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Cymbalta vs Lyrica
Introduction
For patients with chronic pain conditions like fibromyalgia or neuropathic ailments such as diabetic peripheral neuropathy, certain medications that alter the processing of pain signals in the central nervous system can help in managing symptoms and improving quality of life. Cymbalta and Lyrica are two such drugs that are commonly prescribed for these issues. They each work differently within the body but have similar effects on mitigating chronic pain. Cymbalta is a serotonin-norepinephrine reuptake inhibitor (SNRI), affecting levels of neurotransmitters serotonin and norepinephrine, which play a role in moderating perception of pain. On the other hand, Lyrica acts on alpha-2-delta subunit of voltage-gated calcium channels reducing the release of several neurotransmitters including glutamate, noradrenaline, substance P and calcitonin gene-related peptide (CGRP).
Cymbalta vs Lyrica Side By Side
| Attribute | Cymbalta | Lyrica |
|---|---|---|
| Brand Name | Cymbalta | Lyrica |
| Contraindications | Should not be taken with, or shortly after, MAO inhibitors. | Should not be taken with, or shortly after, MAO inhibitors. |
| Cost | For brand name: around $470 for 60 capsules of 30 mg. Generic: between $0.20 and $2 per day. | For brand name: approximately $430 for 60 tablets of 50 mg. Generic: roughly between $0.30 and $3 per day. |
| Generic Name | Duloxetine | Pregabalin |
| Most Serious Side Effect | Increased thoughts about suicide or self-harm, severe skin reactions, low sodium levels, symptoms similar to serotonin syndrome. | Possible suicidal thoughts or actions, allergic reactions, vision problems, muscle pain/stiffness, rapid weight gain, dizziness/feeling faint. |
| Severe Drug Interactions | MAO inhibitors. | MAO inhibitors. |
| Typical Dose | 20–120 mg/day, with 60 mg/day being effective for most conditions. | 150-600 mg/day, divided into two or three doses. |
What is Cymbalta?
Duloxetine (the generic name for Cymbalta) is a Serotonin and Norepinephrine Reuptake Inhibitor (SNRI), which marked a significant development in the treatment of depression, anxiety, nerve pain, and fibromyalgia. The FDA first approved Duloxetine in 2004. Cymbalta works by increasing levels of serotonin and norepinephrine by inhibiting their reabsorption into the neurons in the brain, effectively keeping these neurotransmitters active for longer periods. It is prescribed to treat various mental health disorders and certain types of chronic pain.
On the other hand, Pregabalin (the generic name for Lyrica) functions as an anti-epileptic drug that also has analgesic effects useful in treating neuropathic pain conditions like fibromyalgia or diabetic peripheral neuropathy. Unlike SNRIs such as Duloxetine/Cymbalta, Pregabalin/Lyrica primarily influences calcium channels rather than directly affecting serotonin or norepinephrine levels.
While both drugs have proven effective at managing different forms of chronic pain conditions with varying mechanisms of action; their side effect profiles differ significantly due to these differences.
What conditions is Cymbalta approved to treat?
Cymbalta is approved for the treatment of various conditions, including:
- Major depressive disorder (MDD)
- Generalized anxiety disorder (GAD)
- Diabetic peripheral neuropathic pain
- Fibromyalgia
- Chronic musculoskeletal pain, including chronic osteoarthritis pain and chronic lower back pain.
How does Cymbalta help with these illnesses?
Cymbalta, also known as duloxetine, helps to manage symptoms of depression and anxiety by increasing the amount of serotonin and norepinephrine available in the synapses of the brain. It does this by blocking their reabsorption into neurons, allowing these chemicals to remain at higher levels for longer periods. Both serotonin and norepinephrine are neurotransmitters that play crucial roles in mood regulation, cognition, memory, sleep patterns and various other physiological processes. In individuals with depression or anxiety disorders, it is believed there are relatively lower levels of these neurotransmitters. Therefore, by boosting their presence in the brain's synaptic connections through Cymbalta's action mechanism can help limit negative effects related to such conditions and aid patients in managing their symptoms more effectively.
What is Lyrica?
Lyrica, also known as pregabalin, is an anticonvulsant and neuropathic pain agent that works by slowing down impulses in the brain that cause seizures. It also affects chemicals in the brain that send pain signals across the nervous system. Pregabalin was first approved by the FDA in 2004 and it's primarily used to treat fibromyalgia, neuropathic pain (pain from damaged nerves), and certain types of seizures.
Unlike Cymbalta (duloxetine), Lyrica is not a selective serotonin and norepinephrine reuptake inhibitor (SNRI). This means it does not inhibit the reabsorption of serotonin or norepinephrine. Its mechanism of action primarily focuses on decreasing nerve-related pain signals rather than modulating neurotransmitter levels. Therefore, its side-effect profile differs from SNRIs like Cymbalta; for instance, weight gain can occur with Lyrica but is less common with SNRIs such as Cymbalta. Furthermore, Lyrica’s unique effects can be particularly beneficial for patients who do not respond well to “typical” SNRI drugs.
What conditions is Lyrica approved to treat?
Lyrica is approved by the FDA for the management of various conditions including:
- Neuropathic pain associated with diabetic peripheral neuropathy
- Postherpetic neuralgia (nerve pain from herpes zoster or "shingles" virus)
- Fibromyalgia, a chronic condition that causes widespread muscle and joint pain
- As an adjunctive therapy for partial onset seizures in adults.
How does Lyrica help with these illnesses?
Gamma-aminobutyric acid (GABA) is a neurotransmitter that plays key roles in regulating relaxation and reducing neuronal excitability throughout the nervous system. Its role extends to pain regulation, making it pertinent for individuals suffering from conditions like fibromyalgia. Lyrica works by binding to calcium channels in nerve cells, increasing GABA levels, and thereby decreasing the release of neurotransmitters such as glutamate, norepinephrine, and substance P which are involved in pain signal transmission. This action effectively diminishes pain signals sent to the brain from damaged nerves, offering relief from neuropathic pain conditions. Unlike Cymbalta, which impacts both serotonin and norepinephrine levels and can have wide-ranging effects on mood disorders as well as some types of pain, Lyrica specifically targets nerve-related pain symptoms with its unique mechanism of action. It's often prescribed when patients do not respond well or cannot tolerate other types of drugs used for neuropathic conditions.
How effective are both Cymbalta and Lyrica?
Both duloxetine (Cymbalta) and pregabalin (Lyrica) have established histories of success in treating patients with fibromyalgia, neuropathic pain, and generalized anxiety disorder. They were initially approved by the FDA only a few years apart. Since they act on different neurotransmitters, they may be prescribed under different circumstances. The effectiveness of Cymbalta and Lyrica in alleviating symptoms was directly studied in multiple clinical trials; both drugs exhibited similar efficacy in managing symptoms as well as promising safety profiles.
A 2007 review demonstrated that Cymbalta is effective at reducing pain levels starting from the first week of treatment for many conditions including diabetic peripheral neuropathy, major depressive disorder, and generalised anxiety disorder. Its side effect profile is comparable to other antidepressants used for these indications while also providing substantial benefits due to its dual action on serotonin-norepinephrine reuptake inhibition.
On the other hand, a 2014 review indicated that Lyrica seems to be more effective than placebo for postherpetic neuralgia and diabetic neuropathy but there was no clear evidence it worked for the pain from damaged nerves seen in HIV or cancer-related nerve damage. Nonetheless, it's typically considered an important treatment option due to its unique mechanism acting on voltage-dependent calcium channels designed to decrease release of several neurochemicals including glutamate, norepinephrine, substance P and calcitonin gene-related peptide.
Despite robust data supporting their use individually there are limited head-to-head studies between these two medications so choosing one over another often comes down to factors like patient comorbidities (eg depression), individual side-effect tolerability or physician experience with either medication.
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At what dose is Cymbalta typically prescribed?
Oral dosages of Cymbalta range from 20–120 mg/day, but research demonstrates that a dose of 60 mg/day is usually effective for managing both depression and generalized anxiety disorder in most people. For chronic musculoskeletal pain or fibromyalgia, patients are generally started on a dose of 30 mg/day which can be increased to 60mg after one week. The maximum dosage that should not be exceeded is typically 120 mg/day. On the other hand, Lyrica doses vary significantly depending on the condition being treated; however, they generally range between 150-600mg per day divided into two or three doses. As always, it's important to follow your healthcare provider's instructions when adjusting medication regimens.
At what dose is Lyrica typically prescribed?
Lyrica treatment is usually initiated at a dose of 150 mg/day, split into two or three doses throughout the day. This dosage can then be increased to 300 mg/day, divided into equal doses and spaced evenly apart. The maximum daily dose is typically 600 mg, taken in two or three separate doses of either 200 or 300mg each. If there is no response to treatment at the initial dose after one week, it could then be tested at a higher dosage following your doctor's recommendation.
What are the most common side effects for Cymbalta?
Common but typically milder side effects of Cymbalta and Lyrica can include:
- Dizziness
- Somnolence (sleepiness/drowsiness)
- Dry mouth
- Nausea, loss of appetite, constipation or diarrhea
- Anxiety, nervousness and insomnia
- Sweating more than usual - especially at night
- Blurred vision
- Weight gain (more common with Lyrica)
- Decreased libido or sexual ability
- Tremor or uncontrolled shaking movement
If you experience any severe symptoms such as trouble breathing or skin rashes, seek immediate medical attention.
Are there any potential serious side effects for Cymbalta?
In the case of Cymbalta versus Lyrica, both medications have their own potential side effects that need to be considered:
Cymbalta has been known in some cases to increase thoughts about suicide or self-harm, especially if taken by people under 24 years old. Similarly, it can cause severe skin reactions and allergic responses such as hives, difficulty breathing, swelling in your face or throat. Other serious side effects include blurred vision, eye pain or swelling; fast or pounding heartbeats; low sodium levels leading to headache, confusion and loss of coordination; and symptoms similar to serotonin syndrome like agitation and hallucinations.
On the other hand with Lyrica there could also be serious adverse reactions including possible suicidal thoughts or actions. Allergic reactions may manifest as hives and facial swelling among others. Vision problems might occur along with muscle pain/stiffness due its effect on nervous system. People taking Lyrica should be vigilant for signs of these potential issues: unexplained muscle weakness/pain/tenderness (signs of rhabdomyolysis), rapid weight gain (a symptom indicating potential congestive heart failure) , dizziness/feeling faint (indicating potentially low blood pressure). It is important that any unusual symptoms are reported promptly for proper medical evaluation.
What are the most common side effects for Lyrica?
While taking Lyrica, you might experience some of the following side effects:
- Dry mouth and increased appetite
- Dizziness and drowsiness
- Swelling in your hands or feet
- Blurred vision
- Weight gain
- Trouble concentrating or memory problems
- Constipation, gas
- Sleep disturbances (insomnia) -Muscle weakness, lack of coordination
Are there any potential serious side effects for Lyrica?
While Lyrica is generally well-tolerated, there are some possible severe side effects that you should be aware of. These can include:
- Signs of an allergic reaction such as hives; difficulty breathing or swallowing; swelling in your face, lips, tongue or throat
- New or worsening depression or anxiety; feelings of restlessness; thoughts about suicide or hurting yourself
- Sudden changes in behavior or mood including confusion and unusual thoughts
- Problems with balance, coordination, vision (including blurred vision), eye pain and seeing halos around lights
- Rapid heartbeats and chest pain
- Muscle weakness and tenderness (especially if accompanied by fever)
- Breathing problems - particularly if you have a history of asthma
If any of these symptoms manifest while taking Lyrica it's important to seek immediate medical advice.
Contraindications for Cymbalta and Lyrica?
Both Cymbalta and Lyrica, as with most medications for neuropathic pain and fibromyalgia, could potentially worsen depression or anxiety in some individuals. If you notice your mental health deteriorating, experience an increase in suicidal ideation, thoughts, or behavior while taking these drugs, it is crucial to seek immediate medical attention.
Neither Cymbalta nor Lyrica should be taken if you are using, or have recently used MAO inhibitors (MAOIs). Always inform your physician about any medications you are currently on; MAOIs will require a gap of approximately 5 weeks without treatment to ensure they are completely eliminated from the system before starting therapy with either Cymbalta or Lyrica. This is vital to prevent dangerous interactions between these drugs.
How much do Cymbalta and Lyrica cost?
For the brand name versions of these drugs:
- The price for 60 capsules of Cymbalta (30 mg) averages around $470, which works out to about $7.80–$15.60/day, depending on your dose.
- The cost of 60 tablets of Lyrica (50 mg) is approximately $430, working out to be about $7.10/day.
Thus, if you are in the higher dosage range for Cymbalta (i.e., 90 mg/day or higher), then brand-name Lyrica could potentially be less expensive on a per-day treatment basis. It must be noted that cost should not serve as a primary factor in determining which medication best suits your needs.
As for generic versions:
- Duloxetine (the generic form of Cymbalta) can cost between $0.20 and $2 per day depending upon the daily dosage requirements.
- Pregabalin (generic Lyrica), on the other hand, costs roughly between $0.30 and $3 per day based on dosages ranging from 75mg up to 600mg daily.
These prices vary significantly among pharmacies and locations; therefore it's crucial to discuss with healthcare professionals before making decisions solely based on pricing factors.
Popularity of Cymbalta and Lyrica
Duloxetine, available under the brand name Cymbalta, was estimated to have been prescribed to about 10.8 million people in the US in 2020. Duloxetine accounted for just over 22% of prescriptions for drugs used to treat depression and nerve pain in the United States. Its use has generally increased since its approval by FDA in 2004.
Pregabalin, sold under brands like Lyrica, was prescribed to approximately 9 million individuals within the same year. Pregabalin accounts for about one-fifth of all prescriptions related to neuropathic pain management and anxiety disorders. The number of pregabalin prescriptions has seen a substantial rise following its approval as an antiepileptic drug by FDA; however, it has maintained a steady rate over recent years.
Conclusion
Both Cymbalta (duloxetine) and Lyrica (pregabalin) have long-standing records of usage in patients with neuropathic pain, fibromyalgia, and certain types of anxiety disorders. They are supported by numerous clinical studies indicating their effectiveness over placebo treatments. While they can be used together under physician supervision, they work differently - Cymbalta works primarily on serotonin and norepinephrine to manage depression-like symptoms while Lyrica acts on calcium channels reducing the release of neurotransmitters like glutamate, noradrenaline, substance P.
Cymbalta is often chosen as a first-line treatment option for major depressive disorder or generalized anxiety disorder due to its dual action on both serotonin and norepinephrine. On the other hand, Lyrica is typically considered as an adjuvant therapy for patients who did not respond well to initial treatments or need relief from nerve-related pain conditions such as peripheral diabetic neuropathy or post-herpetic neuralgia.
Both drugs are available in generic form which represents substantial cost savings especially for uninsured patients. Both medications may require an adjustment period; hence effects may not be noticeable immediately.
The side effect profile between the two drugs shares similarities but also has distinctions; both might lead to dizziness or sleepiness but sexual dysfunction is more common with Cymbalta whereas weight gain is more likely with Lyrica. Patients must closely monitor their state when starting these medications and seek immediate medical help if they notice worsening depression symptoms or have suicidal thoughts.
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Refrences
- Bidari, A., Moazen-Zadeh, E., Ghavidel-Parsa, B., Rahmani, S., Hosseini, S., & Hassankhani, A. (2019, March 14). Comparing duloxetine and pregabalin for treatment of pain and depression in women with fibromyalgia: an open-label randomized clinical trial. DARU Journal of Pharmaceutical Sciences. Springer Science and Business Media LLC.http://doi.org/10.1007/s40199-019-00257-4
- Trivedi, M. H., Desaiah, D., Ossanna, M. J., Pritchett, Y. L., Brannan, S. K., & Detke, M. J. (2008, May). Clinical evidence for serotonin and norepinephrine reuptake inhibition of duloxetine. International Clinical Psychopharmacology. Ovid Technologies (Wolters Kluwer Health).http://doi.org/10.1097/yic.0b013e3282f41d7e
- Dhillon, S. (2012, December 14). Duloxetine. Drugs & Aging. Springer Science and Business Media LLC.http://doi.org/10.1007/s40266-012-0040-1
- Zareba, G. (2005). Pregabalin: A new agent for the treatment of neuropathic pain. Drugs of Today. Portico.http://doi.org/10.1358/dot.2005.41.8.910482
- Frampton, J. E., & Plosker, G. L. (2007). Duloxetine. CNS Drugs. Springer Science and Business Media LLC.http://doi.org/10.2165/00023210-200721070-00004