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Ok, what does this file consist of?

Is this something you made entirely in Photoshop, so that when you make the PDF it is just one big image on the page(s)?

Do you have the pro version of Acrobat? If not, one thing you can try is printing to a PDF file from Adobe Reader. Sounds odd but sometimes this works quite well and can significantly reduce the size of your PDF file. Open the large PDF in Adobe reader, go to File --> Print, choose Adobe PDF from the drop down list of printers. This will allow you to "print" to another PDF file.

If you have Acrobat, try running PDF Optimizer.