Cymbalta Vs. Strattera: 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.

Strattera^® (atomoxetine) is a non-stimulant medication used to treat attention-deficit hyperactivity disorder (ADHD) by selectively inhibiting the reuptake of norepinephrine, which helps improve focus and reduce impulsivity. Its FDA-approved indication is for the treatment of ADHD in both children and adults. Strattera is available in capsule form, taken once or twice daily. Common side effects include dry mouth, insomnia, decreased appetite, and nausea, while more serious risks include increased heart rate and blood pressure. Strattera carries a boxed warning for an increased risk of suicidal thoughts in children and adolescents, especially during the initial treatment period.

Serotonin and norepinephrine reuptake inhibitor (SNRI)

Selective 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

Strattera (atomoxetine hydrochloride) is indicated:

• For the treatment of attention-deficit/hyperactivity disorder (ADHD)

• Typically taken orally once daily

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

• Typically taken orally once or twice daily

• Comes in 10 mg, 18 mg, 25 mg, 40 mg, 60 mg, 80 mg, and 100 mg 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 (≥5% and at least twice the incidence of placebo patients):

Child and adolescent clinical trials:

• Nausea

• Vomiting

• Fatigue

• Decreased appetite

• Abdominal pain

• Sleepiness

Adult clinical trials:

• Constipation

• Dry mouth

• Nausea

• Decreased appetite

• Dizziness

• Erectile dysfunction

• Urinary hesitation

• 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 atomoxetine or other constituents of product

• Strattera use within 2 weeks after discontinuing MAOI or other drugs that affect brain monoamine concentrations

• Narrow angle glaucoma

• Pheochromocytoma or history of pheochromocytoma

• Severe cardiovascular disorders that might deteriorate with clinically important increases in HR and BP

• Drug interactions: monoamine oxidase inhibitors (MAOIs), CYP2D6 inhibitors, antihypertensive drugs and pressor agents, albuterol (or other beta agonists)

• 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

• Suicidal ideation

• Severe liver injury

• Serious cardiovascular events

• Emergent cardiovascular symptoms

• Effects on blood pressure and heart rate

• Emergent psychotic or manic symptoms

• Bipolar disorder

• Aggressive behavior or hostility should be monitored

• Possible allergic reactions, including anaphylactic reactions, angioneurotic edema, urticaria, and rash

• Effects on urine outflow

• Prolonged erection

• Growth

• Concomitant use of potent CYP2D6 inhibitors or use in patients known to be CYP2D6 PMs

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 IDEATION IN CHILDREN AND ADOLESCENTS

Increased risk of suicidal ideation in children or adolescents.

No suicides occurred in clinical trials.

Patients started on therapy should be monitored closely.

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