Cymbalta Vs. Pristiq: 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.

Pristiq^® (desvenlafaxine) is a serotonin-norepinephrine reuptake inhibitor (SNRI) used to treat major depressive disorder (MDD) by increasing the available levels of serotonin and norepinephrine in the brain, which helps improve mood and emotional balance. Its FDA-approved indication is for the treatment of major depressive disorder in adults. Off-label uses may include managing anxiety disorders, hot flashes related to menopause, and other mood disorders. Pristiq comes in extended-release tablet form, taken once daily. Common side effects include nausea, dizziness, dry mouth, male sexual dysfunction, and insomnia. 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)

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

Pristiq (desvenlafaxine succinate) is indicated:

• For the treatment of adults with major depressive disorder (MDD)

• Typically taken orally once daily

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

• Typically taken orally once daily

• Comes in 25 mg, 50 mg, and 100 mg extended-release 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 common adverse reactions (incidence ≥5% and twice the rate of placebo in the 50 or 100 mg dose groups) were:

• Nausea

• Dizziness

• Insomnia

• Excessive sweating

• Constipation

• Sleepiness

• Decreased appetite

• Anxiety

• Specific male sexual function disorders

• 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 desvenlafaxine succinate, venlafaxine hydrochloride, or any excipients in the Pristiq formulation

• Serotonin syndrome and MAOIs

• 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/hypomania

• Discontinuation syndrome

• Seizure

• Low blood sodium: Can occur in association with SIADH.

• Interstitial lung disease and eosinophilic pneumonia

• Sexual dysfunction

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 the risk of suicidal thoughts and behaviors in children, adolescents and young adults taking antidepressants.

Closely monitor for clinical worsening and emergence of suicidal thoughts and behaviors.

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