Cymbalta Vs. Effexor Xr: Drug Comparison

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.

Effexor XR^® (venlafaxine extended-release) is a serotonin-norepinephrine reuptake inhibitor (SNRI) used to treat mood disorders by increasing the available levels of serotonin and norepinephrine in the brain, which helps regulate mood and anxiety. Its FDA-approved indications include major depressive disorder (MDD), generalized anxiety disorder (GAD), social anxiety disorder, and panic disorder. Off-label uses may include treatment for migraine prevention as well as treatment for premenstrual dysphoric disorder (PMDD) and neuropathic pain. Effexor XR comes in extended-release capsules, taken once daily. Common side effects include nausea, dizziness, insomnia, and sweating. It has a boxed warning for an increased risk of suicidal thoughts and behaviors in children, adolescents, and young adults, particularly during the early stages of treatment.

Serotonin and norepinephrine reuptake inhibitor (SNRI)

Serotonin and norepinephrine reuptake inhibitor (SNRI)

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

Effexor XR (venlafaxine hydrochloride) is indicated for the treatment of adults with:

• Major depressive disorder (MDD)

• Generalized anxiety disorder (GAD)

• Social anxiety disorder (SAD)

• Panic disorder (PD)

• Typically taken orally once daily

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

• Typically taken orally once daily

• Comes in 37.5 mg, 75 mg, and 150 mg extended-release capsules

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

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

• Nausea

• Sleepiness

• Dry mouth

• Sweating

• Abnormal ejaculation

• Anorexia

• Constipation

• Impotence (men)

• Libido decreased

• 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

• Hypersensitivity to venlafaxine hydrochloride, desvenlafaxine succinate, or any excipients in the Effexor XR formulation

• Concomitant use of monoaminoxidase inhibitors (MAOIs) or within 14 days of discontinuing an MAOI

• 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

• Serotonin syndrome

• Elevated blood pressure

• Increased risk of bleeding

• Angle‑closure glaucoma

• Activation of mania or hypomania

• Discontinuation syndrome

• Seizures

• Low blood sodium

• Interstitial lung disease and eosinophilic pneumonia

• Sexual dysfunction

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

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.

WARNING: SUICIDAL THOUGHTS AND BEHAVIORS

Increased risk of suicidal thoughts and behavior in pediatric patients and young adults taking antidepressants. Closely monitor all antidepressant-treated patients for clinical worsening and emergence of suicidal thoughts and behaviors.

Effexor XR is not approved for use in pediatric patients.

*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.

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