Drug class: Serotonin-norepinephrine reuptake inhibitors 

What is Pristiq?

Pristiq is an antidepressant belonging to a group of drugs called selective serotonin and norepinephrine reuptake inhibitors (SNRIs). Desvenlafaxine affects chemicals in the brain that may be unbalanced in people with depression.

Pristiq is used to treat major depressive disorder.

Pristiq may also be used for purposes not listed in this medication guide.

Warnings

Do not use Pristiq within 7 days before or 14 days after you have used an MAO inhibitor, such as isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, or tranylcypromine.

People with depression or mental illness may have thoughts about suicide. Some young people may have increased suicidal thoughts when first starting a medicine to treat depression. Tell your doctor right away if you have any sudden changes in mood or behavior, or thoughts about suicide.

Do not stop using this medicine without first talking to your doctor.

Before taking this medicine

You should not take Pristiq if you are allergic to desvenlafaxine or venlafaxine (Effexor).

Do not use Pristiq within 7 days before or 14 days after you have used an MAO inhibitor, such as isocarboxazid, linezolid, methylene blue injection, phenelzine, tranylcypromine, and others. A dangerous drug interaction could occur.

Tell your doctor if you also use stimulant medicine, opioid medicine, herbal products, or medicine for depression, mental illness, Parkinson’s disease, migraine headaches, serious infections, or prevention of nausea and vomiting. An interaction with desvenlafaxine could cause a serious condition called serotonin syndrome. Ask your doctor before making any changes in how or when you take your medications.

To make sure you can safely take Pristiq, tell your doctor if you have any of these other conditions:

• heart disease, high blood pressure, high cholesterol, or a stroke;
• bipolar disorder (manic depression);
• depression, suicidal thoughts;
• liver or kidney disease;
• glaucoma;
• seizures or epilepsy;
• sexual problems;
• lung or breathing problems;
• a bleeding or blood clotting disorder; or
• low levels of sodium in your blood.

Some young people have thoughts about suicide when first taking an antidepressant. Your doctor should check your progress at regular visits. Your family or other caregivers should also be alert to changes in your mood or symptoms.

Ask your doctor about taking Pristiq if you are pregnant. Taking desvenlafaxine during late pregnancy could increase your risk of excessive bleeding just after you give birth, and may cause serious medical complications in the baby. However, you may have a relapse of depression if you stop taking your antidepressant. Tell your doctor right away if you become pregnant. Do not start or stop taking Pristiq without your doctor’s advice.

If you are pregnant, your name may be listed on a pregnancy registry to track the effects of desvenlafaxine on the baby.

It may not be safe to breastfeed a baby while you are using this medicine. Ask your doctor about any risks.

Pristiq is not FDA-approved for use by anyone younger than 18 years old.

How should I take Pristiq?

Take Pristiq exactly as prescribed by your doctor. Follow all directions on your prescription label and read all medication guides or instruction sheets.

Take Pristiq with water at the same time each day, with or without food.

Swallow the tablet whole and do not crush, chew, or break it.

Your blood pressure will need to be checked often.

Tell your doctor if you have any changes in sexual function, such as loss of interest in sex, trouble having an orgasm, or (in men) problems with erections or ejaculation. Some problems can be treated.

It may take several weeks before your symptoms improve. Keep using the medication as directed and tell your doctor if your symptoms do not improve.

Do not stop using Pristiq suddenly, or you could have unpleasant symptoms (such as dizziness, vomiting, agitation, sweating, confusion, numbness, tingling, or electric shock feelings). Ask your doctor how to safely stop using this medicine.

Some tablets are made with a shell that is not absorbed or melted in the body. Part of the tablet shell may appear in your stool. This is a normal side effect and will not make the medicine less effective.

Store at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line .

What to avoid

Desvenlafaxine may impair your thinking or reactions. Avoid driving or hazardous activity until you know how this medicine will affect you.

Ask your doctor before taking a nonsteroidal anti-inflammatory drug (NSAID) such as aspirin, ibuprofen, naproxen, Advil, Aleve, Motrin, and others. Using an NSAID with desvenlafaxine may cause you to bruise or bleed easily.

Avoid drinking alcohol.

Pristiq side effects

Get emergency medical help if you have signs of an allergic reaction to Pristiq: skin rash or hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Tell your doctor right away if you have new or sudden changes in mood or behavior, including new or worse depression or anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, more active or talkative, or have thoughts about suicide or hurting yourself.

Call your doctor at once if you have:

• a seizure;
• easy bruising or bleeding (nosebleeds, bleeding gums), blood in your urine or stools, coughing up blood;
• blurred vision, eye pain or swelling, or seeing halos around lights;
• cough, chest discomfort, trouble breathing; or
• low blood sodium – headache, confusion, problems with thinking or memory, weakness, feeling unsteady.

Seek medical attention right away if you have symptoms of serotonin syndrome, such as: agitation, hallucinations, fever, sweating, shivering, fast heart rate, muscle stiffness, twitching, loss of coordination, nausea, vomiting, or diarrhea.

Common Pristiq side effects may include:

• dizziness, drowsiness, anxiety;
• increased sweating;
• nausea, decreased appetite, constipation;
• sleep problems (insomnia); or
• decreased sex drive, impotence, or difficulty having an orgasm.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects.

What other drugs will affect Pristiq?

Taking Pristiq with other drugs that make you drowsy can worsen this effect. Ask your doctor before using opioid medication, a sleeping pill, a muscle relaxer, or medicine for anxiety or seizures.

Many drugs (including some over-the-counter medicines and herbal products) can increase your risk of bleeding if you take them with Pristiq, especially:

• a blood thinner such as warfarin, or other medicine used to prevents blood clots; or
• an NSAID (nonsteroidal anti-inflammatory drug) – aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib, diclofenac, indomethacin, meloxicam, and others.

What is Cymbalta?

Cymbalta is a selective serotonin and norepinephrine reuptake inhibitor antidepressant (SSNRI). Duloxetine affects chemicals in the brain that may be unbalanced in people with depression.

Cymbalta is used to treat major depressive disorder in adults. It is also used to treat general anxiety disorder in adults and children who are at least 7 years old.

Cymbalta is also used in adults to treat nerve pain caused by diabetes (diabetic neuropathy), or chronic muscle or joint pain (such as low back pain and osteoarthritis pain).

Cymbalta is also used to treat fibromyalgia (a chronic pain disorder) in adults and children at least 13 years old.

Warnings

Do not take Cymbalta within 5 days before or 14 days after you have used a MAO inhibitor, such as isocarboxazid, linezolid, phenelzine, rasagiline, selegiline, or tranylcypromine, or methylene blue injection.

Cymbalta should not be used if you have narrow angle glaucoma.

Some young people have thoughts about suicide when first taking an antidepressant. Stay alert to changes in your mood or symptoms. Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

Do not stop using Cymbalta without first talking to your doctor.

Before taking this medicine

You should not use Cymbalta if you are allergic to duloxetine.

Do not take Cymbalta within 5 days before or 14 days after you have used an MAO inhibitor, such as isocarboxazid, linezolid, methylene blue injection, phenelzine, or tranylcypromine. A dangerous drug interaction could occur.

Tell your doctor if you also use stimulant medicine, opioid medicine, herbal products, or medicine for depression, mental illness, Parkinson’s disease, migraine headaches, serious infections, or prevention of nausea and vomiting. An interaction with duloxetine could cause a serious condition called serotonin syndrome.

Cymbalta is not approved for use by anyone younger than 7 years old.

To make sure this medicine is safe for you, tell your doctor if you have:

• heart problems, high blood pressure;
• liver or kidney disease;
• slow digestion;
• a seizure;
• bleeding problems;
• sexual problems;
• narrow-angle glaucoma;
• bipolar disorder (manic depression);
• drug addiction or suicidal thoughts; or
• if you drink large amounts of alcohol.

People with depression or mental illness may have thoughts about suicide. Some young people may have increased suicidal thoughts when first starting a medicine to treat depression. Stay alert to changes in your mood or symptoms. Your family or caregivers should also watch for sudden changes in your behavior.

Taking an SNRI antidepressant during late pregnancy could increase your risk of excessive bleeding after you give birth, and may cause serious medical complications in the baby. However, stopping the medicine may not be safe if you have a relapse of depression. Do not start or stop taking this medicine without asking your doctor.

If you are pregnant, your name may be listed on a pregnancy registry to track the effects of duloxetine on the baby.

If you are breastfeeding, tell your doctor if you notice drowsiness, feeding problems, and slow weight gain in the nursing baby.

How should I take Cymbalta?

Take Cymbalta exactly as prescribed by your doctor. Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose.

Taking Cymbalta in higher doses or more often than prescribed will not make it more effective, and may increase side effects.

Swallow the capsule whole and do not crush, chew, break, or open it.

Take with or without food.

Your blood pressure will need to be checked often.

Tell your doctor if you have any changes in sexual function, such as loss of interest in sex, trouble having an orgasm, or (in men) problems with erections or ejaculation. Some sexual problems can be treated.

Your symptoms may not improve for up to 4 weeks.

Do not stop using duloxetine suddenly, or you could have unpleasant symptoms (such as agitation, confusion, tingling or electric shock feelings). Ask your doctor before stopping the medicine.

Store at room temperature away from moisture and heat.

Dosing information

Usual Adult Dose for Depression:

Initial dose: 20 mg to 30 mg orally 2 times a day
Maintenance dose: 60 mg per day, given either once a day OR 30 mg orally 2 times a day
Maximum dose: 120 mg/day.

Usual Adult Dose for Fibromyalgia:

Initial dose: 30 mg orally once a day for at least 1 week
Maintenance dose: 30 to 60 mg orally once a day.

Usual Adult Dose for Generalized Anxiety Disorder:

Initial dose: 60 mg orally once a day
Maintenance dose: 60 to 120 mg orally once a day
Maximum dose: 120 mg/day.

Usual Adult Dose for Pain:

Initial dose: 30 to 60 mg orally once a day
Maintenance dose: 60 mg orally once a day.

Usual Adult Dose for Neuropathic Pain:

Initial dose: 30 to 60 mg orally once a day
Maintenance dose: 60 mg orally once a day.

Usual Adult Dose for Chronic Pain:

Initial dose: 30 to 60 mg orally once a day
Maintenance dose: 60 mg orally once a day.

Usual Geriatric Dose for Generalized Anxiety Disorder:

Initial dose: 30 mg orally once a day for at least 2 weeks
Maintenance dose: 60 mg orally once a day
Maximum dose: 120 mg/day.

Usual Pediatric Dose for Generalized Anxiety Disorder:

7 to 17 years:
-Initial dose: 30 mg orally once a day for at least 2 weeks
-Maintenance dose: 30 to 60 mg orally once a day
-Maximum dose: 120 mg/day.

Usual Pediatric Dose for Fibromyalgia:

13 years and older:
-Initial dose: 30 mg orally once a day for at least 1 week
-Maintenance dose: 30 to 60 mg orally once a day.

What happens if I miss a dose?

Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line .

Overdose symptoms may include vomiting, dizziness or drowsiness, seizures, fast heartbeats, fainting, or coma.

What should I avoid while taking Cymbalta?

Ask your doctor before taking a nonsteroidal anti-inflammatory drug (NSAID) such as aspirin, ibuprofen, naproxen, Advil, Aleve, Motrin, and others. Using an NSAID with duloxetine may cause you to bruise or bleed easily.

Avoid driving or hazardous activity until you know how this medicine will affect you. Your reactions could be impaired. Dizziness or fainting can cause falls, accidents, or severe injuries.

Avoid getting up too fast from a sitting or lying position, or you may feel dizzy.

Drinking alcohol may increase your risk of liver damage, especially if you take Drizalma.

Cymbalta side effects

Get emergency medical help if you have signs of an allergic reaction to Cymbalta (hives, difficult breathing, swelling in your face or throat) or a severe skin reaction (fever, sore throat, burning eyes, skin pain, red or purple skin rash with blistering and peeling).

Tell your doctor right away if you have new or sudden changes in mood or behavior, including new or worse depression or anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, more active or talkative, or have thoughts about suicide or hurting yourself.

Call your doctor at once if you have:

• pounding heartbeats or fluttering in your chest;
• a light-headed feeling, like you might pass out;
• easy bruising, unusual bleeding;
• vision changes;
• painful or difficult urination;
• liver problems – right-sided upper stomach pain, itching, dark urine, jaundice (yellowing of the skin or eyes);
• low blood sodium – headache, confusion, problems with thinking or memory, weakness, feeling unsteady; or
• manic episodes – racing thoughts, increased energy, decreased need for sleep, risk-taking behavior, being agitated or talkative.

Seek medical attention right away if you have symptoms of serotonin syndrome, such as: agitation, hallucinations, fever, sweating, shivering, fast heart rate, muscle stiffness, twitching, loss of coordination, nausea, vomiting, or diarrhea.

Common Cymbalta side effects may include:

• drowsiness;
• nausea, constipation, loss of appetite;
• dry mouth; or
• increased sweating.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect Cymbalta?

Sometimes it is not safe to use certain medications at the same time. Some drugs can affect your blood levels of other drugs you take, which may increase side effects or make the medications less effective.

Ask your doctor before taking a nonsteroidal anti-inflammatory drug (NSAID) such as aspirin, ibuprofen, naproxen, Advil, Aleve, Motrin, and others. Using an NSAID with Cymbalta may cause you to bruise or bleed easily.