Cymbalta Vs. Trazodone: 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.

Trazodone is an antidepressant that works by inhibiting serotonin reuptake and blocking certain serotonin receptors, helping to improve mood and alleviate symptoms of depression. Its FDA-approved indication is for the treatment of major depressive disorder (MDD) in adults. Off-label uses include treating insomnia, anxiety, and chronic pain. Trazodone is available in tablet form, typically taken once or twice daily, often at bedtime due to its sedating effects. Common side effects include swelling, drowsiness, nasal congestion, dizziness, and dry mouth. There is a risk of increased suicidal thoughts and behaviors in children, adolescents, and young adults, similar to other antidepressants.

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

Trazodone is indicated:

• For the treatment of major depressive disorder (MDD)

• Typically taken orally once daily

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

• Typically taken orally in divided doses per day

• Comes in 50 mg, 100 mg, 150 mg, and 300 mg 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 that of placebo) are:

• Swelling

• Blurred vision

• Fainting

• Drowsiness

• Fatigue

• Diarrhea

• Nasal congestion

• Weight loss

• 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

• Concomitant use of monoamine oxidase inhibitors (MAOIs), or use within 14 days of stopping MAOIs

• Drug interactions: CNS depressants, CYP3A4 inhibitors, CYP3A4 inducers, digoxin, phenytoin, 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

• Cardiac arrhythmias

• Positional low blood pressure and fainting

• Increased risk of bleeding

• Prolonged erection

• Activation of mania or hypomania

• Potential for cognitive and motor impairment

• Angle-closure glaucoma

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

Antidepresants increased the risk of suicidal thoughts and behaviors in pediatric and young adult patients.

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

Trazodone hydrochloride tablet 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 trazodone hydrochloride label used by Accord Healthcare, Inc. See the Full Prescribing Information for more complete information. This information may not be accurate for all medications that include the active ingredient trazodone.