Pristiq vs. Effexor: Differences, similarities, and which is better for you

Drug overview & main differences | Conditions treated | Efficacy | Insurance coverage and cost comparison | Side effects | Drug interactions | Warnings | FAQ

More than 16 million American adults have depression (major depressive disorder). Pristiq and Effexor are two popular medications indicated for the treatment of depression, a common mental health condition. Effexor XR (extended-release) also treats generalized anxiety disorder, panic disorder, and social anxiety. Both drugs are approved by the United States Food and Drug Administration (FDA). Wyeth Pharmaceuticals LLC, a subsidiary of Pfizer, makes both drugs in the brand-name forms.

Pristiq and Effexor are classified in a group of medications called SNRIs (serotonin-norepinephrine reuptake inhibitors). They work by regulating the reuptake of neurotransmitters called serotonin and norepinephrine in the CNS (central nervous system), thereby improving depression symptoms.

Notice how Pristiq’s generic name is desvenlafaxine, and Effexor’s generic name is venlafaxine. These drugs are very similar. When Effexor (venlafaxine) is metabolized, it turns into an active metabolite—desvenlafaxine.

Although Pristiq and Effexor are both SNRIs, they have some differences, which we will outline below.

What are the main differences between Pristiq and Effexor?

Pristiq and Effexor are both SNRI antidepressants available in brand and generic form. Both drugs are approved for use in adults.

Pristiq is available as an extended-release tablet. Dosing may vary, but the standard dose is 50 mg daily.

Effexor is available in tablet form, and also as an extended-release capsule and extended-release tablet form. A typical dose is 75 or 150 mg daily (XR formulation).

Conditions treated by Pristiq and Effexor

Pristiq (What is Pristiq?) is indicated for the treatment of major depressive disorder (MDD) in adults. Sometimes, Pristiq is prescribed off-label for other uses.

Effexor (immediate-release) is indicated to treat major depressive disorder. Effexor XR (What is Effexor?) is indicated for major depressive disorder, generalized anxiety disorder, social anxiety disorder, and panic disorder.

Is Pristiq or Effexor more effective?

A meta-analysis looked at the safety and efficacy of Pristiq and Effexor. The researchers concluded that both drugs were similar in terms of efficacy in treating depression, as well as side effects. However, patients who took Pristiq had less nausea than patients who took Effexor.

Consult your healthcare provider for medical advice. Only your healthcare provider can determine which medication is better for you, based on your medical condition(s) and history, as well as any medications you take that can interact with Pristiq or Effexor.

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Coverage and cost comparison of Pristiq vs. Effexor

Insurance and Medicare Part D plans usually cover Pristiq. The out-of-pocket price of a typical prescription of 30, 50 mg generic tablets is about $380. A free SingleCare card can bring the price down to less than $60.
Insurance and Medicare Part D plans usually cover Effexor XR (the more popularly prescribed type of Effexor). The out-of-pocket price of a typical prescription of 30, 150 mg generic capsules is about $140. You can use a free SingleCare card to bring the price down to approximately $15.

As insurance plans vary and are subject to change, contact your health insurance plan for current coverage information.

Common side effects of Pristiq vs. Effexor

The most common side effects of Pristiq are nausea, dizziness, insomnia, excess sweating, constipation, sleepiness, decreased appetite, anxiety, and male sexual problems.

The most common side effects of Effexor XR are nausea, sleepiness, dry mouth, sweating, sexual problems, decreased appetite, and constipation.

Other side effects may occur. Consult your healthcare professional for a full list of adverse effects.

*percentages listed are for Effexor XR, the more commonly prescribed formulation of Effexor
Source: DailyMed (Pristiq), DailyMed (Effexor XR)

Drug interactions of Pristiq vs. Effexor

Using SNRI antidepressants with MAO inhibitors can increase the risk of serotonin syndrome, which can be life-threatening. Pristiq or Effexor must be separated from an MAOI by seven to 14 days, depending on which medication is stopped first. Pristiq or Effexor should not be taken with other medications that increase serotonin levels, like other SNRI or SSRI antidepressants, triptans for migraines, and opioids, for the same reason.  Also, the cough suppressant dextromethorphan, which is found in Robitussin-DM as well as many other cough and cold products, should be avoided, as it can also cause serotonin syndrome when combined with Pristiq or Effexor.

Other drugs that may interact with Pristiq or Effexor include NSAIDs (non-steroidal anti-inflammatory drugs) such as aspirin or ibuprofen, and anticoagulants (blood thinners) like warfarin. Avoid alcohol when taking Pristiq or Effexor.

If Pristiq is taken with a medication that is metabolized by an enzyme called cytochrome P 2D6, the other medication may build up to levels that are too high and can become toxic. Dosage adjustment may be required. Effexor does not have this interaction.

This is not a full list of drug interactions. Consult your healthcare provider for a complete list of drug interactions.

Warnings of Pristiq and Effexor

All antidepressants, including Pristiq and Effexor, have a boxed warning of suicidality. A boxed warning is the most serious warning required by the FDA. Children, adolescents, and young adults (up to 24 years old) who take antidepressant drugs have an increased risk of suicidal thoughts and behavior. All patients on antidepressant medications should be carefully monitored.

Other warnings include:

• Pristiq and Effexor are not approved to treat pediatric patients.
• Serotonin syndrome is a serious, life-threatening emergency caused by the buildup of too much serotonin. Patients who take Pristiq or Effexor should be carefully monitored for signs and symptoms of serotonin syndrome, such as hallucinations, seizures, changes in blood pressure, and agitation. Patients should seek emergency medical treatment if any of these symptoms occur. Patients who take other drugs that increase serotonin levels (triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone, dextromethorphan, amphetamines, St. John’s Wort, and MAOIs) are at higher risk for serotonin syndrome.
• Pristiq or Effexor may raise blood pressure. Monitor blood pressure regularly. If you have high blood pressure or heart problems, consult your healthcare provider before taking Pristiq or Effexor.
• SNRIs may increase bleeding risk. The risk increases with concomitant use of aspirin, NSAIDs, or warfarin.
• Activation of mania or hypomania may occur. In patients with bipolar disorder, an antidepressant may precipitate a mixed/manic episode.
• Avoid SNRIs or use with caution in patients with untreated anatomically narrow angles (angle-closure glaucoma). Ask your healthcare provider if you are at risk.
• When you stop taking Pristiq or Effexor, ask your healthcare provider for a tapering schedule. Abrupt discontinuation can cause withdrawal symptoms such as nausea, tremors, confusion, and seizures. Reducing the dose gradually can help avoid these symptoms.
• Hyponatremia (low sodium levels) due to the syndrome of inappropriate antidiuretic hormone secretion (SIADH) may occur. Patients may experience headaches, difficulty concentrating, memory impairment, confusion, weakness, and unsteadiness, potentially leading to falls. More severe cases can occur. Patients should seek emergency treatment if symptoms occur, and discontinue the SNRI.
• Do not drive or operate machinery until you know how Pristiq or Effexor affects you.
• Talk to your healthcare provider about using Pristiq or Effexor if you have a history of seizures.
• In rare cases, there have been reports of rash and allergic reactions/systemic anaphylaxis reactions or angioedema. If you experience a rash or allergic symptoms, stop taking Pristiq or Effexor and seek medical treatment immediately. Do not take Pristiq or Effexor if you are allergic to any of the ingredients.
• Rare cases of interstitial lung disease and eosinophilic pneumonia have been associated with these medications. If you are taking Pristiq or Effexor and have shortness of breath, cough, or chest discomfort, seek immediate medical attention.
• Pristiq or Effexor should only be used in pregnancy if the benefit to the mother is greater than the risk to the baby. Stopping the medication may cause a relapse of depression or anxiety. Therefore, patients should be evaluated on a case-by-case basis. Your healthcare provider can weigh the risk versus benefits of using an SNRI during pregnancy. Neonates exposed to SNRIs in the third trimester have developed complications requiring prolonged hospitalization, respiratory support, and tube feeding. If you are already on Pristiq or Effexor and find out you are pregnant, contact your healthcare provider immediately.
• Pristiq: Swallow a tablet whole, with water. Do not chew, crush, dissolve, or divide the tablets.
• Effexor XR: Swallow capsule whole with water. Do not divide, crush, chew, or place the capsule in water. Alternatively, you can open the capsule, sprinkle the contents on a spoonful of applesauce, and immediately swallow the mixture, followed by drinking a glass of water.

Frequently asked questions about Pristiq vs. Effexor

What is Pristiq?

Pristiq is an SNRI antidepressant. Pristiq treats depression in adults. The generic name is desvenlafaxine.

What is Effexor?

Effexor is also an SNRI antidepressant. Effexor treats depression in adults. Effexor XR (extended-release) treats depression, social anxiety disorder, panic disorder, and generalized anxiety disorder. The generic name of Effexor is venlafaxine.

Are Pristiq and Effexor the same?

The medications are very similar. When Effexor is metabolized in the body, it turns into desvenlafaxine, the active ingredient of Pristiq. The two drugs are similar but have some differences, such as in dose, price, side effect rates of occurrence, and drug interactions.

Is Pristiq or Effexor better?

Both drugs are similar in terms of efficacy. Your healthcare provider can guide you regarding which drug may be appropriate for you.

Can I use Pristiq or Effexor while pregnant?

Consult your healthcare provider for advice. He or she will weigh the benefits of taking an antidepressant vs. the risk to the baby. Neonates exposed to certain antidepressants, including SNRIs or SSRIs (selective serotonin reuptake inhibitors like Prozac), in the third trimester of pregnancy, have developed serious complications.

If you are already on Pristiq or Effexor and find out that you are pregnant, consult your OB-GYN immediately for advice. If you are breastfeeding, consult your OB-GYN as well.

Can I use Pristiq or Effexor with alcohol?

No. Pristiq or Effexor should not be taken with alcohol because the combination may increase the risk of respiratory depression (slowed breathing, not getting enough oxygen) and increase sedation and drowsiness, and impair alertness. The combination can also worsen anxiety and depression.

Does Pristiq help with anxiety?

Although Pristiq is only indicated to treat depression, some doctors prescribe it off-label for anxiety. However, in clinical trials, 3% of patients who took Pristiq 50 mg (the recommended dose) experienced anxiety as a side effect. Some people need to try different medications to see which works best. Consult your healthcare provider for more information.

Is Pristiq a mood stabilizer?

Drugs classified as mood stabilizers are usually used to treat bipolar disorder. Pristiq is indicated to treat depression. Taking Pristiq may make your mood feel more stable, but it is not classified as a mood stabilizer. Pristiq is an SNRI antidepressant.

Is venlafaxine a SNRI?

Yes. Effexor (venlafaxine) is an SNRI. Other SNRIs for depression include Pristiq (desvenlafaxine), Fetzima (levomilnacipran), and Cymbalta (duloxetine).