“Pristiq” is the latest in the group of anti-depressants known as SNRIs, or serotonin and norepinephrine reuptake inhibitors. Also in this class is Cymbalta (duloxetine), which is the only anti-depressant that has an FDA approval for fibromyalgia. “Venlafaxine” (Effexor, Effexor XR) is another SNRI and is quite similar to Pristiq which is the trade name for “desvenlafaxine.
I suspect we will be hearing more about Pristiq because it is so similar to Effexor and Cymbalta. I began prescribing Effexor for FMS and pain patients several years ago because it seemed to work better on their depression/pain overlap than the SSRIs which are “selective serotonin reuptake inhibitors”. Examples of SSRIs are Paxil, Zoloft, Celexa, and many others.

This is called “off-label” prescribing by the FDA and simply means that the physician is prescribing a medication for something the FDA has not approved it for. It is entirely accepted and legal and is done with all kind of medications we know can help a particular problem but has not gone through the arduous FDA process.

We know that the neurotransmitters serotonin and norepinephrine seem to be involved in FMS (see “What causes Fibromyalgia”), CFS, and other chronic pain syndromes. Therefore a medication that boosts the levels of these could potentially be helpful.

My concern with Pristiq is that it is not very flexible in it’s dosing at this time. Those of us with FMS and related disorders can be unusually sensitive to medications. My axiom is to “start low and go slow.”
Start with a very low dose and gradually increase the dose if until there is a response.
On the other hand the fact that it is sustained-release is a plus. This allows for once/daily dosing and more constant drug levels.
This does not mean to try Pristiq if your physician recommends it. It may work great for you. I suspect, however, that a lower dosage form of Pristiq will be needed if it is to become helpful in our quest.

Yours, Dr. Don

P.S. If any of you have tried or are on Pristiq I would love to hear from you in the comments section or by email!!!

Tags: anti-depressants, back pain, CFIDS, chronic back pain, chronic pain, cymbalta, effexor, fibromyalgia, Fibromyalgia and Chronic Fatigue, fibromyalgia cure, pain, pain modulation, pristiq, SNRIs, SSRIs

This entry was posted on Wednesday, November 19th, 2008 at 4:08 pm and is filed under Anxiety and Depression, Fibromyalgia and Chronic Fatigue, Uncategorized, chronic pain, pain. You can leave a response, or trackback from your own site.