Pristiq: Targeted Serotonin-Norepinephrine Reuptake Inhibition for MDD
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Synonyms | |||
Pristiq (desvenlafaxine) is a prescription serotonin-norepinephrine reuptake inhibitor (SNRI) approved for the treatment of major depressive disorder (MDD) in adults. It represents a refined molecular approach derived from venlafaxine, designed to offer a targeted mechanism of action with a potentially favorable tolerability profile. As an extended-release formulation, it supports stable plasma concentrations with once-daily dosing, which may enhance adherence and consistent therapeutic effect. Its clinical use is supported by robust trial data demonstrating efficacy in improving depressive symptoms.
Features
- Active ingredient: Desvenlafaxine
- Pharmacologic class: Serotonin-norepinephrine reuptake inhibitor (SNRI)
- Formulation: Extended-release tablets
- Available strengths: 25 mg, 50 mg, 100 mg
- Administration: Oral, once daily
- FDA-approved indication: Major depressive disorder (MDD)
Benefits
- Dual reuptake inhibition may provide broader symptomatic relief compared to SSRIs for some patients
- Once-daily dosing supports treatment adherence and consistent pharmacokinetics
- Demonstrated efficacy in improving mood, interest, and reducing anxiety symptoms associated with MDD
- Extended-release formulation minimizes peak-trough fluctuations, potentially reducing side effects
- May offer a therapeutic option for patients with inadequate response to other antidepressants
Common use
Pristiq is primarily prescribed for the management of major depressive disorder in adult patients. It is used to treat the emotional and physical symptoms of depression, which may include persistent sadness, loss of interest in activities, changes in appetite or sleep, fatigue, and difficulty concentrating. Some clinicians may also use it off-label for certain anxiety disorders, though this is not an FDA-approved indication. Treatment is typically initiated after a thorough diagnostic assessment confirms MDD.
Dosage and direction
The recommended starting dose for Pristiq is 50 mg once daily, taken orally with or without food. Tablets should be swallowed whole and not crushed, chewed, or dissolved. Dosage may be adjusted based on individual patient response and tolerability, with maximum recommended dose being 400 mg daily, though most patients respond at 50 mg. Dose adjustments should be made at intervals of not less than one week. For patients with hepatic or renal impairment, dosage reduction is recommended.
Precautions
- Monitor for worsening depression or emergence of suicidal thoughts, especially during initial treatment or dose adjustments
- May increase blood pressure; regular monitoring recommended
- Use with caution in patients with a history of mania/hypomania
- May cause serotonin syndrome, particularly when used with other serotonergic drugs
- Discontinuation symptoms may occur; taper gradually when stopping treatment
- Use caution in patients with history of seizures
- May affect platelet aggregation; use caution in patients with bleeding tendencies
Contraindications
- Hypersensitivity to desvenlafaxine, venlafaxine, or any product components
- Concurrent use with monoamine oxidase inhibitors (MAOIs) or within 14 days of stopping MAOI treatment
- Initiation of Pristiq in patients being treated with linezolid or intravenous methylene blue
Possible side effects
Common side effects (≥5% and twice placebo):
- Nausea
- Dizziness
- Insomnia
- Hyperhidrosis
- Constipation
- Decreased appetite
- Anxiety
- Fatigue
Less common but serious side effects:
- Suicidal thoughts and behaviors
- Serotonin syndrome
- Increased blood pressure
- Abnormal bleeding
- Angle-closure glaucoma
- Hyponatremia
- Sexual dysfunction
Drug interaction
- MAOIs: Risk of serious, sometimes fatal, reactions including serotonin syndrome
- Other serotonergic drugs: Increased risk of serotonin syndrome
- Drugs that interfere with hemostasis: Increased risk of bleeding
- Drugs metabolized by CYP2D6: Desvenlafaxine may increase concentrations of these drugs
- Alcohol: May enhance CNS effects
- Strong CYP3A4 inhibitors: May increase desvenlafaxine concentrations
Missed dose
If a dose is missed, take it as soon as remembered unless it is closer to the time of the next dose. Do not double the dose to make up for a missed dose. Maintain regular dosing schedule. If multiple doses are missed, contact healthcare provider for guidance on resuming treatment.
Overdose
Symptoms may include serotonin syndrome, drowsiness, vertigo, tachycardia, changes in blood pressure, and seizures. There is no specific antidote. Provide supportive care and symptomatic treatment. Gastric lavage with airway protection may be considered if performed soon after ingestion. Monitor cardiac function and vital signs. Dialysis is unlikely to be effective due to high protein binding.
Storage
Store at room temperature (20-25°C or 68-77°F). Excursions permitted to 15-30°C (59-86°F). Keep in original container, tightly closed. Protect from moisture and light. Keep out of reach of children and pets. Dispose of unused medication properly according to local regulations.
Disclaimer
This information is for educational purposes only and does not constitute medical advice. Pristiq is available by prescription only and should be used under the supervision of a qualified healthcare professional. Individual results may vary. Patients should not alter their treatment regimen without consulting their prescribing physician. Full prescribing information should be reviewed before initiation of therapy.
Reviews
Clinical trials demonstrate Pristiq’s efficacy in treating MDD, with significant improvement in depression rating scales compared to placebo. Many patients report meaningful improvement in depressive symptoms within 4-8 weeks of treatment. Some real-world evidence suggests particular benefit for patients with comorbid anxiety symptoms. However, individual responses vary, and some patients may experience side effects that limit tolerability. Long-term maintenance studies support its efficacy in preventing relapse of depressive episodes when continued at therapeutic doses.