Pristiq: Targeted Serotonin-Norepinephrine Reuptake for Depression Relief
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Synonyms | |||
Pristiq (desvenlafaxine) is an extended-release oral antidepressant belonging to the serotonin-norepinephrine reuptake inhibitor (SNRI) class. It is specifically engineered to inhibit the reuptake of both serotonin and norepinephrine, two key neurotransmitters implicated in mood regulation. Approved by the FDA for the treatment of major depressive disorder (MDD) in adults, Pristiq offers a modern pharmacological approach with a favorable metabolic profile. Its active metabolite design eliminates the need for hepatic CYP2D6 conversion, potentially reducing variability in patient response. This agent represents a significant option for clinicians seeking efficacy with a once-daily dosing regimen.
Features
- Active ingredient: Desvenlafaxine succinate
- Pharmacologic class: Serotonin-norepinephrine reuptake inhibitor (SNRI)
- Available strengths: 25 mg, 50 mg, 100 mg extended-release tablets
- Administration: Oral, once daily with or without food
- Elimination half-life: Approximately 11 hours
- Primary excretion route: Renal (45%)
- Special formulation: Extended-release to maintain stable plasma concentrations
Benefits
- Dual mechanism action simultaneously enhances both serotonin and norepinephrine activity
- Demonstrated efficacy in improving mood, energy levels, and interest in daily activities
- Once-daily dosing regimen supports treatment adherence and convenience
- Linear pharmacokinetics with minimal CYP450 interactions compared to earlier antidepressants
- Lower risk of pharmacokinetic drug interactions due to minimal CYP2D6 metabolism
- Established safety profile across multiple clinical trials involving diverse patient populations
Common use
Pristiq is indicated for the treatment of major depressive disorder (MDD) in adults. The medication is typically prescribed when a clinician determines that simultaneous modulation of both serotonin and norepinephrine pathways may provide therapeutic advantage over selective serotonin reuptake inhibitors (SSRIs). Clinical decision-making often considers factors such as previous treatment response, side effect profiles, and specific symptom patterns including fatigue, anhedonia, or comorbid anxiety. Treatment duration varies based on individual response, with maintenance therapy recommended for those with recurrent depressive episodes.
Dosage and direction
The recommended therapeutic dose of Pristiq is 50 mg once daily, taken at approximately the same time each day. Tablets should be swallowed whole and not crushed, chewed, or dissolved. Administration may occur with or without food, though consistency in timing is advised to maintain steady-state concentrations. For patients with hepatic impairment, maximum recommended dose is 50 mg daily. For those with severe renal impairment (CrCl <30 mL/min) or end-stage renal disease, maximum recommended dose is 50 mg every other day. Dose adjustments should be implemented gradually, with titration occurring at intervals of no less than one week.
Precautions
Patients should be monitored for clinical worsening, suicidality, or unusual changes in behavior, particularly during initial treatment and dose adjustments. Pristiq may increase the risk of bleeding events, especially when used concomitantly with NSAIDs, aspirin, or other anticoagulants. Caution is advised in patients with a history of mania/hypomania, seizures, or angle-closure glaucoma. Blood pressure monitoring is recommended due to potential dose-dependent increases. Discontinuation symptoms may occur; gradual tapering is recommended rather than abrupt cessation. Patients should be advised regarding the potential for impaired judgment, thinking, or motor skills.
Contraindications
Pristiq is contraindicated in patients with known hypersensitivity to desvenlafaxine, venlafaxine, or any excipients in the formulation. Concomitant use with monoamine oxidase inhibitors (MAOIs) is contraindicated due to risk of serotonin syndrome. MAOIs should be discontinued at least 14 days before initiating Pristiq treatment, and Pristiq should be discontinued at least 7 days before starting an MAOI. Additional contraindications include uncontrolled narrow-angle glaucoma and severe hepatic impairment.
Possible side effects
Common adverse reactions (incidence ≥5% and at least twice placebo) include:
- Nausea (22%)
- Dizziness (13%)
- Hyperhidrosis (10%)
- Constipation (9%)
- Decreased appetite (8%)
- Anxiety (6%)
- Insomnia (6%)
Less frequent but clinically significant effects may include:
- Increased blood pressure
- Elevated cholesterol levels
- Sexual dysfunction
- Weight changes
- Fatigue
- Visual disturbances
Drug interaction
Pristiq has potential interactions with:
- MAOIs: Risk of serotonin syndrome (contraindicated)
- Serotonergic drugs (triptans, tramadol, lithium): Increased serotonergic effects
- NSAIDs, aspirin, warfarin: Increased bleeding risk
- Drugs metabolized by CYP3A4: Pristiq is a weak inhibitor
- CNS-active drugs: Additive effects on cognitive and motor performance
- Drugs that interfere with hemostasis: Potentiated bleeding risk
Missed dose
If a dose is missed, patients should take it as soon as remembered unless it is closer to the time of the next scheduled dose. In that case, the missed dose should be skipped and the regular dosing schedule resumed. Patients should not take double or extra doses to make up for a missed dose. Consistency in daily administration is important to maintain therapeutic plasma levels.
Overdose
Symptoms of overdose may include serotonin syndrome, dizziness, nausea, vomiting, tachycardia, hypertension, sedation, and seizures. In cases of suspected overdose, immediate medical attention is required. Treatment should focus on supportive care and symptomatic management. Gastric lavage may be considered if presentation is early. Activated charcoal may be administered. There is no specific antidote for desvenlafaxine overdose. Dialysis is unlikely to be effective due to Pristiq’s large volume of distribution.
Storage
Store at room temperature (20-25°C or 68-77°F) with excursions permitted between 15-30°C (59-86°F). Keep in original container with lid tightly closed to protect from moisture. Keep out of reach of children and pets. Do not use beyond the expiration date printed on the packaging. Properly dispose of any unused medication through medication take-back programs or according to FDA guidelines.
Disclaimer
This information is provided for educational purposes only and does not constitute medical advice. Treatment decisions should be made exclusively by qualified healthcare professionals based on individual patient assessment. The prescribing physician should be consulted for complete information regarding indications, contraindications, warnings, precautions, and adverse reactions. Patients should not alter or discontinue medication without medical supervision.
Reviews
Clinical trials demonstrate Pristiq’s efficacy in treating MDD, with significant improvement in HAM-D17 scores compared to placebo. Many patients report improved mood, energy, and functionality within 4-8 weeks of treatment initiation. Some users note gastrointestinal side effects during the initial treatment period that often diminish with continued use. Healthcare providers frequently cite the once-daily dosing and predictable pharmacokinetics as advantageous for long-term management. Individual responses vary, and treatment should be regularly evaluated for effectiveness and tolerability.