PRISTIQ WITHDRAWAL AND TAPERING HELP

PRISTIQ WITHDRAWAL SYMPTOMS MAY INCLUDE:

aggression, anxiety, balance issues , blurred vision, brain zaps, concentration impairment, constipation, crying spells, depersonalization, diarrhea, dizziness. electric shock sensations, fatigue, flatulence, flu-like symptoms, hallucinations, hostility, highly emotional, indigestion, irritability, impaired speech, insomnia, jumpy nerves, lack of coordination, lethargy, migraine headaches / increased headaches, nausea, nervousness, over-reacting to situations, paranoia, repetitive thoughts or songs, sensory & sleep disturbances, severe internal restlessness (akathisia), stomach cramps, tremors, tinnitus (ear ringing or buzzing), tingling sensations, troubling thoughts, visual hallucinations / illusions, vivid dreams, speech or visual changes, worsened depression 

PRISTIQ SIDE EFFECTS MAY INCLUDE: 

allergic reaction (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives), irregular heartbeat or pulse, low blood pressure (dizziness, weakness), high blood pressure (severe headache, blurred vision), chills or fever, unusual bleeding or bruising, rash or hives, Suicidal Ideation, Headache, tremor, nervousness, or anxiety; difficulty concentrating, constipation, nausea, diarrhea, dry mouth, or changes in appetite or weight, weakness, increased sweating, sleeping or insomnia, decreased sex drive, impotence, or difficulty having an orgasm

PRISTIQ ADVERSE REACTIONS MAY INCLUDE: per PDR  

Severe: seizures,  angioedema,  pancreatitis,  suicidal ideation,  SIADH,  GI bleeding,  cardiomyopathy,  myocardial infarction,  Stevens-Johnson syndrome,  toxic epidermal necrolysis,  erythema multiforme,  eosinophilic pneumonia,  serotonin syndrome,  neonatal abstinence syndrome

Moderate: withdrawal, constipation, impotence, hypercholesterolemia, orthostatic hypotension, proteinuria, ejaculation dysfunction, hypertriglyceridemia, blurred vision, hypertension, dystonic reaction, teeth grinding (bruxism), sinus tachycardia, urinary retention, hyperprolactinemia, elevated hepatic enzymes, peripheral vasodilation, mania, hallucinations, depression, akathisia, impulse control symptoms, hostility, hyponatremia, platelet dysfunction, hematoma, bleeding, dyspnea

Mild: nausea, xerostomia,   hyperhidrosis,  dizziness,  insomnia,  drowsiness,  fatigue,  anore,  anxiety,  abnormal dreams,  yawning,  chills,  weight gain,  dysgeusia,  syncope,  photosensitivity,  rash, a lopecia, t innitus,  flushing,  musculoskeletal pain,  asthenia,  weight loss, i rritability,   restlessness,   ecchymosis, p etechiae,   cough

PRISTIQ BOXED WARNINGS: per PDR 

Children, suicidal ideation

Pristiq is not FDA approved for the treatment of major depressive disorder (MDD) in children or adolescents. Efficacy in MDD was not demonstrated in two 8-week controlled trials of 587 pediatric patients 7 to 17 years of age. In addition, more patients receiving Pristiq than placebo had a decrease in body weight of 3.5% or greater from their baseline weight (14% to 22% vs. 7%). During long-term extension studies in the same population, the mean changes in weight approximated expected changes based on data from age and gender-matched controls. In October 2004, the FDA directed manufacturers of all antidepressants to add a boxed warning to their product labels detailing the risk of suicide in pediatric patients. The risk of suicidality for these drugs was identified in a pooled analysis of 24 placebo-controlled trials (n = 4,400) lasting up to 16 weeks in pediatric patients with MDD, obsessive compulsive disorder (OCD), or other psychiatric disorders. The analysis showed a greater risk of suicidality during the first few months of treatment in those receiving antidepressants. The average risk of such events on drug was 4% and 2% for placebo; however, no suicides occurred in these trials. Pooled analysis of short-term clinical trials during early phase treatment with antidepressants in young adults (18 to 24 years) also showed an increased risk of suicidal thinking and behavior. The clinical need for an antidepressant in pediatrics or young adults for any use must be weighed against the risk of increased suicidality; patients who are started on therapy should be observed closely for clinical worsening, suicidality, or unusual changes in behavior, particularly within the first few months of starting therapy or during dose changes. It is unknown if the suicidality risk in children or young adults extends to longer-term therapy. The possibility of a suicide attempt is inherent in patients with depressive symptoms, whether these occur in primary depression or in association with another primary disorder. All patients with a history of suicidal ideation or behaviors and those with a prominence of suicidal ideation prior to treatment should be closely monitored during treatment with Pristiq. In patients who exhibit worsening of depression or suicidality, a decision should be made to change or discontinue treatment. If discontinuing, the medication should be tapered as rapidly as possible, but with recognition that abrupt discontinuation can also cause adverse symptoms. All antidepressants should be prescribed in the smallest quantity consistent with good patient management to reduce the risk of overdose.

According to the FDA:

Clinical Worsening/Suicide Risk: Monitor for clinical worsening and suicide risk 

Serotonin Syndrome or Neuroleptic Malignant Syndrome (NMS)-like Reactions: Serotonin syndrome or NMS-like reactions have been reported with SSRIs and SNRIs. Discontinue Pristiq and initiate supportive treatment.

Elevated Blood Pressure: Has occurred with Pristiq. Hypertension should be controlled before initiating treatment. Monitor blood pressure regularly during treatment 

Abnormal Bleeding: Pristiq may increase the risk of bleeding events. Patients should be cautioned about the risk of bleeding associated with the concomitant use of Pristiq and NSAIDs, aspirin, or other drugs that affect coagulation 

Narrow-angle Glaucoma: Mydriasis has occurred with Pristiq. Patients with raised intraocular pressure or those at risk of angle-closure glaucoma should be monitored .

Activation of Mania/Hypomania: Has occurred. Use cautiously in patients with Bipolar Disorder. Caution patients about the risk of activation of mania/hypomania 

Cardiovascular/Cerebrovascular Disease: Use cautiously in patients with cardiovascular or cerebrovascular disease

Cholesterol and Triglyceride Elevation: Have occurred. Use cautiously in patients with lipid metabolism disorders. Consider monitoring serum cholesterol and triglyceride

Seizure: Can occur. Use cautiously in patients with seizure disorder  

Hyponatremia: Can occur in association with SIADH 

 Discontinuation Symptoms: Have occurred. Taper the dose when possible and monitor for discontinuation symptoms  

 Renal Impairment: Reduces the clearance of Pristiq. Dosage adjustment is necessary in severe and ESRD. In moderate renal impairment, the dose should not exceed 50 mg/day  

 Seizure: Can occur. Use cautiously in patients with seizure disorder  

Hyponatremia: Can occur in association with SIADH 

Drugs Containing Desvenlafaxine or Venlafaxine: Should not be used concomitantly with Pristiq  

 Interstitial Lung Disease and Eosinophilic Pneumonia: Can occur 

 REFERENCES:

https://www.accessdata.fda.gov/drugsatfda_docs/label/2012/021992s030lbl.pdf

https://www.nami.org/Learn-More/Treatment/Mental-Health-Medications/Types-of-Medication/Desvenlafaxine-(Pristiq)

https://www.karger.com/Article/Pdf/491524

https://www.tandfonline.com/doi/abs/10.1185/03007995.2015.1020365

top of page