Cymbalta Vs. Lexapro: 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.

Lexapro^® (escitalopram) is a selective serotonin reuptake inhibitor (SSRI) used to treat anxiety and depression by increasing available serotonin levels in the brain, which helps improve mood and reduce anxiety. Its FDA-approved indications include the treatment of major depressive disorder (MDD) and generalized anxiety disorder (GAD) in adults and adolescents. Off-label uses may include treating panic disorder, obsessive-compulsive disorder (OCD), and social anxiety disorder. Lexapro is available in tablet and oral solution forms, taken once daily. Common side effects include nausea, insomnia, and sexual dysfunction, and it carries a boxed warning for an increased risk of suicidal thoughts and behaviors in children, adolescents, and young adults, particularly during the initial stages of treatment.

Serotonin and norepinephrine reuptake inhibitor (SNRI)

Selective serotonin reuptake inhibitor (SSRI)

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

Lexapro (escitalopram) is indicated for the:

• Treatment of major depressive disorder (MDD) in adults and pediatric patients 12 years of age and older

• Treatment of generalized anxiety disorder (GAD) in adults and pediatric patients 7 years and older

• Typically taken orally once daily

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

• Typically taken orally once daily

• Comes in 5 mg, 10 mg (scored), and 20 mg (scored) tablets

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 commonly observed adverse reactions (incidence ≥ 5% and at least twice the incidence of placebo patients) are:

• Insomnia

• Ejaculation disorder (primarily ejaculatory delay),

• Nausea

• Sweating increased

• Fatigue and sleepiness

• Decreased libido

• Inability to orgasm

• 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

• Do not use MAOIs intended to treat psychiatric disorders with Lexapro or within 14 days of stopping treatment with Lexapro. Do not use Lexapro within 14 days of stopping an MAOI intended to treat psychiatric disorders. In addition, do not start Lexapro in a patient who is being treated with linezolid or intravenous methylene blue

• Concomitant use of pimozide

• Known hypersensitivity to escitalopram or citalopram or any of the inactive ingredients

• Drug interactions: SSRIs, SNRIs, tryptophan, drugs that affect hemostasis (NSAIDs, aspirin, warfarin)

• 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

• Discontinuation syndrome

• Seizures

• Activation of mania/hypomania

• Low blood sodium: Can occur in association with syndrome of inappropriate antidiuretic hormone secretion

• Increased risk of bleeding

• Interference with cognitive and motor performance

• Angle closure glaucoma

• Use in patients with concomitant illness

• Sexual dysfunction

• Pregnancy: SSRI use, particularly later in pregnancy, may increase the risk for persistent pulmonary hypertension and symptoms of poor adaptation (respiratory distress, temperature instability, feeding difficulties, 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 and young adult patients taking antidepressants. Closely monitor all antidepressant-treated patients for clinical worsening and emergence of suicidal thoughts and behaviors. Lexapro is not approved for use in pediatric patients less than 7 years of age.

*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 Lexapro^®. See the Full Prescribing Information for more complete information. Escitalopram, the active ingredient in Lexapro, may also be the active ingredient in other medications, and this information may not be accurate for all medications that include the active ingredient escitalopram.