Abilify Vs. Cymbalta: Drug Comparison

Abilify^® (aripiprazole) is an atypical antipsychotic medication used to treat conditions such as schizophrenia, bipolar disorder, and as an adjunct for major depressive disorder. FDA-approved indications include schizophrenia in adults and adolescents, bipolar I disorder, and as an add-on treatment for depression. Additional uses include treating irritability in autism, borderline personality disorder, and Tourette syndrome. Abilify is available in various forms, including tablets, orally disintegrating tablets, solutions, and injections. Common side effects include akathisia (movements such as fidgeting), weight gain, dizziness, and nausea, while serious warnings include a boxed warning for increased risk of suicidal thoughts in children, adolescents, and young adults, as well as potential drug interactions.

Cymbalta^® (duloxetine) is a serotonin-norepinephrine reuptake inhibitor (SNRI) used to treat depression and anxiety by increasing the available levels of serotonin and norepinephrine in the brain, which helps improve mood and relieve pain. Its FDA-approved indications include major depressive disorder (MDD), generalized anxiety disorder (GAD), fibromyalgia, and chronic pain conditions such as diabetic peripheral neuropathy and musculoskeletal pain. Off-label uses may include treatment for stress urinary incontinence and as migraine prevention. Cymbalta is available in capsule form, taken orally. Common side effects include nausea, dry mouth, drowsiness, and dizziness, and it carries a boxed warning for an increased risk of suicidal thoughts and behaviors in children, adolescents, and young adults, especially during the initial stages of treatment.

Atypical antipsychotic

Serotonin and norepinephrine reuptake inhibitor (SNRI)

Abilify (aripiprazole) is indicated for:

• Schizophrenia

• Acute treatment of manic and mixed episodes associated with bipolar I disorder

• Adjunctive treatment of major depressive disorder

• Irritability associated with autistic disorder

• Treatment of Tourette disorder

Cymbalta (duloxetine hydrochloride) is indicated for the treatment of the following conditions:

• Major depressive disorder (MDD) in adults

• Generalized anxiety disorder (GAD) in adults and pediatric patients 7 years of age and older

• Diabetic peripheral neuropathic pain (DPNP) in adults

• Fibromyalgia (FM) in adults and pediatric patients 13 years of age and older

• Chronic musculoskeletal pain in adults

• Typically taken orally once daily

• Comes in 2 mg, 5 mg, 10 mg, 15 mg, 20 mg, and 30 mg tablets

• Typically taken orally once daily

• Comes in 20 mg, 30 mg, and 60 mg delayed-release capsules

Commonly observed adverse reactions (incidence ≥5% and at least twice that for placebo) were:

Adult patients with schizophrenia:

• Inability to remain still

Pediatric patients (13 to 17 years) with schizophrenia:

• Movement disorders

• Sleepiness

• Tremor

Adult patients (monotherapy) with bipolar mania:

• Inability to remain still

• Sedation

• Restlessness

• Tremor

• Movement disorders

Adult patients (adjunctive therapy with lithium or valproate) with bipolar mania:

• Inability to remain still

• Insomnia

• Movement disorders

Pediatric patients (10 to 17 years) with bipolar mania:

• Sleepiness

• Movement disorders

• Fatigue

• Nausea

• Inability to remain still

• Blurred vision

• Overproduction of saliva

• Dizziness

Adult patients with major depressive disorder (adjunctive treatment to antidepressant therapy):

• Inability to remain still

• Restlessness

• Insomnia

• Constipation

• Fatigue

• Blurred vision

Pediatric patients (6 to 17 years) with autistic disorder:

• Sedation

• Fatigue

• Vomiting

• Sleepiness

• Tremor

• Fever

• Drooling

• Decreased appetite

• Overproduction of saliva

• Movement disorders

• Lethargy

Pediatric patients (6 to 18 years) with Tourette's Disorder:

• Sedation

• Sleepiness

• Nausea

• Headache

• Inflammation of the nose and throat

• Fatigue

• Increased appetite

Most common adverse reactions (≥5% and at least twice the incidence of placebo-treated patients):

Adults:

• Nausea

• Dry mouth

• Sleepiness

• Constipation

• Decreased appetite

• Excessive sweating

Pediatric patients:

• Decreased weight

• Decreased appetite

• Nausea

• Vomiting

• Fatigue

• Diarrhea

• Known hypersensitivity to Abilify

• Drug interactions: Dosage adjustments for certain drug interactions

• Concomitant use of an MAOI antidepressant with Cymbalta is contraindicated

• Use of Cymbalta within 14 days of stopping an MAOI antidepressant is contraindicated

• In linezolid- or intravenous methylene blue-treated patients, initiation of Cymbalta is contraindicated

• Drug interactions: potent inhibitors of CYP1A2, potent inhibitors of CYP2D6

• Cerebrovascular adverse reactions in elderly patients with dementia-related psychosis

• Neuroleptic malignant syndrome

• Tardive dyskinesia

• Metabolic changes: Atypical antipsychotic drugs have been associated with metabolic changes that include hyperglycemia/diabetes mellitus, dyslipidemia, and body weight gain

• Pathological gambling and other compulsive behaviors

• Orthostatic hypotension

• Leukopenia, neutropenia, and agranulocytosis

• Seizures/Convulsions

• Potential for cognitive and motor impairment

• Suicide: The possibility of a suicide attempt is inherent in schizophrenia and bipolar disorder

• Pregnancy: May cause extrapyramidal and/or withdrawal symptoms in neonates with third trimester exposure

• Liver toxicity

• Postural low blood pressure, falls, and fainting

• Serotonin syndrome

• Increased risk of bleeding

• Severe skin reactions

• Activation of mania or hypomania

• Angle-closure glaucoma

• Seizures

• Blood pressure increases

• Inhibitors of CYP1A2 or thioridazine: Avoid co-administration with Cymbalta

• Low blood sodium: Can occur in association with SIADH

• Glucose control in diabetes

• Conditions that slow gastric emptying

• Sexual dysfunction

• Pregnancy: Third trimester use may increase risk for symptoms of poor adaptation (respiratory distress, temperature instability, feeding difficulty, hypotonia, tremor, irritability) in the neonate

WARNING: INCREASED MORTALITY IN ELDERLY PATIENTS WITH DEMENTIA-RELATED PSYCHOSIS and SUICIDAL THOUGHTS AND BEHAVIORS WITH ANTIDEPRESSANT DRUGS

Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death. Abilify is not approved for the treatment of patients with dementia-related psychosis.

Increased risk of suicidal thinking and behavior in children, adolescents, and young adults taking antidepressants. Monitor for worsening and emergence of suicidal thoughts and behaviors.

WARNING: SUICIDAL THOUGHTS AND BEHAVIORS

Increased risk of suicidal thinking and behavior in children, adolescents, and young adults taking antidepressants.

Monitor for worsening and emergence of suicidal thoughts and behaviors.

*This information is from the label for brand name Abilify^®. See the Full Prescribing Information for more complete information. Aripiprazole, the active ingredient in Abilify, may also be the active ingredient in other medications, and this information may not be accurate for all medications that include the active ingredient aripiprazole.

*This information is from the label for brand name Cymbalta^®. See the Full Prescribing Information for more complete information. Duloxetine, the active ingredient in Cymbalta, may also be the active ingredient in other medications, and this information may not be accurate for all medications that include the active ingredient duloxetine.