Pristiq vs EffexorXR

[Geek]

My pdoc is talking about putting me on Pristiq. I have previously taken EffexorXR with some limited results (no significant side effects or withdrawal effects). 

I understand that Pristiq is the active metabolite of Effexor... so how are they different? If Effexor only helped a little, is Pristiq likely to help more?

[mikl_pls]

To my understanding, it helps those most who don't metabolize Effexor well, because Effexor is dependent on its metabolism to O-desmethylvenlafaxine (Pristiq) for it to work well. In people who take venlafaxine who are poor metabolizers of certain CYP450 liver enzymes, they have higher venlafaxine levels and lower O-desmethylvenlafaxine levels, and also have more side effects and higher blood pressure, whereas people who are normal metabolizers or rapid metabolizers of that enzyme had the opposite ratio and lower levels of side effects. God help me if I could find the bookmark with all this info in it.

But to answer your question, if Effexor worked with limited benefits for you, I would think that Pristiq should probably work about the same. Maybe less well, maybe better? Theoretically, it should work better since it's "purer."

In my experience, Effexor worked far better than Pristiq. I felt Pristiq's dose range was far too limited (25-100 mg vs 37.5-375 mg and up to 600 mg in special cases). I've had far better and more consistent luck with Cymbalta than Pristiq or Effexor (works better than Pristiq, fewer side effects than Effexor, especially no weight gain--in fact, Cymbalta has helped me lose weight). That's just my experience and YMMV, etc.

[Geek]

Thanks mikl. That was kind of my sense of things, but I wasn't sure.

I guess we'll see if it helps if and when she puts me on it. I will mention Cymbalta too though.

[aquarian]

4 hours ago, mikl_pls said:

I've had far better and more consistent luck with Cymbalta than Pristiq or Effexor (works better than Pristiq, fewer side effects than Effexor, especially no weight gain--in fact, Cymbalta has helped me lose weight). That's just my experience and YMMV, etc.

That's good to hear. My pdoc recently suggested I try switching from effexor to cymbalta since effexor hasn't worked well for my anxiety since about 2011 and yet I'm still on it. I did try pristiq for at least a few months around 2012 or 2013 but it felt about the same as effexor so I asked to switch back to effexor since it's been around longer and thus cheaper.