Cymbalta Vs. Lyrica: 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.

Lyrica^® (pregabalin) is a medication used to treat nerve pain and seizures by binding to calcium channels in the brain, reducing the release of neurotransmitters involved in pain and seizure activity. Its FDA-approved indications include the treatment of neuropathic pain associated with diabetic neuropathy, fibromyalgia, spinal cord injury, and postherpetic neuralgia, as well as partial-onset seizures in adults. Off-label uses may include anxiety disorders, restless leg syndrome, and chronic pain conditions. Lyrica is available in capsule, liquid solution, and extended-release tablet forms, typically taken twice daily. Common side effects include dizziness, drowsiness, and weight gain, while serious risks include swelling and suicidal thoughts. Caution is advised when used with central nervous system (CNS) depressants such as opioids or alcohol.

Serotonin and norepinephrine reuptake inhibitor (SNRI)

Anticonvulsant

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

Lyrica (pregabalin) is indicated for:

• Neuropathic pain associated with diabetic peripheral neuropathy (DPN)

• Postherpetic neuralgia (PHN)

• Adjunctive therapy for the treatment of partial‑onset seizures in patients 1 month of age and older

• Fibromyalgia

• Neuropathic pain associated with spinal cord injury

• Typically taken orally once daily

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

• Typically taken orally twice or three times daily

• Comes in 25 mg, 50 mg, 75 mg, 100 mg, 150 mg, 200 mg, 225 mg, and 300 mg capsules and 20 mg/mL oral solution

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 (greater than or equal to 5% and twice placebo) in adults are:

• Dizziness

• Sleepiness

• Dry mouth

• Swelling

• Blurred vision

• Weight gain

• Thinking abnormal (primarily difficulty with concentration/attention)

Most common adverse reactions (greater than or equal to 5% and twice placebo) in pediatric patients for the treatment of partial‑onset seizures are:

• Increased weight

• Increased appetite

• 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

• Known hypersensitivity to pregabalin or any of its components

• 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

• Angioedema (e.g., swelling of the throat, head and neck) can occur, and may be associated with life-threatening respiratory compromise requiring emergency treatment

• Hypersensitivity reactions (e.g., hives, dyspnea, and wheezing) can occur

• Antiepileptic drugs, including Lyrica, increase the risk of suicidal thoughts or behavior

• Respiratory depression: May occur with Lyrica, when used with concomitant CNS depressants or in the setting of underlying respiratory impairment

• Lyrica may cause dizziness and somnolence and impair patients’ ability to drive or operate machinery

• Increased seizure frequency or other adverse reactions may occur if Lyrica is rapidly discontinued

• Lyrica may cause peripheral edema

• Lactation: Breastfeeding is not recommended

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