Cymbalta Vs. Zoloft: 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.

Zoloft^® (sertraline) is a selective serotonin reuptake inhibitor (SSRI) used to treat mood disorders by increasing available serotonin levels in the brain, which helps improve mood and reduce symptoms of anxiety and depression. Its FDA-approved indications include the treatment of major depressive disorder (MDD), obsessive-compulsive disorder (OCD), panic disorder (PD), post-traumatic stress disorder (PTSD), social anxiety disorder (SAD), and premenstrual dysphoric disorder (PMDD). Off-label uses may include the treatment of eating disorders and generalized anxiety disorder (GAD). Zoloft is available in tablet and oral solution forms, typically taken once daily. Common side effects include nausea, dizziness, 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 treatment period.

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

Zoloft (sertraline hydrochloride) is indicated for the treatment of:

• Major depressive disorder (MDD)

• Obsessive-compulsive disorder (OCD)

• Panic disorder (PD)

• Posttraumatic stress disorder (PTSD)

• Social anxiety disorder (SAD)

• Premenstrual dysphoric disorder (PMDD)

• 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 tablets 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 (≥5% and twice placebo) in pooled placebo-controlled MDD, OCD, PD, PTSD, SAD and PMDD clinical trials were:

• Nausea

• Diarrhea/Loose stool

• Tremor

• Indigestion

• Decreased appetite

• Excessive sweating

• Ejaculation failure

• Decreased libido

• 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

• Concomitant use of pimozide

• Known hypersensitivity to sertraline or excipients

• Zoloft oral solution only: Concomitant use of disulfiram

• Drug interactions: protein-bound drugs, CYP2D6 substrates

• 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

• Increased risk of bleeding

• Activation of mania/hypomania

• Seizures

• Angle closure glaucoma

• QTc prolongation

• Sexual dysfunction

• Pregnancy: Third trimester use may increase risk for persistent pulmonary hypertension and withdrawal 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

Antidepressants 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.

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