Pristiq interactions: Alcohol, medications, and other factors

In some cases, factors or conditions could prevent your doctor from prescribing Pristiq due to a risk of harm. These are known as contraindications. The contraindications of Pristiq include:

Taking drugs called monoamine oxidase inhibitors

Medications called monoamine oxidase inhibitors (MAOIs) might be used to treat depression. MAOIs and Pristiq can increase the level of a hormone in your brain called serotonin. If the level is too high, it’s possible to develop a condition called serotonin syndrome. In some cases, the condition can be life threatening.

Due to the risk of serotonin syndrome, you should not take Pristiq if you’ve taken an MAOI in the past 14 days. In addition, you should not take an MAOI for at least 7 days after stopping Pristiq treatment.

Examples of MAOIs include:

• linezolid (Zyvox)
• methylene blue (ProvayBlue)
• phenelzine (Nardil)
• isocarboxazid (Marplan)
• tranylcypromine (Parnate)
• selegiline (Emsam, Zelapar)

Before you start to take Pristiq, tell your doctor if you take an MAOI. They can adjust your treatment plan as needed.

Having had an allergic reaction to Pristiq or any of its ingredients

If you’ve had an allergic reaction to Pristiq or any of its ingredients, your doctor will likely not prescribe Pristiq. Taking the drug could cause another allergic reaction. You can ask them about other treatments that may be better choices for you.

Note: Before you start treatment with Pristiq, it’s important to tell your doctor if either of these contraindications apply to you. They can determine whether to prescribe Pristiq.

Drinking alcohol is not recommended if you’re taking Pristiq. This medication may cause certain side effects that can be made worse by drinking alcohol. Examples of these side effects can include:

• nausea
• dizziness
• anxiety
• increased risk of bleeding

To learn more about Pristiq’s side effects, refer to this article.

If you drink alcohol, talk with your doctor about how much, if any, is safe to drink while you’re taking Pristiq.

Before you start treatment with Pristiq, tell your doctor and pharmacist about any prescription, over-the-counter, and other medications you take. By sharing this information with them, you may help prevent possible interactions. (To learn whether Pristiq interacts with supplements, herbs, or vitamins, see the “Pristiq and other interactions” section below.)

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Here’s a chart of drugs that can interact with Pristiq. Keep in mind that this chart doesn’t include all drugs that may interact with Pristiq. Some of these interactions are described in detail just below in “Drug interactions in depth.”

* For details about this interaction, see the “When to avoid Viibryd” section above.
† Pristiq is an SNRI, which is a type of antidepressant.

Here’s a closer look at certain drug interactions of Pristiq.

Certain stimulant medications

Stimulants are drugs often used to treat attention deficit hyperactivity disorder (ADHD) and narcolepsy. (Narcolepsy is a sleep disorder that affects how well you sleep.)

Interaction result. Taking Pristiq in combination with certain stimulant medications may increase your risk of a serious condition called serotonin syndrome.

Interaction explained. Pristiq and certain stimulant medications can increase the level of a hormone in your brain called serotonin. If the level is too high, you may be at an increased risk of serotonin syndrome. This condition can be life threatening.

Examples of stimulant drugs. Here are some stimulants that may interact with Pristiq:

• methylphenidate (Jornay PM, Ritalin, others)
• lisdexamfetamine (Vyvanse)
• amphetamine salts (Adderall, Adderall XR)

Steps you or your doctor may take. Before you start Pristiq treatment, tell your doctor if you take any stimulant medications. Depending on what you’re taking, your doctor may monitor you more often than is typical. They may also recommend that you watch for any symptoms of serotonin syndrome during your treatment. Symptoms may include confusion, hallucinations, sweating, and changes in blood pressure.

Drugs broken down by CYP2D6

If you take any medications that are broken down by an enzyme called CYP2D6, they may interact with Pristiq.

Interaction result. Taking Pristiq with a drug broken down by CYP2D6 can increase your risk of side effects from the drug that is broken down by CYP2D6.

Interaction explained. CYP2D6 works in your body to break down certain drugs or chemicals. Pristiq can prevent CYP2D6 from working. So if you take any medications that are broken down by CYP2D6, they may build up in your body. This can increase your risk of side effects from the drugs.

Examples of drugs that are broken down by CYP2D6. Here are some drugs that may interact with Pristiq:

• desipramine (Norpramin)
• atomoxetine (Strattera)
• dextromethorphan (Delsym)
• metoprolol (Lopressor, Toprol XL)
• nebivolol (Bystolic)
• tolterodine (Detrol LA)
• perphenazine

Steps you or your doctor may take. It’s not likely that taking Pristiq at low doses will cause it to interact with drugs broken down by CYP2D6. So if you take a dose of Pristiq 100 milligrams (mg) or lower, your doctor likely won’t recommend any changes to your other medications.

However, if you’re taking a higher dose of Pristiq, such as 400 mg, your doctor may decrease the dose of your other medication.

If you have questions or concerns about other medications that you take along with Pristiq, talk with your doctor. They can help determine whether the drugs can be broken down by CYP2D6 and whether you need a dosage adjustment.

Diuretics

If you take a diuretic, talk with your doctor before starting Pristiq. Diuretics may be prescribed to treat high blood pressure or fluid retention in people with heart failure.

Interaction result. Taking Pristiq in combination with a diuretic may increase your risk of a low blood sodium level.

Interaction explained. It’s possible for Pristiq to cause low blood sodium levels. Diuretics can also cause this side effect. The combination of these drugs may make low blood sodium levels more likely to occur.

Examples of diuretic drugs. Here are some diuretics that may interact with Pristiq:

• hydrochlorothiazide (Microzide)
• chlorthalidone (Thalitone)
• spironolactone (Aldactone, Carospir)
• furosemide (Lasix)

Steps you or your doctor may take. If you take diuretics, talk with your doctor before starting Pristiq. They may monitor you more often for symptoms of low blood sodium. Symptoms may include nausea, headache, confusion, and fatigue.

If you develop any symptoms, it’s important to contact a doctor right away. They can order a blood test to determine whether your blood sodium level is low. If you have symptoms of low blood sodium, your doctor will recommend the necessary treatment.

Pristiq may have other interactions, such as with supplements, foods, vaccines, or even lab tests. You’ll find details below. Keep in mind that the following information does not include all other possible interactions with Pristiq.

Pristiq interactions with supplements

Before you start treatment with Pristiq, tell your doctor and pharmacist which supplements, herbs, and vitamins you take. By sharing this information with them, you may help prevent possible interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Pristiq interactions with herbs

It’s possible for Pristiq to interact with certain herbs that increase your serotonin levels.

Pristiq works by increasing serotonin levels. If you take an herb that also increases serotonin levels, you may be at an increased risk of serotonin syndrome. (Serotonin syndrome is a condition caused by a buildup of serotonin in your body.)

Examples of herbs that may interact with Pristiq include:

• tryptophan
• 5-HTP
• St. John’s wort
• garcinia cambogia

If you’re taking any herbs, be sure to talk with your doctor before starting Pristiq treatment. They can determine whether any interact with the medication. Then your doctor can adjust your treatment plan as needed.

Pristiq and vitamins

There are no specific reports of vitamins interacting with Pristiq. However, it’s possible that interactions with vitamins could be recognized in the future. Because of this, you should talk with your doctor or pharmacist before taking any vitamin product with Pristiq.

Pristiq and food

There were no reports of food interactions with Pristiq. If you’d like to learn more about eating certain foods during treatment with Pristiq, talk with your doctor.

Pristiq and vaccines

There aren’t any known interactions between Pristiq and vaccines. Your doctor or pharmacist can help determine what vaccines are recommended for you. They can also look over a list of your medications to see whether there are any interactions between the drugs and the vaccines.

Pristiq interactions with lab tests

It’s possible for Pristiq to cause false-positive results on certain urine drug tests. (With a false positive, the results of your drug test incorrectly show certain drugs in your system, even though you haven’t taken them). These tests may be required before starting a new job or during your employment. Specifically, Pristiq may cause you to test positive for phencyclidine (PCP) or amphetamines on some drug tests.

If you need to have a urine drug test while you’re taking Pristiq, it’s important to tell your doctor. They can order a specific urine test called gas chromatography-mass spectrometry. This test should not show a false positive for PCP or amphetamines due to Pristiq.

PRISTIQ AND CANNABIS OR CBD

Cannabis (often called marijuana) and cannabis products, such as cannabidiol (CBD), have not been specifically reported to interact with Pristiq. However, as with any drug or supplement, talk with your doctor before using cannabis in combination with Pristiq. The impact of cannabis may affect how well you stick to your Pristiq treatment plan.

Note: Cannabis is illegal at a federal level but is legal in many states to varying degrees.

Certain medical conditions and other factors may increase the risk of interactions with Pristiq. Before you take this drug, be sure to talk with your doctor about your health history. Pristiq may not be the right treatment option if you have certain medical conditions or other factors affecting your health.

Health conditions or factors that might interact with Pristiq include:

• Suicidal thoughts and behaviors. If you have a history of suicidal thoughts and behaviors, talk with your doctor before taking Pristiq. Pristiq has a boxed warning about this risk. This is a serious warning from the Food and Drug Administration (FDA). For more information, see “Boxed warnings” at the beginning of this article.
• High blood pressure. Pristiq may cause increases in your blood pressure. If you already have high blood pressure, taking Pristiq may raise it further. Before you start Pristiq treatment, your doctor may prescribe medication to help manage your blood pressure. They may also monitor your blood pressure throughout your treatment with Pristiq. This is meant to help prevent it from becoming too high. You can also talk with your doctor about how to monitor your blood pressure at home.
• Heart problems. Before taking Pristiq, tell your doctor about any heart problems that you have, such as high blood pressure or heart disease. This medication can increase your blood pressure, which may worsen existing heart problems. Your doctor may monitor you more often than is typical during your treatment with Pristiq.
• Stroke. If you’ve had a stroke, tell your doctor before taking Pristiq. This medication can increase your blood pressure, which may also increase your risk of stroke. If you’ve already had a stroke, your risk of this side effect may be higher. Your doctor may monitor you more often during your treatment with Pristiq. In some cases, they may recommend a different treatment option for you.
• Bleeding problems. If you have a bleeding problem, such as hemophilia, tell your doctor before starting Pristiq treatment. This medication may increase your risk of bleeding. If you have a bleeding condition, your risk may increase further. Your doctor can help determine whether Pristiq is safe for you to take.
• Mood problems or family history of mood problems. If you have mood problems, such as bipolar disorder, or a family history of mood problems, tell your doctor before taking Pristiq. This medication may increase the risk of mania in people with bipolar disorder. If you or anyone in your family has had a mood problem, your doctor may recommend more frequent monitoring or a different treatment option.
• High triglycerides or high cholesterol. If you have high triglycerides or high cholesterol, tell your doctor before taking Pristiq. This medication may increase your triglyceride and cholesterol levels. And, if you already have high levels, taking Pristiq may worsen your condition. Your doctor can help manage your cholesterol and triglyceride levels before you start taking Pristiq.
• Kidney problems. Before taking Pristiq, tell your doctor about any kidney problems you have, such as chronic kidney disease. This medication can build up in your body if your kidneys aren’t working as well as they should. This can increase your risk of side effects* such as serotonin syndrome. Your doctor may prescribe a lower dose of Pristiq or recommend a different treatment option for you.
• Liver problems. If you have liver problems such as alcohol-related liver disease, tell your doctor before taking Pristiq. Liver problems may cause Pristiq to build up in your body, which can increase your risk of side effects. Due to this risk, your doctor may recommend a lower dose of Pristiq if you have liver problems.
• Seizures. Although rare, it’s possible for Pristiq to cause seizures. If you have a history of seizures, you may be at an increased risk of this side effect. Your doctor can help determine whether Pristiq is a safe treatment option for you.
• Low blood sodium levels. Pristiq may cause low blood sodium levels. If you have or have had a low blood sodium level, tell your doctor before starting Pristiq. You may be at an increased risk of this side effect. Your doctor may monitor your blood sodium levels throughout your treatment with Pristiq. In some cases, they may recommend a different treatment option for you.
• Pregnancy. It’s not known whether it may be safe to take Pristiq during pregnancy. There may be risks if the drug is taken during pregnancy. If you’re pregnant or planning to become pregnant, talk with your doctor before taking Pristiq. For details about the medication’s use during pregnancy, refer to this article.
• Breastfeeding. Pristiq can pass into breast milk, which could cause side effects in a child who is breastfed. If you’re breastfeeding or planning to, talk with your doctor before taking Pristiq.
• Allergic reaction. If you’ve had an allergic reaction to Pristiq or any of its ingredients, your doctor will likely not prescribe Pristiq. For more information, refer to the “When to avoid Pristiq” section above.

* To learn more about Pristiq’s side effects, refer to this article.

Here are some frequently asked questions about Pristiq and possible interactions.

Which over-the-counter pain relievers are safe to take with Pristiq?

The over-the-counter pain medication acetaminophen (Tylenol) is likely safe to take during Pristiq treatment. In some cases, such as if you have muscle or joint pain, your doctor or pharmacist may recommend a topical (applied to the skin) cream or gel such as diclofenac (Voltaren).

Your doctor may recommend that you do not take nonsteroidal anti-inflammatory drugs (NSAIDs) with Pristiq. NSAIDs are medications that relieve or reduce pain. NSAIDs can increase your risk of bleeding, which can be serious. Because Pristiq can also cause bleeding, taking an NSAID with Pristiq may increase your risk further. Examples of NSAIDs include:

• ibuprofen (Motrin, Advil)
• naproxen (Aleve)
• aspirin

If you feel that you need pain medication while taking Pristiq, talk with your doctor. They can help determine the right treatment to help ease your pain.

Can I take Pristiq with an antihistamine, such as Benadryl?

Yes, it’s likely safe to take Pristiq in combination with an antihistamine such as Benadryl (diphenhydramine). There aren’t any known interactions between Pristiq and antihistamines. (Antihistamines are a type of medication that helps treat allergy symptoms.)

However, both Pristiq and diphenhydramine may cause dizziness or sleepiness. So taking both of these medications may increase your risk of these side effects. To learn more about Pristiq’s side effects, refer to this article.

Due to this risk, your doctor may recommend other antihistamines, such as Claritin (loratadine) or Zyrtec (cetirizine), instead of diphenhydramine. These antihistamines are less likely to cause sleepiness.

If you have questions about the best treatment options for you, talk with your doctor or pharmacist.

Are there any interactions between Pristiq and grapefruit or grapefruit juice?

No, there aren’t any known interactions between Pristiq and grapefruit or grapefruit juice. Some drugs do interact with grapefruit and grapefruit juice. However, there’s no known interaction with Pristiq. So it’s likely safe to eat grapefruit or drink grapefruit juice during your treatment with Pristiq.

You can take certain steps to help prevent interactions with Pristiq. Your doctor and pharmacist are key resources, so reach out to them before starting treatment. For example, you should plan to do the following:

• Let them know if you drink alcohol or use cannabis.
• Tell them about any other medications you take, as well as any supplements, herbs, and vitamins.
• Create a medication list, which your doctor and pharmacist can help you fill out.

It’s also important to read the Pristiq label and other paperwork that may come with the drug. The label may have colored stickers that mention an interaction. And the paperwork, sometimes called the medication guide or patient package insert, may contain details about interactions.

If Pristiq doesn’t come with paperwork, you can ask your pharmacist to print a copy. If you need help reading or understanding this information, ask your doctor or pharmacist.

You can also help prevent interactions with Pristiq by taking it exactly as your doctor prescribes.

Besides learning about interactions, you may want to find out more about Pristiq. These resources might help:

• Overview of Pristiq. For a general overview of Pristiq, you can see this article.
• Side effects. If you’re interested in the side effects of Pristiq, see this article. Another option is to refer to the Pristiq prescribing information.
• Dosage specifics. To learn about the dosage of Pristiq, see this article.
• Drug comparison. Find information about how Pristiq compares with Effexor XR and Cymbalta.
• Facts about depression. To learn more about your condition, see our depression hub and mental health hub.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.