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Cymbalta vs Pristiq
Introduction
For patients battling major depressive disorder (MDD) or other forms of depression, specific drugs that modify the levels of mood-related compounds in the brain, known as neurotransmitters, can contribute to stabilizing depressive episodes and managing symptoms. Cymbalta and Pristiq are two such drugs that are commonly prescribed for depression. They each impact different neurotransmitters in the brain, but both have mood-stabilizing effects in patients with depression. Cymbalta is a serotonin and norepinephrine reuptake inhibitor (SNRI), influencing levels of both serotonin and norepinephrine. Pristiq, on the other hand, is also classified as an SNRI, but its primary effect is on the levels of serotonin, with a lesser impact on norepinephrine levels.
Cymbalta vs Pristiq Side By Side
| Attribute | Cymbalta | Pristiq |
|---|---|---|
| Brand Name | Cymbalta | Pristiq |
| Contraindications | Should not be taken with or have recently consumed MAO inhibitors. | Should not be taken with or have recently consumed MAO inhibitors. |
| Cost | For brand name, about $240 for 30 capsules (30 mg). Generic versions can start as low as just over a dollar per day. | For brand name, 60 tablets of 50 mg averages around $400. Generic versions range between $1 and $3 per day. |
| Generic Name | Duloxetine | Desvenlafaxine |
| Most Serious Side Effect | An increase in suicidal thoughts or tendencies, particularly in children and young adults; serious skin reactions; signs of serotonin syndrome. | Increased thoughts about suicide or self-harm; symptoms of an allergic reaction; signs of serotonin syndrome. |
| Severe Drug Interactions | MAO inhibitors. | MAO inhibitors. |
| Typical Dose | 20–60 mg/day, with a starting dose of 30-60mg/day effective for most adults. Maximum dose of 120 mg/day. | 50 mg/day as a standard dose for most adults. Dose can be increased to 100mg/day if there's an inadequate response. |
What is Cymbalta?
Duloxetine (the generic name for Cymbalta) was the first drug of the SNRI class of antidepressants, which marked a significant advancement from the first class of antidepressant drugs known as tricyclic antidepressants (TCAs). Duloxetine was first approved by the FDA in 2004. Cymbalta works by increasing the levels of serotonin and norepinephrine by preventing their reabsorption, effectively keeping them in the brain for longer than usual. It is prescribed for the treatment of different forms of depression, anxiety, fibromyalgia and neuropathic pain. Unlike other antidepressants that influence only serotonin, Cymbalta has a balanced effect on both serotonin and norepinephrine, which can result in it having a broader range of effects, although this can also lead to more potential side effects.
Desvenlafaxine (the generic name for Pristiq), on the other hand, is another SNRI antidepressant which was approved by the FDA in 2008. Similar to Cymbalta, Pristiq also increases the levels of serotonin and norepinephrine in the brain by inhibiting their reuptake. However, it is thought to have a more selective action and primarily acts on serotonin, with less effect on norepinephrine. This selectivity may result in fewer side effects compared to other SNRIs like Cymbalta.
What conditions is Cymbalta approved to treat?
Cymbalta is approved for the treatment of several different conditions:
- Major depressive disorder
- Generalized anxiety disorder
- Diabetic peripheral neuropathic pain
- Fibromyalgia
- Chronic musculoskeletal pain
On the other hand, Pristiq is primarily used for:
- Major depressive disorder
It's worth noting that while both drugs can treat major depressive disorders, they have differences in their additional approved uses. Cymbalta has a wider range of applications including various forms of chronic pain, whereas Pristiq is more focused on depression.
How does Cymbalta help with these illnesses?
Cymbalta, like Prozac, aids in managing depression, but it does this by increasing not only the levels of serotonin but also norepinephrine in the brain's synapses. It achieves this by inhibiting their reuptake by neurons, which allows these neurotransmitters to remain available for longer periods of time. Both serotonin and norepinephrine are neurotransmitters that play significant roles in mood regulation, cognition, sleep patterns, and other bodily functions. Lower levels of these neurotransmitters have been linked to depression. Therefore, by increasing the levels of serotonin and norepinephrine, Cymbalta can minimize the negative effects of depression and help patients manage their symptoms and stabilize their moods. Comparatively, Pristiq also inhibits the reuptake of serotonin and norepinephrine but in different ratios which may make it more suitable for some individuals depending on their specific symptoms and how they react to these medications.
What is Pristiq?
Pristiq is the brand name for desvenlafaxine, a serotonin and norepinephrine reuptake inhibitor (SNRI), meaning it increases the levels of serotonin and norepinephrine in the brain by reducing their reuptake. This mechanism’s purpose is to correct the imbalance of these neurotransmitters, which can help to alleviate symptoms of depression. It was first approved by the FDA in 2008. As Pristiq is an SNRI and not a selective serotonin reuptake inhibitor (SSRI), it also affects norepinephrine, which can offer advantages in the treatment of depression, especially in patients who do not respond well to the “typical” SSRI antidepressant drugs. However, its side-effect profile is also different to that of SSRIs, in particular in that it does not cause sedation. Despite that, it may still cause sexual dysfunction and elevated blood pressure, which are common side effects of SNRIs such as Cymbalta. The effects on serotonin and norepinephrine can be beneficial for the treatment of depression, especially in patients who do not respond well to the “typical” SSRI antidepressant drugs.
What conditions is Pristiq approved to treat?
Pristiq has been approved by the FDA for addressing:
- Major depressive disorder (MDD), where it can help to manage and alleviate symptoms associated with this condition.
- It is also utilized off-label in managing symptoms related to menopause such as hot flashes.
How does Pristiq help with these illnesses?
Norepinephrine is a neurotransmitter that also functions as a hormone, playing significant roles in several bodily processes such as maintaining alertness, enhancing memory recall, focusing attention, and is crucial to the "fight or flight" response, preparing the body for action under stress. Serotonin, like norepinephrine, has been linked to depression when levels are low. Pristiq works by increasing the available levels of both norepinephrine and serotonin in the brain, thereby relieving some of the symptoms associated with depression. Its action on these two neurotransmitters is key to Pristiq's effectiveness as an antidepressant. Unlike Cymbalta, Pristiq doesn't significantly affect the levels of other neurotransmitters, making it a preferred option for patients who may not respond well to other types of antidepressants, or it can be combined with them as necessary.
How effective are both Cymbalta and Pristiq?
Both duloxetine (Cymbalta) and desvenlafaxine (Pristiq) have established histories of success in treating patients with depression, and they were approved by the FDA less than five years apart. Since they act on different neurotransmitters- duloxetine inhibiting serotonin and norepinephrine reuptake, while desvenlafaxine is a selective serotonin reuptake inhibitor -they may be prescribed under different circumstances.
The effectiveness of duloxetine and desvenlafaxine in alleviating depression was directly studied in several clinical trials; both drugs exhibited similar efficacy in managing symptoms of major depressive disorder as well as comparable safety profiles. In these studies, none of the different metrics used to measure efficacy in treating depression significantly differed between patients receiving Cymbalta or those getting Pristiq.
A review from 2012 showed that Cymbalta can start relieving symptoms within the first week of treatment, has a side effect profile that's generally favorable compared to other antidepressants, and it's well-tolerated even among elderly populations. It has become widely used not only for its antidepressant effects but also for its ability to manage chronic pain conditions like fibromyalgia or diabetic neuropathy. The dose showing optimal efficacy varies depending on individual patient needs but typically falls within 60-120 mg/day range.
On the other hand, a recent meta-analysis indicated that Pristiq seems just as effective as placebo at treating depression without causing weight gain - often an issue with many other commonly prescribed antidepressants. However, due to insufficient data confirming its superiority over SSRIs or SNRIs like Cymbalta when used alone for primary treatment purposes – Pristiq is usually considered after first-line treatments have proven ineffective or intolerable due to side effects.
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At what dose is Cymbalta typically prescribed?
Oral dosages of Cymbalta range from 20–60 mg/day, but research shows that a starting dose of 30-60mg/day is effective for treating major depressive disorder in most adults. It's not recommended for children and adolescents under the age of 18. If there hasn't been an adequate response after several weeks, the dosage might be increased gradually by your doctor up to a maximum dose of 120 mg/day. For Pristiq, typical oral dosages are between 50–400 mg/day with studies indicating that the standard initial dose should be around 50mg once daily for most adults suffering from depression. The use and dosage in individuals below the age of 18 need to be determined by a healthcare provider. Dosage can be adjusted based on individual patient needs and responses but should not exceed the maximum suggested limit.
At what dose is Pristiq typically prescribed?
Pristiq treatment typically begins with a dosage of 50 mg/day. This is a standard dose for most adults in treating major depressive disorder. It can be taken at any time of the day, but consistency in timing may help maintain even levels of the drug in your system. Pristiq does not require titration and hence no need for a gradual increase or decrease in dosing when starting or stopping therapy; however, some doctors may consider increasing the dose to 100mg/day if there's an inadequate response to initial therapy after several weeks. The maximum daily dose should preferably not exceed 400 mg per day as it doesn't improve effectiveness and could increase side effects.
What are the most common side effects for Cymbalta?
Common side effects of Cymbalta (duloxetine) and Pristiq (desvenlafaxine) can include:
- Anxiety
- Nervousness
- Insomnia or problems sleeping
- Fatigue or drowsiness that may be due to sedation effect
- General weakness and fatigue
- Tremor, involuntary trembling, or shaking movements
- Decreased appetite (anorexia)
- Nausea which is more common in the first weeks of medication usage
- Digestive discomfort such as dyspepsia and diarrhea
-Dry mouth which could lead to dental issues if persistent -Decreased libido or sex drive. There could also be ejaculation disorder in males. -Sweating, often excessive night sweats are reported by patients on these medications. -Rarely rash might appear as a sign of allergic reaction. -In some cases people report abnormal dreams, sinusitis symptoms like headache and facial pain.
Remember it's important to consult with your healthcare provider about any potential side effects before starting a new medication regimen.
Are there any potential serious side effects for Cymbalta?
Certain side effects can signal a serious condition when taking Cymbalta or Pristiq:
- An increase in suicidal thoughts or tendencies, particularly in children and young adults
- Signs of an allergic response such as hives, difficulty breathing, swelling in the face or throat
- Serious skin reactions such as fever, sore throat, burning eyes, skin pain or a red/purple rash that blisters and peels
- Visual disturbances like blurred vision, eye pain/swelling or seeing halos around lights
- Cardiovascular issues like fast/pounding heartbeats, fluttering sensation within your chest cavity (palpitations), shortness of breath and sudden dizziness suggestive of fainting
- Indications of low sodium levels include headache, confusion, slurred speech pattern accompanied by extreme weakness. Vomiting episodes coupled with loss of coordination and unsteadiness may also be evident.
- A severe reaction from the nervous system could present with very rigid muscles along with high fever. Other symptoms might include sweating profusely concurrently experiencing confusion. Additionally rapid/uneven heartbeats may follow suit causing tremors giving you a feeling similar to fainting.
If any signs suggestive of serotonin syndrome are detected: agitated behavior; hallucinations; hyperthermia; excessive perspiration followed by shivering; tachycardia which is unusually speedy heartbeat rate combined with muscle stiffness/twitches leading to lack of coordination amongst body movements including nausea/vomiting episodes continuing on towards diarrhea.
Should you notice these adverse reactions while on Cymbalta/Pristiq contact your healthcare provider immediately for prompt medical attention.
What are the most common side effects for Pristiq?
When comparing Cymbalta to Pristiq, here are some potential side effects you may experience with Pristiq:
- Dry mouth or throat
- Nausea, vomiting, constipation or stomach pain
- Difficulty sleeping (insomnia)
- Increased sweating and possible feelings of anxiousness or nervousness
- Accelerated heartbeat
- Potential confusion or agitation
- Skin rash is a less common side effect
- Possible changes in weight
- Frequent urination could occur
- Experiencing headaches and dizziness is not uncommon -Muscle stiffness, spasms, twitches, or pain.
Are there any potential serious side effects for Pristiq?
While Pristiq is generally well-tolerated, it can sometimes cause severe side effects. These may include:
- Symptoms of an allergic reaction such as hives; breathing difficulties; swelling of your face, lips, tongue, or throat
- Increased thoughts about suicide or self-harm especially in the first weeks after starting the medication or when doses are adjusted
- A possible seizure (convulsions)
- Sudden confusion and unusual changes in mood or behaviors
- Vision problems including blurred vision, tunnel vision, eye pain or swelling and seeing halos around lights
- Fast or irregular heartbeats
- Signs of serotonin syndrome: agitation, hallucinations (seeing things), fever, sweating excessively fast heartbeat rate which is also known as tachycardia.
If any of these symptoms occur while taking Pristiq you should seek immediate medical attention. It's important to remember that everyone responds differently to medications so if you have any concerns discuss them with your healthcare provider before making any changes to your regimen.
Contraindications for Cymbalta and Pristiq?
Both Cymbalta and Pristiq, like many other antidepressant medications, might exacerbate symptoms of depression in certain individuals. If you notice your depression worsening or an increase in suicidal thoughts or behaviors, it is crucial that you seek immediate medical attention.
Neither Cymbalta nor Pristiq should be taken if you are consuming or have recently consumed monoamine oxidase (MAO) inhibitors. It's vital to inform your physician about any medications you're currently taking; MAOIs will require a period of roughly two weeks to clear from the system to prevent potentially hazardous interactions with both Cymbalta and Pristiq.
How much do Cymbalta and Pristiq cost?
For the brand name versions of these drugs:
- The price for 60 tablets of Pristiq (50 mg) averages around $400, which equates to approximately $13-$26/day depending on your dosage.
- The cost for 30 capsules of Cymbalta (30 mg) is about $240, working out to roughly $8/day.
Therefore, if you are in the higher dosage range for Pristiq (i.e., 100mg per day or more), then brand-name Cymbalta may be less expensive on a per-day treatment basis. Please bear in mind that cost should not be the primary factor when determining which of these medications is right for you.
As with most medications, generic versions are available at significantly lower prices:
- Desvenlafaxine (generic Pristiq) comes in packs ranging from 30 to 90 tablets with costs varying between $1 and $3 per day based on dosages ranging from 50mg to up to 400mg daily.
- Duloxetine (generic Cymbalta) is available in quantities starting from as few as seven capsules up to hundreds. Your costs can start as low as just over a dollar per day and should not exceed about five dollars daily even at higher doses.
Popularity of Cymbalta and Pristiq
Duloxetine, also known by its brand name Cymbalta, was prescribed to approximately 10.3 million people in the United States in 2019. It accounted for roughly 11% of SNRI (Serotonin and Norepinephrine Reuptake Inhibitors) prescriptions that year. Duloxetine is commonly used not only for depression but also generalized anxiety disorder, fibromyalgia, and neuropathic pain associated with diabetes.
Desvenlafaxine, marketed under the brand name Pristiq among others, has seen a steady increase in use since its introduction to the market in 2008. Approximately 2.3 million prescriptions were filled for desvenlafaxine in the US during 2020 making it less widely used than duloxetine but still noteworthy within this group of medications. Like duloxetine, desvenlafaxine is an SNRI antidepressant which can be used to treat major depressive disorder as well as menopausal hot flashes.
Conclusion
Both Cymbalta (duloxetine) and Pristiq (desvenlafaxine) have extensive usage records in patients with depression, and are backed by numerous clinical studies indicating that they are more effective than placebo treatments. In some instances, these two drugs may be used concurrently, but a doctor's careful consideration is required as they can also interact negatively. Owing to their different mechanisms of action – with Cymbalta acting primarily on serotonin and norepinephrine, while Pristiq acts mainly on serotonin – these medications tend to be prescribed under varying circumstances. While both are considered first-line treatment options for major depressive disorder, Cymbalta has the added advantage of being approved for use in generalized anxiety disorder, fibromyalgia and chronic musculoskeletal pain.
Both Cymbalta and Pristiq come in generic form which provides significant cost savings especially for patients who need to pay out-of-pocket. Both may require an adjustment period meaning that effects may not be noticeable immediately.
The side effect profile between the two drugs is similar; however, each medication possesses unique side effects related to its particular mechanism of action. Both drugs are generally well-tolerated although sexual dysfunction and weight gain could potentially occur less frequently with Pristiq compared to Cymbalta. Patients must closely monitor their moods when starting either drug therapy and should seek immediate medical help if they notice worsening depression or any thoughts about self-harm.
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Refrences
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