Question: Now that Pristiq has been out for awhile, what has been the clinical response with your patients compared with the Effexor XR formulation? Rumors have said it is more tolerable and less sexual side effects, although I have tried some samples, and it doesn’t seem to be as calming as Effexor, and I am unsure what the Pristiq 50mg dose is compare to a similar Effexor XR dosage?
Also what SSRI/SNRI tends to have the fewest sexual side effects?
Thanks
Answer:
Pristiq and Cymbalta seem to have less sexual side-effects than Effexor
and if Pristiq at 50mg is an adequate dose it should have the least
sexual effects. 90% of the first 570,000 treated with Pristiq have
stayed with a 50mg dose. This dose has the same efficacy in control
studies as 75-150 of Effexor with better tolerability. The drop out
rate due to side-effects is essentially the same as placebo.
When most people (normal metabolizers) take Effexor – 70% of the benefit
comes from Effexor being metabolized so the effects are very similar.
Pristiq does have a slightly higher ratio of norepinephrine effect
relative to serotonin than Effexor and this could account for your
impression that it’s not as calming – that is most likely a temporary
effect.
Because Pristiq doesn’t require the same liver metabolism as Effexor
there are less issues with drug drug interactions and tolerability for
those people (7-10% of Caucasians) who are poor metabolizers. Poor
metabolizers don’t usually do as well on Effexor and don’t usually
tolerate doses above 75mg. Some people do better on 100mg of Pristiq.
Pristiq is also more cost-effective, especially at 100mg dose – since
there is a 100mg tablet – whereas Effexor frequently requires 225mg or
more necessitating multiple capsules.
Wyeth is also getting ready to launch a program where they will pay 1/2
of your cost (copay or cash) as long as you take it on a continual
basis for life if necessary.
4 thoughts on “Pristiq vs Effexor”
Sorry, but I have to disagree about the cost effectiveness of Pristiq. Pristiq has been costing me $150 for 3 months. Increasing to 100mg would not change that and I would possible pay more. My co-pay for Effexor (generic) is $20 for 3 months. Since Pristiq is not supposed to go generic until 2020 I can’t afford to stay on it, especially since I am approaching medicare age.
Hi, just looking for some advise. I’m a 40 y/o female. I have always had an anxiety disorder that results in depression. My depression became worse when my sister died in 2006 and my mother was dying from breast cancer. I had to take care of my sister’s estate and bring her body home. I also had to care for my mother. Mother died in 2007 and I watched her die. I keep seeing it over and over in my head like a video constantly being played back. My father died of heart disease in 1993. The depression started after dad died and I watched his last breath as well. I have no family left. Although I am married with 3 children I feel alone and the reality hits me like a ton of bricks sometimes. I miss my family and I think about them everyday.
So, I was on Zoloft for years and it killed my Libido. My husband was complaining a lot and I don’t blame him, but he’s not the most understanding or supportive person. It was hell to go off of it as the side effects were bad. I couldn’t handle my anxiety so was switched to Lexapro, and wellbutrin, and the wellbutrin gave me panic attacks. Taken alone, the Lexapro made me feel flat. Not happy, not sad either. Dull. So, went off that and depression became worse. Now my MD has put me on Prestiq. You know the commercial where the doll is getting would back up? Well, that is true, it does give you some energy. But, for me, that is all. It does nothing for my depression. I still feel like a dark cloud is following me around, reminding me of all the bad things that have happened in my life, and I constantly feel like a victim. So, I’m giving Pristiq a little more time as I have only been on it 7 weeks, at least to get me through the holidays. If the depression continues, I don’t know what to try next. What happens to me is I keep thinking about negative things and that just builds up inside making me miserable, physically sick, and I don’t want to exercise. Help, this sucks!!! I have tried psychologists, but found it not helpful. Also, why don’t psychiatrists allow you to talk. It seems they are only there to give you the medicine, that’s it, in and out in 15 minutes. They don’t give you the time to talk and go into detail about what/why you are feeling. One psychiatrist actually got irritated with me that I wanted to talk more. She said, I’m here to manage your meds, that’s all, get on with it!! She was also the one that told me I was a little non-compliant with my meds because the Wellbutrin gave me 2 panic attacks that were uncontrollable, which I never have. Thanks for reading this long blog. Any advice is appreciated.
That is interesting about Pristiq not needing the same liver metabolism as Effexor XR.
I’m on of those that usually ends up taking much less of the suggested start up dose, as I tend to be very sensitive to side effects. I’ve been taking Effexor XR for the past four years or so, and mainly that was at 25mg, a third of the capsule. Eventually, I needed to increase the dosage, and went up to 75mg, and felt well except for word-finding difficulties and a strange reaction to things that normally would make me sad or depressed – instead, I would react with a fear attack (heart rate increase, sweating, flushing, confused) and the increase in heart flutter whenever I would lay down or sit down. These went away when I went off of Effexor for a month, but eventually I was back to being depressed, crying every day, etc. So, I tried 30mg Cymbalta, and had to go down to 10mg, as it was much too stimulating for me. Even 10mg caused neck tension, a feeling like I was in a continuous startled state (like my chest was going to explode, nervous stomach), like taking a big dose of pseudophedrine. Then my doctor let me try Pristiq, and I took the recommended dose of 50mg and this is much more agreeable side-effect wise than the other two. I’m calmer without feeling drugged. The only side effect at the moment is insomnia, otherwise, I don’t feel like I’m taking anything, but at the same time I’m not constantly thinking negative thoughts and it has gotten rid of much of what I call “brain chatter”.
Lisa
I have been on 50mg pristiq for 6 weeks and have experienced notable improvement (Paxil had ceased to be effective after long term use). The cost is a real problem, and my insurance will not cover it. Any suggestions? I would be interested in a survey program.