Does Pristiq Cause Glaucoma? (3+ Side Effects)

In this article, we will discuss whether Pristiq causes glaucoma. We will also discuss how Pristiq is linked to glaucoma, what are its other side effects on the eyes, and how to prevent Pristiq-induced glaucoma. 

Does Pristiq cause glaucoma? 

Yes, Pristiq can cause glaucoma in some individuals. Pristiq is manufactured by Pfizer and angle-closure glaucoma (ACG) is a documented side effect of Pristiq in the medication guide provided by Pfizer (1). 

Pristiq is the brand name for desvenlafaxine which is a serotonin-norepinephrine reuptake inhibitor (SNRI) and an antidepressant. It is an FDA-approved drug for major depressive disorder (MDD). 

Pristiq works by blocking the reuptake of serotonin and norepinephrine (NE) which increases their concentration in the brain. Drugs like antidepressants that increase serotonin and NE levels can cause ACG in some individuals. 

What are the symptoms of angle-closure glaucoma (ACG)?

Glaucoma includes different eye conditions that damage the optic nerve and can result in vision loss. Angle-closure glaucoma (ACG) is one of the types of glaucoma which can be caused by Pristiq. 

ACG occurs when the iris (coloured part of the eye) becomes enlarged and blocks the trabecular meshwork which is responsible for the normal outflow of fluid (aqueous humor) from the eyes (2). 

As the aqueous outflow is obstructed, the pressure inside the eyes or the intraocular pressure (IOP) increases which can irreversibly damage the optic nerves. ACG is associated with the following symptoms (2). 

• teary eyes
• blurry vision
• redness in eyes
• eye pain 
• seeing halos of light 
• headache
• nausea
• vomiting 

If you experience any of the above-mentioned symptoms while taking Pristiq, immediately contact your healthcare provider. ACG is a medical emergency and requires immediate medical attention. 

How does Pristiq cause glaucoma? 

Pristiq increases the levels of serotonin which contributes to elevated IOP. Certain serotonin receptors increase the production of aqueous humor by stimulating blood flow in the ciliary body which increases IOP (2). 

Increased serotonin also results in mydriasis or pupil dilation. This elevates IOP and increases the risk of ACG. Due to these effects, drugs that increase serotonin levels like Pristiq and Celexa, are associated with the occurence of ACG (2). 

Pristiq also increase NE concentration which also contributes to mydriasis and lid retraction that raises the IOP. Thus, the combined effect on serotonin and NE receptors causes mydriasis and increases IOP leading to ACG (2). 

What does research suggest?

Evidence from the literature suggests that antidepressants like Pristiq can cause ACG in individuals who already have certain risk factors for ACG. However, case reports of ACG specifically associated with Pristiq are limited. 

Desvenlafaxine is the active ingredient of Pristiq which is an SNRI and the active metabolite of venlafaxine. Literature mentions that some cases of ACG are reported in females who were being treated with venlafaxine (2). 

Duloxetine is another SNRI like desvenlafaxine and venlafaxine. Reports of duloxetine-induced ACG are also present in the literature (2). 

One study assessed the effects of SNRIs on IOP. The results demonstrated that SNRIs result in pupil dilation and decrease the width of anterior chamber depth (ACD). However, the changes did not raise IOP in patients with an open angle. (3). 

The above-mentioned study shows that individuals having eyes with narrow drainage angles are more susceptible to raised IOP while using SNRIs and can develop ACG (3). 

Thus, research indicates that drugs that have a similar mechanism of action like Pristiq have caused ACG in some individuals. However, case reports related to Pristiq are not well-documented in the literature. 

ACG is an officially documented side effect of Pristiq. Thus, Pristiq can cause ACG in susceptible individuals therefore precautions are necessary. 

Who is at higher risk for Pristiq-induced glaucoma? 

Individuals with pre-existing eye conditions and certain risk factors are more susceptible to ACG caused by Pristiq. Some risk factors that increase the chances of ACG while taking Pristiq include (2) 

• individuals with narrow iridocorneal angle (drainage angle between the iris and the cornea)
• age (higher risk in older adults) 
• gender (higher risk in females)
• family history
• hyperopia (farsightedness) 
• short eyes 

What are some other ocular side effects of Pristiq? 

Other than ACG, Pristiq can cause some other side effects on your eyes such as (4): 

• dry eyes
• blurry vision
• mydriasis (pupil dilation)
• cataract 

What are some long-term effects of Pristiq on the eyes? 

Although SNRIs like Pristiq are associated with a heightened risk of ACG, studies have shown that long-term usage of SNRIs results in a decrease in IOP (2,3,4). This decrease is considered a possible protective effect of these medications (2). 

A reduction in IOP due to long-term usage can be beneficial for eye health because high IOP is associated with certain eye conditions including glaucoma. Literature suggests that this long-term effect of SNRIs needs further investigation (2). 

Evidence suggests that individuals who receive long-term treatment with SNRIs present with increased pupil diameter and shallow anterior chamber depth (4). Whether Pristiq causes these long-term effects needs further investigation. 

How to avoid Pristiq-induced glaucoma? 

To avoid Pristiq-induced glaucoma, your healthcare provider should assess you for the risk factors of ACG. Recommended screening tests before initiating treatment with Pristiq include (2): 

• gonioscopy to examine the drainage angle 
• measuring IOP
• optical coherence tomography of optic nerve head. 

This evaluation is especially recommended for older adults, individuals with pre-existing eye conditions, and a family history. IOP should be monitored regularly during treatment with Pristiq for the patients who present with the risk factors. 

If you experience side effects like blurred vision, teary and red eyes, headache, nausea, and vomiting, you must immediately contact your healthcare provider to avoid complications, 

Your healthcare provider may consider dose reduction or switch to alternative options to avoid the occurrence of ACG and other eye complications. Do not consider stopping the medication abruptly as it can cause withdrawal symptoms. 

In my perspective, Pristiq can cause glaucoma in some individuals. Individuals at higher risk for Pristiq-induced glaucoma include older adults, females, and individuals with a narrow drainage angle. Pristiq results in glaucoma as it cause pupil dilation and increases the intraocular pressure in the eyes. To avoid glaucoma, the healthcare provider must assess the individual for the risk factors of ACG. Individuals with risk factors should undergo regular eye examinations while taking Pristiq. 

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