Does Pristiq cause liver problems? (+5 factors)

In this article, we will discuss the effects of Pristiq on liver functionality. We will discuss whether Pristiq has the potential to cause liver damage or not. We will further, dig deeper into the factors that cause liver damage induced by Pristiq. We will look at the possible management strategies to avoid liver toxicities due to Pristiq. 

Does Pristiq cause liver problems?

Pristiq may cause liver damage. Pristiq is generally a safe and well-tolerated antidepressant but high dosing and long-term use may be associated with some severe complications such as liver damage. 

Taking Pristiq may cause elevated liver enzymes which may be a sign of liver toxicity and damage. However, very few cases are reported of Pristiq-induced liver toxicity or damage, hence these are not commonly associated with Pristiq. 

Pristiq belongs to the serotonin-norepinephrine reuptake inhibitor (SNRI) antidepressant drug class. These drugs increase the levels and activity of serotonin and norepinephrine in the brain. Pristiq is an FDA-approved drug for the treatment of major depressive disorder (1). 

Yellowing of skin and eyes, dark urine, abdominal pain, nausea, and fatigue can be possible signs of liver damage and toxicity. If you experience these symptoms while taking Pristiq, consult your healthcare provider. 

What does research suggest?

According to research studies, almost all antidepressants possess the risk of inducing liver damage and hepatotoxicity. Antidepressants can induce hepatic injuries even at therapeutic doses (2). 

Based on research, very few studies are available related to Pristiq-induced liver damage and toxicity. However, among the other SNRIs, duloxetine, and venlafaxine, which is the parent compound of Pristiq (desvenlafaxine), are commonly associated with severe liver damage and hepatic toxicity (2). 

Liver test abnormalities have been reported in less than 1% of patients taking Pristiq. Very rare instances of acute liver injury have been reported with Pristiq. The onset of liver injury usually persists within 1 to 3 months but Pristiq-induced cases reported were self-limiting which resolved in a few months (3). 

How does Pristiq induce liver damage?

Pristiq can cause liver damage based on its mechanism of action. According to the mechanism of action of Pristiq, it undergoes extensive liver metabolism via the CYP450 primarily by the CYP2D6 enzyme system (3). 

This metabolism of Pristiq via the liver enzymes causes an increased burden on the liver. This metabolism may generate liver metabolites that have damaging effects on the liver cells (3). 

The metabolism of Pristiq in the liver may generate toxic liver metabolites and accumulation of these metabolites leads to long-term liver toxicities and damage.  However, the effect of Pristiq on the liver may vary among patients. 

What factors contribute to liver damage while taking Pristiq?

The following factors play an important role in contributing to liver damage and toxicity while taking Pristiq (3,4): 

• Underlying liver conditions- Patients with pre-existing liver conditions such as liver diseases or hepatitis, are more prone to develop liver damage after initiating treatment with Pristiq.

• Drug interactions- Taking Pristiq along with other medications that are also metabolized in the liver, may cause excessive load on liver functioning leading to liver cell damage. 

• Alcohol consumption- Excessive alcohol consumption burdens the liver. taking pristiq and alcohol together increases the chances of liver toxicity. 

• Individual patient variation- Each patient responds differently to medications. Some patients may experience severe liver damage due to Pristiq while others may not. 

• Dosage and duration– Taking Pristiq in the long term and at high doses raises the chances of developing liver damage and hepatotoxicity. 

• Genetic variations- Some patients are genetically predisposed to develop adverse effects due to medications. Older adults are also more prone to develop liver damage with Pristiq use. 

How to know if Pristiq is affecting your liver?

To know if Pristiq causes liver damage, you should monitor your signs and symptoms from the early course of treatment. Some major signs that suspect a liver injury or damage are (4):

• Jaundice
• Dark-coloured urine
• Nausea and vomiting
• Abdominal pain and swelling
• Rash
• Fatigue
• Light-coloured bowel
• Fever
• Loss of appetite

However, every patient may not experience these signs and side effects but these may commonly appear if your liver is functioning properly. If these symptoms appear, seek immediate medical help. 

How to ensure the safe use of Pristiq?

To ensure safe and effective use of Pristiq, always consult your healthcare provider. Discuss all the signs and side effects faced after initiating your treatment with Pristiq. 

Get yourself regularly checked and monitored for possible and early side effects of liver damage. If your doctor suspects liver damage, you must undergo liver function tests to ensure the safety and efficacy of treatment with Pristiq. 

If your doctor finds it suitable, they may prescribe an alternate antidepressant medication to avoid liver damage by Pristiq. However, every antidepressant tends to cause liver damage but SSRIs such as sertraline and fluvoxamine are generally considered safe among other antidepressants. 

Changing your lifestyle by introducing healthy meals that do not have a profound effect on the liver can be a safe strategy to avoid liver damage. Exercising regularly and maintaining a fit lifestyle may reduce the chances of liver toxicity due to Pristiq. 

In the end, I would suggest you always look for abnormal signs and symptoms while taking any medication. Almost every medication has potential side effects which can be avoided with careful monitoring and examinations.  

As in this case, if you are taking Pristiq and observe yellowing of the skin, dark urine, or severe abdominal pain, then seek immediate medical help and get your liver tests done to evaluate for any potential liver damage due to Pristiq.  

References