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Dr. Kaushik
Dr. Kaushik, Psychiatrist
Category: Mental Health
Satisfied Customers: 4486
Experience:  MD Psychiatry
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Switch from Venlaflaxine to Pristiq, no transition plan

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I'm on day 11 switching from 150mg Venlafaxine (cap) to 50mg Pristiq (pill). My doctor (family) said it's a straight-over switch and did not give me a transition plan. I've been miserably sad and almost non-functional for most of the 11 days. I didn't call the doctor because I assumed the increased sadness and listlessness was my body's unique reaction and would soon blow over. Finally tonight I decided to look into it online and in the Pristiq sample pack info and found out that I should indeed have had a dosage transition plan. But now it's Friday after hours on a holiday weekend.

Seems I have 3 choices: ride it out until Tues. a.m. and call the doctor (please no!); go now to an Instacare or ER to get a transition plan; or take a Venlafaxine (along with the Pristiq?) every day until Tues. Can you advise? I'm really suffering. Not suicidal (never have gotten to that point), but very sad and non-functioning. Thanks very much in advance.

Dr. Kaushik :

Hi there,

Welcome !

Dr. Kaushik :

I am so sorry that you have to put up with this distresing period when such a transition coold have been very smooth , more so because both of these drugs that is pristiq and venlafaxine belong to the same snri anti depressant class and have almost the same chemical structure other than some changes , but what went wrong were two things which made this transition appear to you as a wrong choice by the doctor and these two wrongs were as below ..

Dr. Kaushik :

1) the doctor should have tapered the venlazaxine to a dose of 37.5 mg / day and and then brought you off it or perhaps even directly shifted you to 50 mg of pristiq from this dose of 37.5 mg , this would have not caused any such problems that you are encountering now , as what wrong he did was that he did not brought you down from a fairly high dose of venlafaxine and switched your over to pristiq from such a high dose of venlafaxine which your body could not cope up and hence the symptoms results , some of which are withdrawal symptoms and some of these are the symptoms of your underlying condition. You see for furtre always keep one thing in mind that no matter what but a switch over should be done only when the previous drug is weaned off completely or to such a low dose which can be condusive for safer switch over.

Dr. Kaushik :

2) other than the above error that your doctor did , another error of judgment from his side was to maintain you on 50 mg dose , when a dos eof 100 mg of pristiq was required to bring out the same effects of venlafaxine at 150 mg, you see this 50 mg dose of pristiq is not capable of producing same posiitve effects as 150 mg dose of venlafaxine used to bring out , so ideally you should have been placed on 100 mg of pristiq or atlaeast the dose should have been raised to 100 mg after 1 week of being on 50 mg ..

Dr. Kaushik :

Now the solution to your probolem is that there is no point in getting off pristiq and redoing the transition at this point is no good as you have already passed `11 days so restarting the whole process of transition shall only waste your time especially when minor dose adjustment in pristiq can bring relief to you in a few days .

Dr. Kaushik :

So i reckon the solution to your problem is to up the dose of pristiq to 100 mg / day from the current 50 mg in order to be on an optimal dose of this drug which will be comparable to the 150 mg dose of venlafaxine so as to bring out the relief of symptoms which have been troubling you .

Dr. Kaushik :

So to raise the dose of the pristiq , you either have to take permission from your doctor on phone or go gto ER or you shall wait till tuesday till your doctor is available to meet you, the final say is yours , i have just laid down some options for solution in front of you..

Dr. Kaushik :

I hope this helps..

Wish you all the best..

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Customer: replied 4 years ago.

Thank you so very much, Dr. Kaushik. I greatly appreciate your very thorough explanation of how this transition should have occurred and why I should double the dose of Pristiq at this point and not use any Venlafaxine. I will do exactly that tomorrow after I get permission at an ER. First thing in the morning!


What a wonderful service this is. I felt so much better when I first submitted my question tonight just knowing I was going to get some information on what to do. Now that I have received your answer, I feel even better than before. Thank you, thank you. :)



Caroline Otto in Highland, Utah

You are welcome ..


Thanks for the kind words..


Warm regards..

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