How to taper Pristiq (desvenlafaxine)?

From the Guidelines

Tapering Pristiq should be done gradually under medical supervision to minimize withdrawal symptoms, with a recommended reduction of 50mg increments every 2-4 weeks, as suggested by recent studies on antidepressant withdrawal 1. When considering tapering Pristiq, it's essential to prioritize minimizing withdrawal symptoms, which can be severe and protracted, including anxiety, agitation, low mood, and somatic symptoms, as reported in patient studies 1.

• A typical taper involves reducing the dose by 50mg increments every 2-4 weeks, though this varies based on individual factors.
• For example, someone on 100mg might decrease to 50mg for 2-4 weeks before stopping completely.
• Extended-release formulations make it difficult to cut pills, so your doctor may prescribe lower-dose tablets or recommend taking doses every other day during the final reduction phase.
• Common withdrawal symptoms include dizziness, nausea, headache, irritability, and "brain zaps" (electric shock-like sensations). Tapering is necessary because Pristiq affects serotonin and norepinephrine levels in the brain, and sudden discontinuation can cause these neurotransmitters to fluctuate rapidly, leading to withdrawal symptoms, as noted in studies on antidepressant dependence and withdrawal 1. If withdrawal symptoms become severe during tapering, your doctor might slow the taper schedule or temporarily return to a slightly higher dose before continuing the reduction more gradually, emphasizing the need for close medical supervision and individualized tapering plans 1. To manage symptoms during the tapering process, it's recommended to stay hydrated, maintain regular sleep patterns, and use stress-reduction techniques, as these can help alleviate some of the withdrawal symptoms associated with Pristiq tapering.

From the FDA Drug Label

When discontinuing therapy, gradual dose reduction is recommended whenever possible to minimize discontinuation symptoms [see Dosage and Administration (2.5) and Warnings and Precautions (5.7)]. The 25 mg per day dose is intended for a gradual reduction in dose when discontinuing treatment. Gradually reduce the dosage rather than stopping desvenlafaxine abruptly whenever possible.

To taper Pristiq (desvenlafaxine), gradual dose reduction is recommended to minimize discontinuation symptoms. The dosage can be reduced to 25 mg per day when discontinuing treatment. It is advised to gradually reduce the dosage rather than stopping the medication abruptly whenever possible 2.

From the Research

Tapering Pristiq

To taper Pristiq (desvenlafaxine), a selective serotonin-norepinephrine reuptake inhibitor (SNRI), it is essential to follow a gradual tapering schedule to minimize discontinuation symptoms.

• Discontinuation symptoms can be mild, short-lived, and self-limiting but may be distressing and lead to decreased productivity 3.
• Common symptoms include dizziness, nausea, headache, irritability, diarrhea, anxiety, abnormal dreams, fatigue, and hyperhidrosis 4.
• The incidence of antidepressant withdrawal syndrome (AWS) is common, with a pooled incidence of 42.9% 5.
• Tapering the dose can reduce the incidence of AWS compared to abrupt stoppage, although the difference may not be significant 5.
• Risk factors for withdrawal symptoms include being female, younger, experiencing adverse effects early in treatment, taking higher doses or longer duration of medication, and abrupt cessation of drugs 5, 6.
• It is recommended to taper antidepressants, including Pristiq, over a period of more than four weeks to minimize withdrawal symptoms 7.

Tapering Schedule

• There is no specific tapering schedule recommended for Pristiq, but a gradual taper over several weeks or months is suggested 3, 7.
• The tapering duration may not be associated with withdrawal symptoms or relapse rate, but a slower taper may be beneficial in reducing symptoms 6.
• Healthcare professionals should be educated about the potential adverse effects of SNRI discontinuation and counsel patients appropriately 3, 7.

Relapse Risk

• Withdrawal symptoms may increase the risk of relapse, and experiencing withdrawal symptoms can be associated with a higher relapse risk 6.
• Early depressive symptoms and withdrawal symptoms can be associated with a higher relapse risk, and tapering duration may not be associated with relapse rate 6.
• It is crucial to monitor patients for relapse after discontinuing Pristiq and consider alternative treatment options if necessary 6.