Pristiq Interactions: Alcohol, Medications, and Others

When should I avoid Pristiq?

Certain health conditions or other factors could raise your risk of harm if you take Pristiq. In such cases, your doctor may not prescribe Pristiq for you. These are known as contraindications. The list below includes contraindications of Pristiq.

If you take monoamine oxidase inhibitors (MAOIs). Taking certain medications called MAOIs with Pristiq can increase your risk of serotonin syndrome. With serotonin syndrome, a build-up of serotonin in your body can cause serious complications. This can sometimes be life threatening.

Due to this risk, you should not take an MAOI within 7 days of stopping Pristiq treatment. Also, you should not take Pristiq within 14 days of stopping an MAOI.

Examples of MAOIs include:

• selegiline (Emsam)
• phenelzine (Nardil)
• linezolid (Zyvox)
• methylene blue (ProvayBlue)

If you’ve had an allergic reaction. If you’ve had an allergic reaction to Pristiq or any of its ingredients, or to venlafaxine (Effexor XR), your doctor likely won’t prescribe Pristiq. This is because taking the drug could cause another allergic reaction. You can ask your doctor about other treatments that may be better options for you.

Before you start taking Pristiq, talk with your doctor if any of the factors above apply to you. Your doctor can determine whether Pristiq is safe for you to take.

Does Pristiq interact with alcohol?

Drinking alcohol while taking Pristiq is not recommended. Alcohol and Pristiq may have some similar side effects. These can include:

• dizziness
• nausea
• increased risk of bleeding

Consuming alcohol while taking Pristiq may increase your risk of these side effects. If you already have these side effects with Pristiq, drinking alcohol may make you feel worse.

To learn more about the side effects of Pristiq, see this article.

If you’re concerned about avoiding alcohol during your Pristiq treatment, talk with your doctor.

Does Pristiq interact with other drugs?

Before you start taking Pristiq, tell your doctor and pharmacist about any prescription, over-the-counter, or other drugs you take. Sharing this information with them may help prevent possible interactions. (To learn whether Pristiq interacts with supplements, herbs, and vitamins, see the “Are there other interactions with Pristiq?” section below.)

If you have questions about drug interactions that may affect you, talk with your doctor or pharmacist.

The table below lists drugs that may interact with Pristiq. Keep in mind that this table does not include all drugs that may interact with Pristiq. For more information about some of these interactions, see the “Drug interactions explained” section below.

Drug interactions explained

Learn more about certain drug interactions that can occur with Pristiq.

Interaction with certain other antidepressants

Pristiq is an antidepressant, and it can interact with certain other antidepressants. These include:

• tricyclic antidepressants such as nortriptyline (Pamelor) and amitriptyline
• selective serotonin reuptake inhibitors such as:
  • fluoxetine (Prozac)
  • escitalopram (Lexapro)
  • paroxetine (Paxil)
  • sertraline (Zoloft)
• serotonin-norepinephrine reuptake inhibitors such as:
  • duloxetine (Cymbalta)
  • venlafaxine (Effexor XR)
  • milnacipran (Savella)

What could happen

Pristiq and other antidepressants can raise the level of serotonin in your body. Taking Pristiq with these antidepressants can increase your risk of serotonin syndrome. With serotonin syndrome, too much serotonin builds up in your body. This can lead to serious, sometimes life-threatening, complications, including coma.

Symptoms of serotonin syndrome can include:

• diarrhea
• high body temperature
• high blood pressure
• fast heart rate
• muscle spasms
• tremor
• sweating
• seizures
• loss of consciousness

What you can do

Before taking Pristiq, tell your doctor about all the medications you take. If you take other antidepressants that may increase your serotonin level, your doctor will determine whether Pristiq is safe for you to take.

If you experience symptoms of serotonin syndrome while taking Pristiq, seek emergency medical care right away.

Interaction with certain beta-blockers

Pristiq can interact with certain beta-blockers. These drugs are used to treat high blood pressure, irregular heart rate, and other conditions.

Certain beta-blockers are broken down in your body by an enzyme (protein) called CYP2D6. Taking Pristiq with beta-blockers or other medications broken down by CYP2D6 can raise your risk of side effects from the beta-blockers or other medications broken down by this enzyme.

Examples of beta-blockers that can interact with Pristiq include:

• metoprolol (Toprol XL, Lopressor)
• nebivolol (Bystolic)
• proprannolol (Inderal LA)

What could happen

Taking certain beta-blockers with Pristiq can cause levels of the beta-blocker to build up in your body. This may increase your risk of side effects from the beta-blocker.

What you can do

Before you start Pristiq treatment, tell your doctor about all the medications you take. If you take a beta-blocker with Pristiq, your doctor may lower the dosage of your beta-blocker. This can help reduce your risk of side effects.

Interaction with blood thinners

Pristiq can interact with blood thinners, which are drugs that treat or help prevent blood clots. Blood thinner drugs can cause bleeding.

Examples of blood thinners include:

• warfarin (Jantoven)
• aspirin
• clopidogrel (Plavix)
• heparin
• enoxaparin (Lovenox)

What could happen

Pristiq can increase your risk of bleeding. Taking this drug with other medications that can cause bleeding can further increase this risk.

Taking Pristiq with blood thinners can cause bleeding such as:

• bruising
• nosebleeds
• stomach bleeding

In rare cases, bleeding can be severe and even life threatening.

What you can do

Before you start taking Pristiq, tell your doctor if you take a blood thinner. They’ll monitor you for signs of bleeding when you begin Pristiq treatment, after any dose changes, and when you stop taking Pristiq.

If you have symptoms of bleeding while taking Pristiq, contact your doctor. These can include:

• bleeding gums
• unusual bruising
• blood in your stool

If you experience these symptoms, your doctor will determine whether you should continue taking Pristiq.

Are there other interactions with Pristiq?

Pristiq may have other interactions. They could occur with supplements, foods, vaccines, or even lab tests. See below for details. Note that the information below does not include all other possible interactions with Pristiq.

Does Pristiq interact with supplements?

Before you start taking Pristiq, talk with your doctor and pharmacist about any supplements, herbs, and vitamins you take. Sharing this information with them may help you avoid possible interactions.

If you have questions about interactions that may affect you, talk with your doctor or pharmacist.

Pristiq interactions with herbs

Pristiq may interact with the herbal supplements St. John’s wort and tryptophan. Both supplements can increase serotonin in your body. Pristiq also increases serotonin. So, taking it with St. John’s wort or tryptophan can increase your risk of serotonin syndrome.

For more details about serotonin syndrome, see the “Drug interactions explained” section above.

Pristiq and vitamins

There are currently no reports of Pristiq interacting with vitamins. But this doesn’t mean that vitamin interactions won’t be recognized in the future.

For this reason, it’s still important to check with your doctor or pharmacist before taking any of these products while taking Pristiq.

Does Pristiq interact with food?

There are currently no reports of Pristiq interacting with food. If you have questions about eating certain foods during your treatment with Pristiq, talk with your doctor.

Does Pristiq interact with vaccines?

Currently, there aren’t any reports of vaccines interacting with Pristiq. Talk with your doctor if you have questions about getting vaccines while you’re taking Pristiq.

Does Pristiq interact with lab tests?

Pristiq can cause false-positive results* in urine tests for phencyclidine (PCP) or amphetamines. These tests may be required before starting a new job or during your employment.

If you need a urine drug test done while taking Pristiq, tell your doctor or the person administering the test about any medications you take. They can order a different drug test that will not show a false-positive result.

* With a false positive, the results of your drug test incorrectly show certain drugs in your system, even though you haven’t taken them.

Does Pristiq interact with cannabis or CBD?

There are currently no reports of Pristiq interacting with cannabis (commonly called marijuana) or cannabis products such as cannabidiol (CBD). But as with any drug or supplement, talk with your doctor before using cannabis with Pristiq.

Note: Cannabis is illegal at a federal level but is legal in many states to varying degrees.

Does my health history affect whether I should take Pristiq?

Certain medical conditions or other health factors may raise the risk of interactions with Pristiq. Before taking Pristiq, talk with your doctor about your health history. They’ll determine whether Pristiq is right for you.

Health conditions or other factors that might interact with Pristiq include:

Suicidal thoughts and behaviors. Pristiq has a boxed warning for the risk of suicidal thoughts and behaviors. This is a serious warning from the food and Drug Administration (FDA). Before you start taking Pristiq, let your doctor know if you have a history of suicidal thoughts and behaviors. To learn more about this warning, see the “Boxed warnings” section at the beginning of this article.

Bleeding problems. Pristiq can increase your risk of bleeding. If you already have a bleeding problem, such as hemophilia, Pristiq may worsen it. Talk with your doctor about whether Pristiq is safe for you to take.

High blood pressure. Taking Pristiq may raise your blood pressure. If you already have high blood pressure, Pristiq can raise it even more. Before taking Pristiq, tell your doctor know if you have high blood pressure or take medication to lower your blood pressure. They’ll likely monitor your blood pressure regularly while you’re taking this medication.

If your blood pressure is high before you begin taking Pristiq, your doctor may prescribe medication to lower your blood pressure before you start Pristiq treatment.

Kidney problems. If you have a kidney problem (such as chronic kidney disease), Pristiq levels could build up in your body. This may increase your risk of side effects from Pristiq. Before taking Pristiq, tell your doctor if you have a kidney condition. If you have moderate or severe kidney problems, your doctor may prescribe a lower dosage of Pristiq for you.

Liver problems. If you have a liver problem, such as alcohol-related liver disease, Pristiq levels may build up in your body. This can raise your risk of side effects from the drug. Before starting Pristiq treatment, talk with your doctor if you have a liver problem. They’ll likely prescribe a lower dosage of Pristiq for you.

Heart problems. Pristiq can increase your blood pressure, which may worsen heart problems, such as coronary artery disease. Before taking Pristiq, let your doctor know if you have a heart condition. They’ll likely check your blood pressure regularly while you’re taking this drug.

Stroke. Taking Pristiq can increase your blood pressure, which may increase your risk of stroke. If you’ve had a stroke in the past, your risk of having another while taking Pristiq one is higher. If you’ve had a stroke before, talk with your doctor before starting Pristiq treatment. They may recommend a different treatment option for you. If they do prescribe Pristiq, they’ll likely monitor your blood pressure more often than usual.

Bipolar disorder. Taking Pristiq to treat depression caused by bipolar disorder can cause episodes of mania. Before you start treatment with Pristiq, tell your doctor about any mental health conditions you or your family have, including bipolar disorder. Sharing this information will help them determine whether Pristiq is safe for you to take.

Seizures. In rare cases, Pristiq can cause seizures. If you have a condition that causes seizures, Pristiq may further increase your risk of having a seizure. Your doctor can determine whether Pristiq is safe for you to take.

Low blood sodium level. Pristiq may cause low level of sodium in your blood. If your level is already low, taking Pristiq could lower it even more. Talk with your doctor if you currently have or have had low blood sodium levels. They’ll likely monitor your sodium level regularly during your Pristiq treatment. In some cases, they may recommend a different treatment option for you.

High cholesterol or high triglycerides. Pristiq can increase cholesterol or triglyceride levels in some people. If you already have a high level, this drug may worsen your condition. Tell your doctor if you have high cholesterol or triglyceride levels before you start taking Pristiq. They’ll likely monitor your levels closely while you’re taking this medication. Your doctor can also recommend ways to help manage your cholesterol and triglyceride levels.

Glaucoma. Pristiq may worsen a certain kind of glaucoma called closed-angle glaucoma. Before taking Pristiq, let your doctor know if you have glaucoma. They’ll determine whether this medication is safe for you to take.

Pregnancy. It’s not known whether it’s safe to take Pristiq during pregnancy. If you’re pregnant or planning to become pregnant, talk with your doctor before starting Pristiq treatment. They’ll discuss with you the risks and benefits of taking Pristiq during pregnancy.

Breastfeeding. It’s not known whether Pristiq is safe to take while breastfeeding. But the drug has been shown to pass into breast milk in small amounts. If you’re breastfeeding or planning to do so, talk with your doctor about whether Pristiq is safe for you to take.

Allergic reaction. If you’ve had an allergic reaction to Pristiq, venlafaxine (Effexor XR), or any of Pristiq’s ingredients, your doctor will likely not prescribe Pristiq. This is because taking the drug could cause another allergic reaction. You can ask your doctor about other treatments that may be better choices for you.

Common questions about Pristiq and interactions

Find answers to some frequently asked questions about Pristiq and possible interactions.

What pain reliever can I take with Pristiq?

Acetaminophen (Tylenol) is a pan reliever generally considered safe to take with Pristiq. You can buy many products with acetaminophen over the counter (OTC). But you should still talk with your doctor or pharmacist before taking any OTC medications with Pristiq. They can tell you whether they’re safe to take together.

Pristiq can interact with certain other pain relievers. These include OTC nonsteroidal anti-inflammatory drugs such as aspirin and ibuprofen (Advil, Motrin) and the prescription drugs fentanyl and tramadol. For more information about these interactions, see the “Does Pristiq interact with other drugs?” section above.

Are there interactions between gabapentin and Pristiq?

No. Currently, there are no reports of an interaction between gabapentin and Pristiq. Gabapentin is a prescription drug used to treat certain types of seizures and nerve pain.

Pristiq may interact with certain other medications used to treat nerve pain, such as duloxetine (Cymbalta). For more details about this interaction, see “Drug interactions explained” above.

It’s important to note that Pristiq may increase the risk of seizures, which gabapentin is used to treat. Let your doctor know if you have a history of seizures before starting Pristiq treatment. They’ll determine if this medication is safe for you to take.

How can I prevent interactions?

Taking certain steps can help you avoid interactions with Pristiq. Before starting treatment, talk with your doctor and pharmacist. Things to discuss with them include:

• Whether you drink alcohol or use cannabis.
• Other medications you take, as well as any vitamins, supplements, and herbs. Your doctor or pharmacist can help you fill out a medication list.
• What to do if you start taking a new drug during your Pristiq treatment.

It’s also important to understand Pristiq’s label and other paperwork that may come with the drug. Colored stickers that describe interactions may be on the label. And the paperwork (sometimes called the patient package insert or medication guide) may have other details about interactions. (If you did not get paperwork with Pristiq, ask your pharmacist to print a copy for you.) If you have trouble reading or understanding this information, your doctor or pharmacist can help.

Taking Pristiq exactly as prescribed can also help prevent interactions.

What should I ask my doctor?

If you still have questions about Pristiq and its possible interactions, talk with your doctor.

Questions you may want to ask your doctor include:

• Do I need to space out when I take my mediations throughout the day to avoid interactions?
• Does venlafaxine (Effexor XR) have similar interactions to Pristiq?
• If I take Pristiq and have certain health conditions, will I be monitored more closely during treatment?

To learn more about Pristiq, see these articles:

• Pristiq (desvenlafaxine)
• Dosage for Pristiq: What You Need to Know
• Side Effects of Pristiq: What You Need to Know

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Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.