Can Pristiq (desvenlafaxine) cause shakiness or tremors?

Does Pristiq (Desvenlafaxine) Cause Shakiness or Tremors?

Yes, Pristiq (desvenlafaxine) can cause tremors and shakiness as a documented side effect, occurring in approximately 2-9% of patients depending on dosage. 1

Side Effect Profile Related to Shakiness

Desvenlafaxine, a serotonin-norepinephrine reuptake inhibitor (SNRI), has several neurological side effects that can manifest as shakiness:

• Tremor: Reported in 2-9% of patients taking Pristiq, with higher incidence at doses above 50mg 1
• Dizziness: Common side effect (occurs in ≥5% of patients) that may contribute to feeling of shakiness 1
• Nervous system disorders: Including disturbance in attention that may present with motor symptoms 1

Risk Factors for Developing Shakiness

Several factors may increase the likelihood of experiencing tremors with Pristiq:

• Dose-dependent relationship: Higher doses (>100mg) are associated with increased risk of tremor (up to 9% incidence vs 2% with placebo) 1
• Age: Elderly patients may have higher serum levels due to decreased clearance, potentially increasing side effects 1
• Renal impairment: Reduced clearance can lead to higher drug concentrations 1
• Hepatic dysfunction: Can affect metabolism of the medication 1
• Drug interactions: Concomitant use with other serotonergic medications may increase risk 1

Management of Shakiness/Tremors

If tremors develop while taking Pristiq, consider these approaches:

1. Dose adjustment: Since tremors are dose-dependent, reducing the dose may help alleviate symptoms while maintaining therapeutic effect 1

2. Timing modification: Taking the medication with food may help reduce side effects 1

3. Monitoring: Regular follow-up to assess if tremors are transient or persistent

4. Medication switch: If tremors are severe or persistent, consider switching to an alternative antidepressant with a different side effect profile

Important Considerations

• Onset timing: Tremors may appear early in treatment and sometimes diminish over time as the body adjusts to the medication

• Discontinuation: If discontinuing due to tremors, gradual tapering is essential to avoid withdrawal symptoms including dizziness, irritability, sensory disturbances, and tremors 1

• Serotonin syndrome: In rare cases, severe tremors could be a sign of serotonin syndrome, especially if combined with other symptoms like confusion, fever, muscle rigidity, or sweating - this requires immediate medical attention 1

Conclusion

Tremor is a recognized side effect of Pristiq that occurs in a significant minority of patients. The risk increases with higher doses, and patients should be informed about this potential side effect when starting treatment. If tremors develop and are bothersome, dosage adjustment or medication change may be warranted after clinical evaluation.