11 Pristiq Side Effects to Know About: Nausea, Sexual Problems, and More

Pristiq (desvenlafaxine) is a prescription medication that’s FDA approved to treat depression. It’s a serotonin and norepinephrine reuptake inhibitor (SNRI). It raises levels of serotonin and norepinephrine in the brain. This helps regulate your mood, among other actions.

Pristiq is usually well-tolerated. Most side effects are mild and go away on their own as your body gets used to the medication. But it’s good to know about possible Pristiq side effects and how to manage them.

Pristiq side effects at a glance

Below is a list of common and rare Pristiq side effects. Keep in mind that this isn’t a complete list of all possible side effects. So reach out to your healthcare team if you experience any concerning side effects, even if they’re not listed here.

Promotion disclosure

Pristiq (Desvenlafaxine Succinate ER)

Avg retail price

$238.41(Save 90.44%)

GoodRx discount

$22.79

See all discounts

How it works

Use GoodRx to find medications, pharmacies, and discounts.

GoodRx discounts can help you pay less for your prescription.

Bring your free coupon or savings card to the pharmacy.

Common Pristiq side effects include:

• Insomnia (trouble sleeping)

• Drowsiness

• Fatigue

• Nausea

• Vomiting

• Dizziness

• Tremor (shaky hands)

• Sexual problems

• Nervousness or anxiety

• Increased sweating (hyperhidrosis)

• Unusual dreams

• Dry mouth

• Constipation

• Yawning

• Decreased appetite

Rare but serious Pristiq side effects include:

• Raised blood pressure

• Higher risk of bleeding

• Serotonin syndrome

• Withdrawal symptoms (if you suddenly stop Pristiq)

• Worsening of certain types of glaucoma

• Low sodium levels

This medication also has a boxed warning for suicidal thoughts and behavior. This is the FDA’s most serious warning for medications. While rare, this side effect can be life-threatening.

Let’s take a closer look at 11 Pristiq side effects and how to manage them.

1. Insomnia or drowsiness

Both insomnia and drowsiness are common Pristiq side effects. Some people also experience fatigue. These typically go away as your body gets used to the medication. You shouldn’t drive or perform other tasks that require focus until you know how Pristiq makes you feel.

EXPERT PICKS: WHAT TO READ NEXT

• What’s the right dose? Your kidney and liver function can affect what Pristiq dosage you should take. Find out if the standard starting dosage is right for you.

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

• When do antidepressants start working? Antidepressants can take time to become fully effective. Find out how long it can take to notice your symptoms improving, plus how to know your medication is working.

Most people take Pristiq once a day. If it causes insomnia, try taking your dose in the morning. If it causes drowsiness, take your dose in the evening. This change is sometimes all you need to help manage sleep-related Pristiq side effects.

If your insomnia or drowsiness doesn’t improve after adjusting your dose timing, talk to your healthcare team. They may be able to provide additional tips to help manage these side effects.

2. Nausea or vomiting

Nausea and vomiting are common side effects of many antidepressants, including Pristiq. They usually improve or resolve after you’ve been taking the medication for a few weeks.

If you feel nauseous after taking Pristiq, try taking it with food. This can help lessen or prevent this side effect. Staying well hydrated and avoiding greasy or fried foods can also help minimize nausea.

If nausea or vomiting doesn’t get better after a few weeks, talk to your prescriber. Pristiq may not be the best choice for you.

3. Decreased appetite

Pristiq can also lower your appetite. This can go hand-in-hand with nausea. It should be mild in nature.

There are plenty of tips to help you get the nutrients you need when you don’t feel hungry:

• Try nutrient-dense smoothies that include fruits, vegetables, and sources of protein.

• Hydrate between meals instead of while you’re eating.

• Eat smaller portions when you’re less hungry. Eat larger portions when your appetite is at its highest.

• Make your food appetizing by incorporating bright colors or interesting flavors.

If your appetite doesn’t improve or you’re losing weight, reach out to your healthcare team.

4. Dizziness

Dizziness is another common Pristiq side effect. This can be quite bothersome. It can also raise the risk of falls in certain people, especially older adults. Dizziness from Pristiq should get better or stop as your body adjusts to the medication.

If you find that Pristiq is making you dizzy, try taking your dose at bedtime. This can help limit dizziness to the time when you’re already lying in bed. It’s also important to be careful while changing positions, such as going from sitting to standing. Do so slowly and while holding onto a sturdy surface.

Talk to your healthcare team if your dizziness is severe or doesn’t go away.

5. Increased sweating

Excessive sweating is another common Pristiq side effect. It’s not dangerous, but it can interfere with your quality of life.

Let your healthcare team know if this side effect is bothersome. If Pristiq is working well for your depression symptoms, it’s likely that they’ll recommend staying on it and managing this side effect with antiperspirants or lifestyle changes.

Consider wearing moisture-wicking fabrics and avoiding environments that may cause you to sweat (if possible). You should also make sure your deodorant contains an antiperspirant. If these at-home tips don’t seem to help, let your prescriber know.

6. Sexual problems, such as erectile dysfunction

SNRIs, including Pristiq, commonly cause erectile dysfunction (ED), low libido, and other sexual side effects. Unlike some of the side effects listed above, sexual problems don't generally improve with time.

If you’re experiencing sexual side effects from Pristiq, let your prescriber know. In some cases, they may suggest switching to an antidepressant that’s less likely to cause these side effects. They might also recommend ED medications if Pristiq is otherwise working well for your depression symptoms.

7. Anxiety

Feeling nervous, anxious, or jittery is also a possible Pristiq side effect. This is most noticeable when you first start the medication. These feelings should get better as your body adjusts to Pristiq.

If you’re experiencing severe anxiety from Pristiq, contact your prescriber. They might suggest lowering your dose or trying a different antidepressant. But don’t try to stop Pristiq or lower your dose without your prescriber’s OK. As we’ll discuss later, this can cause uncomfortable withdrawal symptoms.

8. Dry mouth

Dry mouth is another common Pristiq side effect. It’s typically mild and goes away on its own as your body gets used to the medication.

You can manage dry mouth by sipping water throughout the day, chewing sugar-free gum, or sucking on ice chips. You can also try an over-the-counter saliva substitute, such as Biotene. If these tips don’t work, let your healthcare team know. They may have other suggestions to help manage this Pristiq side effect.

9. Suicidal thoughts or behaviors

Pristiq’s labeling has a boxed warning for worsened depression and suicidal thoughts. This is rare, but it warrants immediate medical attention.

The risk for this serious Pristiq side effect seems to be higher for people under age 25. It’s also most likely to happen during the first few months of taking the medication. If you notice unusual mood changes or thoughts, contact your healthcare team right away.

If you or someone you know is having thoughts of suicide, you’re not alone, and help is available. Call the National Suicide Prevention Lifeline at 988, or text HOME to 741-741 to reach the Crisis Text Line.

10. Serotonin syndrome

In rare cases, Pristiq can cause a potentially life-threatening condition known as serotonin syndrome. This can happen when there’s too much serotonin in your brain. Your risk for this complication goes up if you take Pristiq along with other medications that raise serotonin levels.

Examples of medications that increase serotonin include:

• Other antidepressants

• St. John’s wort

• Some antibiotics

• Some opioid pain relievers

• Some nausea medications

• Triptan migraine medications

• Dextromethorphan (Delsym)

These aren’t the only medications that raise serotonin levels. Share an up-to-date medication list with your prescriber and pharmacist before starting Pristiq. They can use this list to identify potential interactions.

Signs and symptoms of serotonin syndrome include a fast heart rate, sweating, and muscle stiffness. Muscle spasms, fever, and seizures are also possible. Seek medical attention right away if you think you’re experiencing serotonin syndrome.

11. Withdrawal symptoms

Stopping or lowering your dose of Pristiq suddenly can cause withdrawal symptoms. These can include headache, upset stomach, and a “pins and needles” sensation. This is called antidepressant discontinuation syndrome. While they’re not dangerous, withdrawal symptoms are uncomfortable.

Speak with your prescriber if you want to stop taking Pristiq. They can help develop a schedule for you to slowly lower your dosage. This strategy can help lower the risk of experiencing withdrawal symptoms.

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.

Why trust our experts?

Written by:

Sarah Morin, RPh

Sarah Morin, RPh, has been a registered pharmacist for over 25 years. She started out as a hospital pharmacist, working at Rhode Island Hospital and then at the University of Connecticut Health Center.

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:

Ferras Bashqoy, PharmD, BCCCP, BCPPS

Ferras Bashqoy, PharmD, BCCCP, BCPPS, is a clinical pharmacotherapy specialist in the Neonatal Intensive Care Unit (NICU) at Hassenfeld Children’s Hospital in New York City. His favorite part of the job is working with preterm newborns because they are strong and mighty despite their size.

Our editorial standards

Meet our experts