7 Pristiq (Desvenlafaxine) Interactions: Alcohol, Ibuprofen, and More

There are several options for treating depression, but many people take antidepressants to help manage their symptoms. Pristiq (desvenlafaxine) is one example. It’s a serotonin and norepinephrine reuptake inhibitor (SNRI). And it’s usually taken by mouth once daily.

When you first start taking Pristiq, your prescriber will likely talk to you about what to expect, including the possible side effects. But it’s also important to keep in mind Pristiq’s potential drug interactions. Some of these interactions can be managed with close monitoring. But other Pristiq interactions can be serious and may need to be avoided completely.

Pristiq interactions at a glance

Medications and substances that can interact with Pristiq include:

• Monoamine oxidase inhibitors (MAOIs), such as selegiline (Emsam, Zelapar)

• Other SNRIs, such as venlafaxine (Effexor XR) and duloxetine (Cymbalta)

• Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac) and sertraline (Zoloft)

• Tricyclic antidepressants (TCAs), such as amitriptyline

• Triptans, such as sumatriptan (Imitrex)

• Opioids like oxycodone (Roxicodone, OxyContin) and tramadol (ConZip)

• Lithium (Lithobid)

• Buspirone

• Trazodone

• Stimulants, such as mixed amphetamine salts (Adderall)

• Blood thinners, such as warfarin (Coumadin, Jantoven) and apixaban (Eliquis)

• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Motrin, Advil) and aspirin

• Atomoxetine (Strattera)

• Dextromethorphan (Delsym)

• Beta blockers, such as metoprolol (Toprol XL, Lopressor)

• Tolterodine (Detrol LA)

• St. John’s wort, an herbal supplement

• Alcohol

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Here, we’ll cover seven Pristiq interactions you should know more about. But keep in mind that this isn’t a complete list of interactions you should be aware of. If you have questions about taking Pristiq, talk to your prescriber or pharmacist. And be sure to show them your current medication list so they can check for possible interactions.

1. MAOIs

MAOIs are rarely prescribed medications that are approved to treat conditions like depression and Parkinson’s disease. They’re not used often because of their many interactions and side effects, as well as the dietary restrictions that are needed to take them.

MAOIs can interact with Pristiq because they also raise levels of serotonin in the brain. Combining these medications with Pristiq can result in a condition called serotonin syndrome. Serotonin syndrome is a rare but serious health issue caused by excess serotonin in the brain. Symptoms of serotonin syndrome can include sweating, a fast heartbeat, and abnormal body movements. Severe cases can result in death.

You shouldn’t take Pristiq and an MAOI at the same time. And, if you’re switching from an MAOI to Pristiq, you should wait 14 days in between. If you’re switching from Pristiq to an MAOI, you should wait 7 days in between.

2. Other antidepressants

Like Pristiq and MAOIs, other types of antidepressants also raise serotonin levels. If you take Pristiq along with other antidepressants, you’re more likely to experience side effects, including serotonin syndrome.

Examples of antidepressants that can interact with Pristiq include:

• Other SNRIs, such as venlafaxine and duloxetine

• SSRIs, such as sertraline and fluoxetine

• TCAs, such as amitriptyline and desipramine

• Auvelity (dextromethorphan / bupropion)

• Trazodone

• Buspirone

EXPERT PICKS: WHAT TO READ NEXT

• What to expect while taking Pristiq (desvenlafaxine): Interacting substances raise the risk of certain side effects. Read more about Pristiq side effects here.

• Taking the right dosage: Learn about recommended Pristiq dosages with this expert guide, which also covers what to do if you forget to take a dose.

• Does Pristiq cause weight gain? Get the answer to this and other frequently asked questions about Pristiq.

Many people only take one type of antidepressant at a time. But for some people, prescribers may suggest taking an additional antidepressant for an increased effect. In these cases, the benefit of combining antidepressants likely outweighs the risk of an interaction.

3. Alcohol

Alcohol can have many different effects on the body, including drowsiness and dizziness. There is no amount of alcohol that’s considered safe to drink. And if you combine alcohol with Pristiq, you’re even more likely to experience side effects.

Drowsiness is also a possible side effect of Pristiq. So taking it with alcohol can worsen this effect and impact your ability to complete daily activities or to focus clearly. In general, it’s best to avoid alcohol while taking Pristiq.

Talk with your prescriber about how much alcohol you drink before starting treatment with Pristiq. They can determine if it’s safe for you to take Pristiq and recommend strategies to help you stop drinking, if needed.

4. Triptans

Triptans are a class of medications that are taken as needed for migraines. Like antidepressants, they can raise serotonin levels in the brain. Taking triptans with Pristiq raises the risk of serotonin syndrome and other side effects.

Examples of triptans include:

• Sumatriptan

• Rizatriptan (Maxalt, Maxalt-MLT)

• Zolmitriptan (Zomig)

• Eletriptan (Relpax)

• Frovatriptan (Frova)

• Naratriptan

• Almotriptan

If you have migraines while taking Pristiq, your prescriber can advise you on the best migraine medication options. It’s possible they may still recommend a triptan despite the potential for an interaction. But they’ll likely ask you to watch for new or worsening Pristiq side effects.

5. Opioids

Opioids are prescription-only pain medications that are used when other treatments don’t provide adequate relief. All opioids can cause drowsiness, and some increase levels of serotonin. Because of this, they can interact with Pristiq.

Examples of opioids that can interact with Pristiq include:

• Oxycodone

• Hydrocodone / acetaminophen

• Tramadol

• Methadone (Methadose)

Your prescriber may recommend avoiding opioids while taking Pristiq. But if you need to take an opioid while being treated with Pristiq, watch for symptoms like extreme drowsiness, excessive sweating, and a fast heartbeat. Contact your prescriber right away if you experience any of these effects. Or seek emergency medical care if your symptoms seem severe.

6. Blood thinners

Blood thinners are medications that are used to prevent and treat unwanted blood clots. The term “blood thinner” is used to describe both anticoagulant and antiplatelet medications. Because of how these medications work, they raise the risk of bleeding. Pristiq can also slightly raise your risk of bleeding. So combining blood thinners with Pristiq can make bleeding even more likely.

Examples of blood thinners that can interact with Pristiq include:

• Warfarin

• Apixaban

• Rivaroxaban

• Dabigatran (Pradaxa)

• Edoxaban (Savaysa)

• Clopidogrel (Plavix)

• Ticagrelor (Brilinta)

Be sure to let your prescriber know if you’re taking a blood thinner. They may suggest taking a different antidepressant. Or, if the combination is necessary, they may ask you to watch for new or worsening bleeding or bruising.

7. NSAIDs

NSAIDs are a group of medications that treat pain, inflammation, and fever. Some are available over the counter, while others require a prescription. NSAIDs can interact with Pristiq because they can also increase the risk of bleeding. Though, NSAIDs are not considered blood thinners.

Examples of NSAIDs include:

• Ibuprofen

• Aspirin

• Naproxen (Naprosyn, Aleve)

• Meloxicam

Talk to your prescriber before taking an NSAID with Pristiq. They may give you the OK to take an NSAID occasionally. But since some people have higher bleeding risks than others, it’s a good idea to check with your prescriber first.

How to save on Pristiq

There are ways to save on Pristiq, which is available as both a brand-name and generic medication. GoodRx can help you navigate between GoodRx coupons, copay savings cards, and patient assistance programs to save money on your prescription.

• Save with GoodRx: Anyone with a valid prescription, regardless of insurance status, can use GoodRx to purchase a 30-day supply of brand-name Pristiq at an exclusive cash price of $200.10. A 30-day supply of generic Pristiq may cost as low as $22.00 with a free GoodRx discount.

• Save with a copay savings card: If you have commercial insurance, you may be eligible to pay as little as $4 per month for Pristiq using a savings card from the manufacturer.

• Save with patient assistance programs: If you’re uninsured or underinsured, you may be eligible for Pristiq’s patient assistance program, which offers the medication free of charge.

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Written by:

Austin Ulrich, PharmD, BCACP

Austin Ulrich, PharmD, BCACP, is a board-certified ambulatory care clinical pharmacist. In his early career, he provided direct patient care in a variety of settings, including hospital and community pharmacies, and in a primary care clinic as a clinical pharmacist.

Edited by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

Reviewed by:

Jennifer Gershman, PharmD, CPh, PACS

Jennifer Gershman, PharmD, is a licensed pharmacist in Florida. She has worked in the pharmacy industry for more than 15 years and is currently a medical writer.

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