Pristiq

Major Depressive Disorder

Pristiq is primarily prescribed for the treatment of major depressive disorder (MDD), which is commonly referred to as depression. It belongs to a class of medications known as serotonin and norepinephrine reuptake inhibitors (SNRIs).

This medication works by helping to restore the balance of certain natural chemicals in the brain. By doing so, it may help improve various symptoms associated with depression, such as:

• Persistent feelings of sadness, emptiness, or hopelessness
• Loss of interest in activities once enjoyed
• Changes in appetite or weight
• Sleep problems, such as insomnia or sleeping too much
• Decreased energy or constant fatigue
• Difficulty thinking, concentrating, or making decisions

Pristiq is specifically approved for use in adults. It is intended to help improve a person's mood, energy level, and overall sense of well-being.

Mechanism of Action

Pristiq belongs to a class of medications called serotonin-norepinephrine reuptake inhibitors (SNRIs). It works by affecting the balance of two natural chemicals in the brain called serotonin and norepinephrine.

These chemicals are neurotransmitters, which act as messengers between nerve cells. They are known to play a significant role in regulating mood, emotions, and mental health. In many people with depression, these chemicals may not be functioning correctly or may be in short supply.

Pristiq works by:

• Blocking reuptake: After serotonin and norepinephrine are released by a nerve cell, they are normally reabsorbed by that same cell. Pristiq blocks this reabsorption process.
• Increasing availability: By preventing reabsorption, the medication allows more of these chemicals to remain in the space between nerve cells (the synapse).
• Improving communication: With more serotonin and norepinephrine available, communication between nerve cells is enhanced, which helps to stabilize mood and relieve symptoms of depression.

Common Side Effects

Many people using Pristiq experience mild side effects. These often improve as the body adjusts to the medication. Common side effects include:

• Nausea and vomiting
• Dizziness or drowsiness
• Dry mouth
• Increased sweating
• Constipation or loss of appetite
• Difficulty sleeping (insomnia)
• Anxiety or jitteriness
• Sexual problems, such as decreased sex drive or difficulty reaching orgasm

Serious Side Effects

Contact a healthcare provider immediately if you experience any of the following serious side effects:

• Serotonin syndrome: Symptoms include agitation, hallucinations, rapid heart rate, muscle stiffness, twitching, or loss of coordination.
• Vision changes: Eye pain, redness, swelling, or blurred vision.
• Low sodium levels: Headache, confusion, severe weakness, or feeling unsteady.
• Bleeding problems: Unusual bruising or bleeding, such as nosebleeds or bleeding gums.
• High blood pressure: Severe headache or chest pain.
• Seizures

Allergic Reactions

Seek emergency medical help if you notice signs of an allergic reaction, such as a skin rash, hives, swelling of the face, lips, or throat, or difficulty breathing.

Suicidal Thoughts and Behaviors

Antidepressants may increase the risk of suicidal thoughts or actions in children, teenagers, and young adults, particularly during the first few months of treatment or when the dose is changed. It is important to monitor for worsening depression, irritability, agitation, or unusual changes in behavior.

Serotonin Syndrome

A potentially life-threatening condition called serotonin syndrome can occur, especially when this medication is taken with other drugs that affect serotonin levels. Symptoms may include agitation, hallucinations, rapid heartbeat, dizziness, muscle stiffness, or digestive issues.

Interactions with MAOIs

Pristiq must not be used within 14 days of taking a monoamine oxidase inhibitor (MAOI). Using these medications together can cause dangerously high blood pressure or serotonin syndrome.

Blood Pressure and Heart Health

This medication can cause an increase in blood pressure. Regular blood pressure monitoring is typically recommended during treatment. It should be used with caution in individuals with a history of heart disease or high blood pressure.

Increased Risk of Bleeding

Taking Pristiq may increase the risk of bleeding events. This risk is higher if the medication is used alongside aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen, or blood thinners like warfarin.

Discontinuation Symptoms

Stopping this medication suddenly can lead to withdrawal symptoms such as dizziness, nausea, headache, irritability, and sleep disturbances. The dose is usually decreased gradually under medical supervision.

Other Precautions

• Angle-Closure Glaucoma: This medication may trigger an eye emergency in people with certain eye structures.
• Hyponatremia: Low blood sodium levels can occur, particularly in older adults or those taking diuretics.
• Seizures: Caution is advised for individuals with a history of seizure disorders.
• Lung Problems: Rare cases of lung inflammation or pneumonia have been reported.

Pregnancy

The use of Pristiq during pregnancy requires a careful discussion with a healthcare provider to weigh the benefits of treatment against potential risks to the fetus. If you are pregnant or planning to become pregnant, consult your doctor before starting or stopping this medication.

Research indicates that infants exposed to SNRIs like Pristiq during the third trimester may experience complications at birth that require hospitalization, respiratory support, or tube feeding. Reported symptoms in newborns include:

• Breathing problems
• Seizures
• Tremors or jitteriness
• Feeding difficulties
• Low blood sugar
• Muscle stiffness or limpness
• Constant crying

There is also a potential risk of persistent pulmonary hypertension of the newborn (PPHN), a serious lung condition. However, untreated depression during pregnancy also carries risks for both the parent and the baby. Healthcare providers may suggest enrolling in a pregnancy registry to monitor the health of those taking antidepressants while pregnant.

Breastfeeding

Pristiq passes into breast milk. Because the effects on a nursing infant are not fully known, it is important to discuss breastfeeding with a healthcare provider. They can help determine if the benefits of breastfeeding outweigh the potential risks of the infant being exposed to the medication.

Dosage Forms

Pristiq is supplied as an extended-release tablet for oral use.

This medication is designed to be swallowed whole. The tablets should not be crushed, chewed, dissolved, or divided, as these actions can interfere with the controlled release of the medicine into the body.

FDA Approval and Indications

Pristiq (desvenlafaxine) is approved by the U.S. Food and Drug Administration (FDA) for the treatment of major depressive disorder (MDD) in adults. It is a serotonin and norepinephrine reuptake inhibitor (SNRI) that was first approved for use in 2008.

Boxed Warning

The FDA has issued its most serious safety notification, a boxed warning, for Pristiq. This warning highlights that antidepressants may increase the risk of suicidal thinking and behavior in children, adolescents, and young adults up to age 24. Healthcare providers are advised to monitor patients of all ages closely for clinical worsening or the emergence of suicidal tendencies, especially during the initial months of treatment or following dosage adjustments.

Usage Restrictions

Pristiq is not FDA-approved for use in pediatric patients. The safety and effectiveness of the medication in children and adolescents have not been established. Additionally, while it is not a controlled substance, it must be dispensed with a Medication Guide that informs patients of potential risks.

Withdrawal Symptoms

Abruptly stopping Pristiq (desvenlafaxine) can cause a range of withdrawal symptoms, sometimes called discontinuation syndrome. These effects may appear shortly after the last dose is taken.

Reported withdrawal symptoms include:

• Dizziness, nausea, and headache
• Anxiety, irritability, and agitation
• Mood swings or confusion
• Tiredness and sweating
• Problems sleeping (insomnia)
• Sensory changes, such as tingling, numbness, or sensations similar to electric shocks

How to Stop Safely

To prevent or reduce withdrawal symptoms, healthcare providers typically recommend a gradual reduction in dosage rather than stopping the medication suddenly. It is important to follow a tapering schedule provided by a doctor. If symptoms become severe or unmanageable during the tapering process, seek medical advice.