited to the female market at all.

There are no limits on who may be prescribed Pristiq (desvenlafaxine) except not to children or the under-25 age range due to the high risk of suicide. Among the elderly population, antidepressants are known to be outrageously overprescribed, and the number of complications due to multiple medications, co-occurring disorders, and medical conditions makes the problem exponentially worse.10 It is unfortunate that though general medical practitioners are highly skilled technicians in their bio-physical healing arena, they are less skilled in nutritional aspects of improving health, and are, tragically, wholly untrained in treating mental health issues, let alone within a holistic or drug-free context.

What is Pristiq Prescribed to Treat?

In 2007, the FDA approved Pristiq to treat MDD or major depressive disorder in adults.12

Pristiq has also been prescribed off-label for the following:

  • depression in adolescents 13
  • Fibromyalgia
  • hot flashes for women in menopause
  • women’s menstrual difficulties
  • chronic pain
  • anxiety
  • bipolar
  • neuropathy associated with diabetes

A wide range of populations and age ranges have been prescribed Pristiq beyond its FDA approval for the treatment of a wide array of conditions. This may have resulted in a significant number of patients for whom Pristiq did not provide the relief they were seeking, with the additional problem of not knowing how to get off Pristiq safely.

Side Effects That Lead People to Wanting Pristiq Tapering Help

Pristiq tapering would resolve fears about health issues related to the drug. A 2012 adverse reaction report (among several similar) lists 36 suicides and deaths attributed to Pristiq for that year.1 This report often omits the ages but includes both males and females. The physician attending the patient at death listed Pristiq, and sometimes multiple antidepressants as the cause of death from suicide, renal failure, hepatic failure, thrombocytopenia, and other drug-induced conditions. Cardiac arrest and serotonin syndrome accounted for other deaths reported in the study of adverse reactions to Pristiq and other SNRI antidepressants. These deaths raise concerns.

Except in the case of serotonin syndrome or other medical emergency situations as noted above, Pristiq taper protocols should be as gradual as possible. Only in the case of serotonin syndrome, Stevens-Johnson syndrome, dropping sodium levels, or other major life-threatening reactions such as seizures, skin eruptions, cardiac events, etc., would a physician be justified in calling for immediate Pristiq cessation.

serotonin syndrome getting off pristiqEmergency treatment for serotonin syndrome or Steven-Johnson syndrome, or other life-threatening adverse events, is possible only in a hospital setting with an emergency ward, critical or intensive care unit, and trained emergency staff immediately on hand to keep the patient alive if possible.

Those caring for or living with the person should also be apprised of the possibility of these types of worst-case scenarios, and know exactly what to do should they occur. A word of caution: some VOIP phone lines do not have 911 access. It is a good practice to work out an alternative plan so as not to delay access to an ambulance if one is ever needed.

CAUTION:  Pristiq Timed-release …

There is an additional complication with exactly how to gradually withdraw from PristiqXR because it is a timed-release medication. Like virtually all other antidepressants, the side effects of Pristiq can be quite uncomfortable and harsh, and extremely hard to tolerate, which may lead to the decision to quit taking it. But trying to quit Pristiq gradually may not be as straightforward as it is for drugs that are not time-release formulations.

The FDA recommends gradual Pristiq cessation whenever possible and acknowledges that abruptly getting off Pristiq or another SNRI medication is associated with potential patient risk. FDA warnings are clear that abrupt Pristiq cessation can have disastrous health impacts.2,7

But no directions are provided as to how exactly to gradually reduce a timed-release pill that only comes in 50mg and 100mg doses, and where the maximum daily dose is 100mg. Clearly, there is an oversight and a huge gap here in giving instruction and guidance to either prescribing physicians or their patients. The task of withdrawal from a timed-release antidepressant is somewhat like figuring out the Rubik’s cube before YouTube.

Alternative to Meds Center’s Physicians Are Trained in How to Quit Pristiq Safely

According to the very apparent absence of available literature, it is clear that there is little direction given to medical practitioners to assist their patients in how to get off Pristiq. Antidepressant tapering and tapering SNRIs or similar medications is not part of the medical training given to doctors in school before they start practicing, nor is it provided by drugmakers or even the FDA, as mentioned above.

Thankfully, Alternative to Meds Center utilizes fully licensed psychiatrists, and other fully licensed and certified doctors, nurses, and practitioners who ARE trained in safe Pristiq tapering protocols. One could say that Alternative to Meds Center has “cracked the code” for how to get off Pristiq with minimum discomfort and maximum comfort and safety. Contact the center for more details on the protocols designed for safe Pristiq tapering.

The Best Solution for Safe Tapering from Pristiq

Alternative to Meds Center provides the finest help with how to get off Pristiq in a nurturing in-patient setting. The center’s Pristiq cessation program (alternatives and withdrawal) has overcome the difficulty of administering gradually reduced dosage and indeed is completely oriented toward patient safety and comfort. For over a decade and a half, Alternative to Meds Center has assisted thousands of clients stopping Pristiq and other medications safely, gently, and comfortably.

Our programs are administered using techniques that allow for a safe and gradual withdrawal from Pristiq despite it being a timed-release medication. Program steps are individually tailored for each client which benefits the client’s overall personal health. Discovering and eliminating root causes for mental distress, depression, fatigue, sleep issues, insomnia, anxiety, or other undesirable conditions is what makes it possible to elevate and improve natural mental health. That is our prime goal which we offer to our clients, and in so doing, likely reduce or eliminate entirely the need for prescription medications.

pristiq holistic treatmentsPrograms implement a blend of many protocols such as neurotoxin testing and removal, nutritional deficiency testing and correction using both oral and IV infusions, and holistic adjunct therapies designed for enhanced patient comfort, a better quality of sleep, more energy, and a brightened mood. We use many additional program components such as restoring the microbiome, life coaching, relaxation therapies, mineral baths, craniosacral massage, nebulized glutathione treatments, prescribed dietary changes, and more, under the oversight of our holistic practitioners including our fully licensed holistic psychiatrist. You are invited to view our services overview pages for more details on the services provided at the center for Pristiq tapering and improving mental health holistically.

Pristiq tapering treatment offered at Alternative to Meds Center is an investment in you for your health-focused and sustainable recovery.

1. Table of Findings, Pristiq (desvenlafaxine) Death Suspected Cause Side Effect Reports, published c.2012 [cited 2022 July 5]

2. FDA Pristiq Drug Label, published 2012, revised Feb. 2018 [cited 2022 July 5]

3. Weissman AM, et al., “Pooled analysis of antidepressant levels in lactating mothers, breast milk, and nursing infants.” Am J Psychiatry. 2004 Jun;161(6):1066-78. doi: 10.1176/appi.ajp.161.6.1066. PMID: 15169695 [cited 2022 July 5]

4. Tourian K et al., “A 10-Month, Open-Label Evaluation of Desvenlafaxine in Outpatients With Major Depressive Disorder.” Primary Care Companion for CNS Disorders 2011, PMID 21977353 [cited 2022 July 5]

5. Leggett C, et al.,”Antidepressant Use in Late Gestation and Breastfeeding Rates at Discharge from Hospital.” J Hum Lact. 2017 Nov;33(4):701-709. doi: 10.1177/0890334416678209. Epub 2016 Dec 1. PMID: 28984528. [cited 2022 July 5]

6. Rantamäki T, Yalcin I. Antidepressant drug action–From rapid changes on network function to network rewiring. Prog Neuropsychopharmacol Biol Psychiatry. 2016 Jan 4;64:285-92. doi: 10.1016/j.pnpbp.2015.06.001. Epub 2015 Jun 9. PMID: 26066070. [cited 2022 July 5]

7. Montgomery SA, Fava M, Padmanabhan SK, Guico-Pabia CJ, Tourian KA. Discontinuation symptoms and taper/poststudy-emergent adverse events with desvenlafaxine treatment for major depressive disorder. Int Clin Psychopharmacol. 2009 Nov;24(6):296-305. doi: 10.1097/YIC.0b013e32832fbb5a. PMID: 19779354. [cited 2022 July 5]

8. Sansone RA, Sansone LA. Serotonin norepinephrine reuptake inhibitors: a pharmacological comparison. Innov Clin Neurosci. 2014 Mar;11(3-4):37-42. PMID: 24800132; PMCID: PMC4008300. [cited 2022 July 5]

9. Frank C. Recognition and treatment of serotonin syndromeCan Fam Physician. 2008;54(7):988-992. [cited 2022 July 5]

10. Low Y, Setia S, Lima G. Drug-drug interactions involving antidepressants: focus on desvenlafaxineNeuropsychiatr Dis Treat. 2018;14:567-580. Published 2018 Feb 19. doi:10.2147/NDT.S157708 [cited 2022 July 5]

11. Simon LV, Keenaghan M. Serotonin Syndrome. 2022 Feb 4. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–. PMID: 29493999. [cited 2022 July 5]

12. Naseeruddin R, Rosani A, Marwaha R. Desvenlafaxine. [Updated 2022 Feb 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: [cited 2022 July 5]

13. Atkinson S, Lubaczewski S, Ramaker S, England RD, Wajsbrot DB, Abbas R, Findling RL. Desvenlafaxine Versus Placebo in the Treatment of Children and Adolescents with Major Depressive Disorder. J Child Adolesc Psychopharmacol. 2018 Feb;28(1):55-65. doi: 10.1089/cap.2017.0099. Epub 2017 Nov 29. PMID: 29185786; PMCID: PMC5771531. [cited 2022 July 5]

Originally Published Oct 16, 2019 by Diane Ridaeus

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

Dr. Samuel Lee

Dr. Samuel Lee is a board-certified psychiatrist, specializing in a spiritually-based mental health discipline and integrative approaches. He graduated with an MD at Loma Linda University School of Medicine and did a residency in psychiatry at Cedars-Sinai Medical Center and University of Washington School of Medicine in Seattle. He has also been an inpatient adult psychiatrist at Kaweah Delta Mental Health Hospital and the primary attending geriatric psychiatrist at the Auerbach Inpatient Psychiatric Jewish Home Hospital. In addition, he served as the general adult outpatient psychiatrist at Kaiser Permanente.  He is board-certified in psychiatry and neurology and has a B.A. Magna Cum Laude in Religion from Pacific Union College. His specialty is in natural healing techniques that promote the body’s innate ability to heal itself.

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Nothing on this Website is intended to be taken as medical advice. The information provided on the website is intended to encourage, not replace, direct patient-health professional relationships. Always consult with your doctor before altering your medications. Adding nutritional supplements may alter the effect of medication. Any medication changes should be done only after proper evaluation and under medical supervision.

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