What to Know About Pristiq XR Side Effects

Every medication comes with potential side effects, and Pristiq XR (Desvenlafaxine) is no exception. The good news is that most side effects are mild, manageable, and often improve within the first few weeks of treatment.

This guide covers the common and serious side effects of Pristiq XR based on FDA labeling, who may be more at risk, and when you should contact your doctor.

What Is Pristiq XR?

Pristiq XR is an extended-release serotonin-norepinephrine reuptake inhibitor (SNRI) approved to treat Major Depressive Disorder (MDD) in adults. It contains the active ingredient Desvenlafaxine, which is the active metabolite of Venlafaxine (Effexor XR). For more details, see our full guide on what Pristiq XR is and how it's used.

Common Side Effects

The following side effects were reported in clinical trials. Most are dose-related, meaning they're more likely at higher doses. Many improve after the first 1-2 weeks:

• Nausea — reported in about 22% of patients; the most common side effect
• Dizziness — about 13%
• Increased sweating (hyperhidrosis) — about 10%
• Constipation
• Decreased appetite
• Insomnia or difficulty sleeping
• Dry mouth
• Fatigue
• Headache
• Tremor
• Diarrhea
• Sexual side effects — including decreased libido, erectile dysfunction, and difficulty reaching orgasm

These side effects are generally mild to moderate. If any of them are persistent or bothersome, talk to your doctor — but don't stop taking Pristiq XR without medical guidance.

Serious Side Effects

While less common, Pristiq XR can cause serious side effects that need immediate medical attention:

Suicidal Thoughts (FDA Boxed Warning)

Pristiq XR carries a boxed warning — the FDA's most serious warning — about increased risk of suicidal thinking and behavior in children, adolescents, and young adults (ages 18-24), especially during the first few months of treatment or when doses change. Pristiq XR is not approved for use in children.

Call your doctor or 988 (Suicide & Crisis Lifeline) immediately if you experience new or worsening depression, anxiety, agitation, panic attacks, or thoughts of self-harm.

Serotonin Syndrome

This is a rare but potentially life-threatening condition that can occur when too much serotonin builds up in your body. Symptoms include:

• Agitation or restlessness
• Rapid heartbeat
• Fever
• Muscle twitching or rigidity
• Loss of coordination
• Hallucinations

Risk increases if you take Pristiq XR with other serotonergic medications. See our guide on Pristiq XR drug interactions for the full list.

Increased Blood Pressure

Pristiq XR can raise blood pressure because it affects norepinephrine. Your doctor should monitor your blood pressure before and during treatment.

Abnormal Bleeding

SNRIs may increase bleeding risk, especially if you also take NSAIDs, Aspirin, or blood thinners.

Other Serious Side Effects

• Angle-closure glaucoma — sudden eye pain, vision changes, swelling or redness
• Hyponatremia — low sodium, especially in older adults; symptoms include headache, weakness, confusion
• Seizures
• Liver damage (hepatotoxicity)
• Mania or hypomania activation — particularly in patients with bipolar disorder
• Discontinuation syndrome — if you stop abruptly (see below)

Side Effects in Specific Populations

Older Adults

Elderly patients may be more susceptible to hyponatremia (low sodium) and falls due to dizziness. Doctors may use lower starting doses.

Pregnant Women

Pristiq XR is Pregnancy Category C. Use during the third trimester may cause complications in the newborn, including difficulty breathing and feeding. Discuss the risks and benefits with your OB/GYN.

People With Kidney or Liver Problems

Dose adjustments are recommended: max 50 mg/day for severe kidney impairment and max 100 mg/day for moderate liver impairment.

How to Manage Common Side Effects

Here are some practical tips for handling the most common side effects:

• Nausea: Take Pristiq XR with food. This often improves within the first week or two.
• Insomnia: Take your dose in the morning rather than at night.
• Dry mouth: Sip water throughout the day, chew sugar-free gum, or use a saliva substitute.
• Constipation: Increase fiber and water intake. Over-the-counter stool softeners can help.
• Sweating: Wear breathable fabrics, stay hydrated, and talk to your doctor if it's severe.
• Sexual side effects: These can be persistent — discuss with your doctor, as dose adjustments or switching medications may help.

Never Stop Pristiq XR Abruptly

Stopping Pristiq XR suddenly can cause discontinuation syndrome, with symptoms like dizziness, nausea, headache, irritability, "brain zaps" (electric shock sensations), and vivid dreams. Always taper gradually under your doctor's supervision.

Final Thoughts

Most Pristiq XR side effects are mild and temporary. Nausea, dizziness, and sweating are the most commonly reported, and they often improve as your body adjusts. Serious side effects are rare but real — know the warning signs and don't hesitate to call your doctor.

If you're considering Pristiq XR or have just started, you can learn more about how it works or find a doctor who can answer your questions. And when you're ready to fill your prescription, Medfinder can help you locate a pharmacy with Pristiq XR in stock.