Pristiq vs. Remeron
See how Pristiq and Remeron compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Pristiq is an SNRI taken once daily at a single 50 mg dose, while Remeron is a sedating tetracyclic antidepressant that requires titration up to 45 mg.
Remeron causes more sedation and appetite increase, making it a common off-label choice for insomnia or poor appetite, while Pristiq tends to cause more nausea and less drowsiness.
Both drugs carry a boxed warning for suicidal thinking in children and young adults and should not be combined with MAOIs.
Pristiq vs. Remeron Drug Summary
Pristiq
Pristiq (desvenlafaxine) is a serotonin-norepinephrine reuptake inhibitor (SNRI) approved for major depressive disorder in adults. It is an extended-release tablet taken once daily, usually starting and staying at 50 mg since higher doses show no added benefit.
Remeron
Remeron (mirtazapine) is a tetracyclic antidepressant approved for major depressive disorder in adults. It is taken once daily, usually at bedtime, starting at 15 mg and increasing over time up to a maintenance dose of 45 mg.
Pristiq vs. Remeron Side Effects
Pristiq
Remeron
Pristiq vs. Remeron Dosage
Pristiq
Remeron
| STAGE | DOSE | WHEN |
| Starting dose | 50 mg once daily | Day 1 onward |
| Maximum dose | 50 mg once daily | Same as starting |
| Dose changes | None | Fixed dose |
| STAGE | DOSE | WHEN |
| Starting dose | 15 mg once daily | Weeks 1-2 |
| Maximum dose | 45 mg once daily | Week 5 onward |
| Dose changes | 2 increases | Every 2 weeks |
Pristiq
| STAGE | DOSE | WHEN |
| Starting dose | 50 mg once daily | Day 1 onward |
| Maximum dose | 50 mg once daily | Same as starting |
| Dose changes | None | Fixed dose |
Remeron
| STAGE | DOSE | WHEN |
| Starting dose | 15 mg once daily | Weeks 1-2 |
| Maximum dose | 45 mg once daily | Week 5 onward |
| Dose changes | 2 increases | Every 2 weeks |
Pristiq vs. Remeron Indications
Pristiq
Pristiq is FDA-approved only for treating major depressive disorder in adults. It has not been studied for use in children or for patients with severe kidney disease without dose adjustments.
Major depressive disorder (MDD) in adults
Only one FDA-approved indication
Not approved for pediatric depression
Dose adjustment needed in severe renal impairment
Remeron
Remeron is FDA-approved for major depressive disorder in adults. Clinicians also prescribe it off-label for insomnia, anxiety, appetite stimulation, and nausea, particularly in older adults or those with cancer.
Major depressive disorder (MDD) in adults
Off-label: insomnia
Off-label: anxiety disorders
Off-label: appetite or weight stimulation
Pristiq vs. Remeron Pros and Cons
Pristiq
Pristiq offers simple, consistent dosing without a titration schedule, and its lower sedation profile makes it easier to take during the day. Coverage varies by plan, and its list price is notably higher than generic mirtazapine.
Pros
No titration needed, one 50 mg dose from day one
Less sedating than Remeron, better suited for daytime use
Not linked to the weight gain seen with Remeron
Simpler dosing schedule with fewer changes to manage
Cons
Nausea affects up to 41% of patients
Hyperhidrosis (excess sweating) is a distinct side effect
Roughly $400 to $543 per month without insurance, more than generic mirtazapine
Remeron
Remeron's sedating effect can help with sleep and appetite in depression, though that same sedation can be a drawback for daytime function. Generic mirtazapine is widely available and much less expensive than brand-name Pristiq.
Pros
Sedating effect can help with sleep in depression with insomnia
Often used off-label to stimulate appetite and weight gain
Available as an orally disintegrating tablet for easier swallowing
Generic mirtazapine costs roughly $10 to $40 per month, much less than Pristiq
Cons
Somnolence affects up to 54% of patients
Weight gain and increased appetite are common side effects
Requires titration over several weeks to reach effective dose
Common Symptoms and Related Diseases You Can Explore
Explore a range of common symptoms the Doctronic Symptom Checker can help you understand.