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Fetzima vs Cymbalta
Introduction
For patients with major depressive disorder (MDD) or other types of depression, certain drugs that modify the levels of neurotransmitters in the brain can help stabilize mood swings and manage symptoms. Fetzima and Cymbalta are two such medications often prescribed for this condition. Each drug influences different neurotransmitters but both have proven to be effective in managing depressive symptoms. Fetzima is a serotonin-norepinephrine reuptake inhibitor (SNRI), which affects the levels of serotonin and norepinephrine in the brain. On the other hand, Cymbalta also falls under SNRIs but it additionally has shown benefit for neuropathic pain conditions due to its dual effect on serotonin and norepinephrine receptors.
Fetzima vs Cymbalta Side By Side
| Attribute | Fetzima | Cymbalta |
|---|---|---|
| Brand Name | Fetzima | Cymbalta |
| Contraindications | Should not be taken if using or have recently stopped using monoamine oxidase (MAO) inhibitors. | Should not be taken if using or have recently stopped using monoamine oxidase (MAO) inhibitors. |
| Cost | For the brand name, approximately $465 for 30 capsules (20 mg). Generic versions cost significantly lower, ranging from $0.80 to $2.40 per day for dosages of 20 mg/day and between $1.60 and nearly $5 per day for higher doses. | For the brand name, approximately $250 for 30 capsules (30mg). Generic (duloxetine) costs start at just under a dollar per pill ($0.90–$1), making daily costs vary widely depending on dosage but generally from about $1 up to $3. |
| Generic Name | Levomilnacipran | Duloxetine |
| Most Serious Side Effect | Increased suicidal thoughts or actions, signs of an allergic reaction, changes in vision, rapid heart rate, hyponatremia, severe nervous system reactions. | Allergic reactions, increased suicidal thoughts or tendencies, seizures, confusion, vision problems, irregular heart rhythms, signs of serotonin syndrome. |
| Severe Drug Interactions | Risk for serotonin syndrome especially if taken with other serotonergic drugs. | Risk for serotonin syndrome especially if taken with other serotonergic drugs. |
| Typical Dose | Oral dosages range from 20-120 mg/day, starting dose of 20 mg/day is generally effective. | Begins at a dose of 30-60mg/day, may be increased up to a maximum of 120 mg/day. |
What is Fetzima?
Levomilnacipran (the generic name for Fetzima) is a selective serotonin and norepinephrine reuptake inhibitor (SNRI). It was first approved by the FDA in 2013. Fetzima works by increasing levels of serotonin and norepinephrine in the brain, effectively extending their presence and impact on mood regulation. It is commonly prescribed to treat Major Depressive Disorder (MDD). Unlike other SNRIs, Fetzima has a higher selectivity for norepinephrine over serotonin, which can lead to different side effects.
On the other hand, Duloxetine (the generic name for Cymbalta), another SNRI that has been available since 2004, also increases levels of free serotonin and norepinephrine. However, it influences both neurotransmitters more equally compared to Fetzima. This balanced effect could result in fewer side effects related specifically to the dominance of one neurotransmitter over another but may affect individuals differently depending on their unique neurochemistry.
What conditions is Fetzima approved to treat?
Fetzima has been approved for the treatment of varying types of depression:
- Major depressive disorder (MDD), also known as clinical depression
- Generalized anxiety disorder (GAD)
Cymbalta, on the other hand, is approved not only for these same conditions but also offers treatment options for several others:
- Diabetic peripheral neuropathic pain
- Fibromyalgia
- Chronic musculoskeletal pain
How does Fetzima help with these illnesses?
Fetzima assists in managing depression by increasing the amount of serotonin and norepinephrine available in the synapses of the brain. It achieves this by inhibiting their reuptake into neurons, thus maintaining higher levels for extended periods. Serotonin and norepinephrine are neurotransmitters - chemicals that act as messengers within the brain and body. They play important roles not only in mood regulation but also attention, learning, memory, sleep patterns among other functions. Depression is thought to be linked with relatively lower levels of these neurotransmitters. Therefore, by boosting serotonin and norepinephrine levels, Fetzima can mitigate depressive symptoms helping patients manage their condition better.
What is Cymbalta?
Cymbalta, also known by its generic name duloxetine, is a serotonin-norepinephrine reuptake inhibitor (SNRI), meaning it increases the levels of serotonin and norepinephrine in the brain by limiting their reabsorption. This leads to an enhanced mood as these neurotransmitters play key roles in maintaining mental balance. Cymbalta was first approved by the FDA in 2004 for major depressive disorder and generalized anxiety disorder treatment. Unlike Fetzima, which primarily enhances norepinephrine levels, Cymbalta impacts both serotonin and norepinephrine making it effective not just for depression but also for certain types of pain such as fibromyalgia and nerve damage caused by diabetes (diabetic neuropathy). Its effect on both neurotransmitters means that its side-effect profile may differ from drugs like Fetzima – common side effects can include nausea, dry mouth, sleepiness or fatigue; however sexual dysfunction is less likely compared to SSRIs. The dual action on serotonin and norepinephrine has been found beneficial especially with patients who do not respond well to “typical” SSRI antidepressant drugs.
What conditions is Cymbalta approved to treat?
Cymbalta is approved by the Food and Drug Administration for the management of several conditions, including:
- Major depressive disorder (MDD)
- Generalized anxiety disorder (GAD)
- Diabetic peripheral neuropathic pain
- Fibromyalgia
- Chronic musculoskeletal pain
How does Cymbalta help with these illnesses?
Serotonin and norepinephrine are neurotransmitters that play significant roles in various processes within the body, including mood regulation, alertness, concentration and stress response. Lower levels of these neurotransmitters have been associated with depression. Cymbalta works by increasing the amounts of serotonin and norepinephrine available in the brain which can help to alleviate symptoms of depression. This drug acts on both serotonin and norepinephrine receptors as a reuptake inhibitor, meaning it helps maintain higher levels of these neurotransmitters in the synaptic gap thereby enhancing their overall effect. While Fetzima also works on these two neurotransmitters, Cymbalta has an additional action on pain perception pathways making it potentially more beneficial for those suffering from co-morbid chronic pain conditions or fibromyalgia along with depression. Therefore, doctors may prescribe Cymbalta when patients do not respond well to "typical" SSRI antidepressants or SNRIs like Fetzima.
How effective are both Fetzima and Cymbalta?
Both levomilnacipran (Fetzima) and duloxetine (Cymbalta) are effective in treating patients with major depressive disorder, and they were approved by the FDA within a decade of each other. Fetzima was approved in 2013 while Cymbalta received its approval back in 2004. Both medications belong to a class of drugs known as serotonin-norepinephrine reuptake inhibitors (SNRIs), but their precise mechanisms differ slightly, leading to different prescribing patterns.
In direct head-to-head studies between Fetzima and Cymbalta, both drugs have shown comparable efficacy for alleviating symptoms of depression. However, these two SNRIs may affect individuals differently due to pharmacological differences; therefore, one medication might work better for some patients than others depending on various factors like genetic makeup or presence of co-existing conditions.
A systematic review from 2017 showed that both Fetzima and Cymbalta can be beneficial starting from the first week of treatment with generally favorable side effect profiles. The same study acknowledged that while there is a large body of evidence supporting the use of older antidepressants like fluoxetine or sertraline, newer options such as Fetzima also show promise for certain patient populations.
While not typically considered first-line treatments for depression (like SSRIs), SNRIs including Cymbalta are often employed when an SSRI hasn't worked effectively or when side effects — particularly sexual dysfunction or weight gain — make them less desirable choices. While data confirming their efficacy as standalone treatments isn't quite as robust compared to traditional SSRIs like Prozac, many find these medications helpful either alone or alongside another type of antidepressant.
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At what dose is Fetzima typically prescribed?
Oral dosages of Fetzima range from 20-120 mg/day, but studies have indicated that a starting dose of 20 mg/day is generally effective for treating major depressive disorder in most people. The dosage can be increased after one week if there is no response up to the maximum recommended daily dose which is 120 mg. On the other hand, Cymbalta's typical starting dosage ranges from 30-60mg once daily with or without food and may be gradually increased by your healthcare provider over several weeks if necessary. Its maximal dose should not exceed 120mg per day. As always, medication plans should be personalized according to individual patient needs under a doctor's supervision.
At what dose is Cymbalta typically prescribed?
Cymbalta treatment typically begins at a dose of 30-60mg/day, taken once daily. Depending on the individual's response and tolerance, this dosage may be increased up to a maximum of 120 mg/day, again taken as a single dose. It is important to note that any increase in dosage should only occur under the guidance of your healthcare provider. If no significant response or improvement is observed after several weeks at the initial dosage level, then your doctor may consider an increment in the daily dose. However, it's essential never to exceed the prescribed highest limit of 120 mg per day without consulting with your healthcare professional.
What are the most common side effects for Fetzima?
Some common side effects of Fetzima include:
- Nausea
- Sweating
- Constipation
- Increased heart rate (tachycardia)
- Urinary hesitation and/or frequency
- Erectile dysfunction, decreased libido (sex drive)
- Abnormal orgasm
- Insomnia or trouble sleeping
On the other hand, Cymbalta can cause:
- Nausea
- Dry mouth
- Sleepiness/drowsiness or insomnia
- Dizziness
- Sweating
- Decreased appetite
- Fatigue, general weakness
- Constipation or diarrhea
- Sexual side effects such as decreased libido (sex drive), abnormal ejaculation, and impotence.
It's worth noting that each individual may react differently to medications so it is critical to communicate any adverse reactions with your healthcare provider.
Are there any potential serious side effects for Fetzima?
While taking Fetzima, some potential severe side effects to be aware of include:
- Increased suicidal thoughts or actions, especially in individuals younger than 24 during the first few weeks of treatment
- Signs of an allergic reaction: hives; difficulty breathing; swelling in your face, lips, tongue, or throat
- Changes in vision including blurred vision and eye pain or swelling
- Rapid heart rate (tachycardia), fluttering chest sensations and breathlessness. If these occur suddenly it may feel like you are about to faint
- Hyponatremia (low sodium levels) can occur - symptoms include headache, confusion and slurred speech coupled with significant weakness and vomiting. Loss of coordination also signals this condition.
- Severe nervous system reactions such as muscle rigidity (stiffness), high fever, sweating profusely along with fast or uneven heartbeats that could manifest as tremors. Feeling light-headed enough to pass out is a clear signal.
An important thing to remember with both Fetzima and Cymbalta is the risk for serotonin syndrome – especially if taken with other serotonergic drugs. Symptoms range from agitation and hallucinations to a quickened heartbeat. Muscle stiffness may couple this along with shivering fits while digestive issues like nausea/vomiting/diarrhea might also occur simultaneously.
Such complications are rare but could potentially be life-threatening so immediate medical attention should be sought if they appear after starting on Fetzima therapy
What are the most common side effects for Cymbalta?
Cymbalta, similar to Fetzima, can have a range of side effects. Some of the most common ones include:
- Dry mouth
- Nausea, vomiting
- Diarrhea or constipation
- Loss of appetite and weight changes
- Drowsiness and fatigue
- Insomnia
- Increased sweating
- Blurred vision
- Headache or dizziness
It's important to note that some people may experience higher blood pressure, increased heart rate or liver problems with Cymbalta. In rare cases, it can cause confusion and unusual thoughts/behaviors. As always, any new symptoms should be reported to your healthcare provider immediately.
Are there any potential serious side effects for Cymbalta?
While Cymbalta is generally well-tolerated by patients, it's essential to be aware of potential serious side effects. These may include:
- Allergic reactions presenting as itching, hives, facial swelling or difficulty breathing
- Increased suicidal thoughts or tendencies
- Seizures or convulsions
- Confusion or significant mood swings
- Vision problems such as blurred vision, eye pain and swelling, seeing halos around lights
- Irregular heart rhythms
- Signs of serotonin syndrome: agitation, hallucinations (seeing things that aren't there), coordination problems, fast heartbeat, rapid changes in blood pressure, dizziness/sweating/flushing
If any of these symptoms occur while taking Cymbalta contact your healthcare provider immediately.
Contraindications for Fetzima and Cymbalta?
Both Fetzima and Cymbalta, like most other antidepressants, have the potential to exacerbate symptoms of depression in certain individuals. If you experience a worsening of your depressive state or an increase in suicidal thoughts or behavior while on either of these medications, it is crucial that you seek immediate medical attention.
Neither Fetzima nor Cymbalta should be taken if you are currently using or have recently stopped using monoamine oxidase (MAO) inhibitors. Always inform your healthcare provider about any and all medications you are taking; MAOIs require approximately 5 weeks to be eliminated from your system completely to prevent potentially harmful interactions with both Cymbalta and Fetzima.
How much do Fetzima and Cymbalta cost?
For the brand name versions of these drugs:
- The price for 30 capsules of Fetzima (20 mg) is about $465, working out to approximately $15.50/day.
- Meanwhile, the price for a similar quantity of Cymbalta (30mg) averages around $250, which works out to about $8.33/day.
Thus, if your prescribed dosage falls on the higher end for Fetzima (i.e., 120 mg/day), then Cymbalta would be less expensive on a per-day treatment basis. However, cost should not be the only factor guiding your decision between these two medications.
Turning our attention to generic versions:
-
Generic Fetzima (levomilnacipran) costs are significantly lower with approximate costs ranging from $0.80 to $2.40 per day for dosages of 20 mg/day and between $1.60 and nearly $5 per day if you take typical doses in range from 40 up to even over 120 mg/day.
-
Duloxetine --the active ingredient in Cymbalta-- comes in packs as small as seven capsules and as large as several hundred; prices start at just under a dollar per pill ($0.90–$1). This means that total daily costs can vary widely depending upon how many pills you take each day but will generally fall somewhere within range from about one buck ($1) up toward maybe three bucks or so ($3).
Remember that while generics are chemically identical to their branded counterparts and equally effective, individual patient response may vary due to factors such as tolerance or possible allergies towards specific components contained by different brands' formulations other than main active substances themselves - hence why it's always best discussing all aspects related with choosing medication together alongside your healthcare provider first before making final decisions based solely upon pricing alone!
Popularity of Fetzima and Cymbalta
Levomilnacipran, in generic form as well as under the brand name Fetzima, was prescribed to approximately 500 thousand individuals in the United States during 2020. Levomilnacipran made up around a quarter of a percent of antidepressant prescriptions that year. It is classified as a serotonin and norepinephrine reuptake inhibitor (SNRI), but its usage has been relatively steady since its introduction.
Duloxetine, including brand versions such as Cymbalta, was prescribed to about 8 million people in the USA during 2020. Duloxetine accounts for roughly 5% of SSNRI prescriptions and just over two percent of all antidepressant prescriptions across the country. The prescription rate for duloxetine has seen an overall increase over the past decade due to its effectiveness not only in treating depression and anxiety disorders but also chronic pain conditions like fibromyalgia and neuropathic pain associated with diabetes.
Conclusion
Both Fetzima (levomilnacipran) and Cymbalta (duloxetine) have solid records of usage in patients with depression as well as anxiety disorders, and are supported by a number of clinical studies indicating their effectiveness over placebo treatments. Occasionally, these drugs may be combined under careful physician supervision because they work on similar neurotransmitters but through slightly different mechanisms. While both medications act on serotonin and norepinephrine, the ratio is different: Fetzima has more effect on norepinephrine than serotonin whereas Cymbalta affects both nearly equally.
Fetzima can be considered when first-line SSRI or SNRI antidepressants aren't effective enough or if side effects become an issue. However, like other antidepressants initially there might not be any noticeable symptom changes until after several weeks of treatment initiation.
Cymbalta also comes in generic form (duloxetine), which represents significant cost savings especially for patients who must pay out of pocket while Fetzima remains available only as a brand-name medication.
The side effect profiles for both drugs are generally comparable, being generally well-tolerated but carrying risks such as headache, constipation and insomnia. In terms of sexual dysfunction often associated with SSRIs/SNRIs medications, some studies suggest that levomilnacipran may cause fewer sexual side effects compared to other antidepressants in this class like duloxetine.
As always it's critical for patients starting either drug to closely monitor their moods due to possible risk of worsening depression or emergence suicidal thoughts particularly during the initial phase or whenever there is a change in dosage. If noticed seek immediate medical attention.
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Refrences
- Frampton, J. E., & Plosker, G. L. (2007). Duloxetine. CNS Drugs. Springer Science and Business Media LLC.http://doi.org/10.2165/00023210-200721070-00004