Cymbalta vs. Effexor: The Best Replacements for Duloxetine

Last Updated: June 16, 2021

Authored by Sharon Levy, MD, MPH

Reviewed by Michael Espelin APRN

Cymbalta alternatives are enormously helpful to many people who don’t tolerate the drug well. While effectively fighting depression, pain, and anxiety, duloxetine hydrochloride has several negative health consequences that may urge patients to seek alternative solutions. Certain drugs similar to this antidepressant can prove to be equally effective in treating these mental illnesses in a way that is most suitable for a person.

This article will compare Effexor vs. Cymbalta and other drugs that can serve as alternatives to duloxetine.

Cymbalta vs. Effexor

Regarding alternatives to duloxetine, Effexor, known by its generic name of venlafaxine, is one of the best choices because it belongs to the same class of antidepressants. Both of these are serotonin and norepinephrine reuptake inhibitors, or SNRIs.

These antidepressants have their similarities, but they should not be considered as direct replacements for one another. The FDA indicates both drugs for the treatment of major depressive disorder and generalized anxiety disorder. However, putting Cymbalta vs. Effexor, the former can be used in treatment for a wider range of medical disorders. These include diabetic peripheral neuropathic pain, fibromyalgia, and chronic musculoskeletal pain. Effexor, on the other hand, can be used for social anxiety disorder and panic disorder.

Pharmacist explaining Cymbalta vs Effexor difference to patients.

With Effexor vs. Cymbalta in terms of adverse reactions, both of these drugs can cause a number of shared side effects, the most common being nausea, drowsiness, dry mouth (xerostomia), constipation, loss of appetite (anorexia), and sweating. However, Effexor differs as it is more likely to cause decreased libido, abnormal ejaculation, impotence, and insomnia.

Regarding the interactions seen with Cymbalta vs. Effexor and other drugs, they are both metabolized by the CYP2D6 isoenzyme. Duloxetine is also metabolized by CYP1A2 in addition to that. So it is important to avoid drugs that significantly inhibit or induce these enzymes, as they will modify their effect in the body.

These drugs should not be used together or paired with monoamine oxidase inhibitors (MAOIs) or serotonergic medications without a medical doctor’s permission, as the combination can lead to serotonin syndrome.

Regarding the potency of Cymbalta vs. Effexor, the former is more potent, as it is used at lower dosages to achieve its therapeutic effect. Still, the efficacy of both drugs is similar.

Cymbalta vs. Lexapro

For patients who worry about the long-term side effects of Cymbalta, Lexapro might be the right alternative drug. Its generic name is escitalopram, and it is a selective serotonin reuptake inhibitor (SSRI).

When considering Cymbalta vs. Lexapro, escitalopram has fewer FDA-approved indications: for treating major depressive disorder in adolescents and adults and generalized anxiety disorder in adults only. Contrarily, duloxetine is only approved for use in adults.

Woman's hand shows on the selected pill.

With drug interactions of Lexapro vs. Cymbalta, both drugs should not be combined with any medication that increases blood serotonin levels, such as other SSRIs, SNRIs, MAOIs, or other serotonergic drugs. It will increase the risk of serotonin syndrome occurring.

Both medications can have side effects when combined with drugs that impair blood clotting. Using either with medications like warfarin or NSAIDs can result in abnormal bleeding.

Regarding side effects of Cymbalta vs. Lexapro, escitalopram has less common adverse reactions than duloxetine. They are more common at higher doses, particularly those using 20mg a day. Insomnia and diarrhea are the most common side effects of escitalopram, and they do not occur regularly with duloxetine. The other common side effects include dry mouth, drowsiness, increased sweating, and constipation.

Information from a 2007 study showed that when considering the efficacy of Lexapro vs. Cymbalta, escitalopram was generally more effective in the treatment of major depressive disorder. It was also better tolerated due to the lower frequency of side effects.

Cymbalta vs. Prozac

Fluoxetine, sold under the brand name Prozac, is an SSRI. It is indicated for use in the treatment of major depressive disorder in ages above 8, obsessive-compulsive disorder (OCD) in ages above 7, and bulimia nervosa and panic disorder in adults. When combined with olanzapine, it can be used for depressive episodes and treatment-resistant depression. It can be seen that its indications differ quite significantly when looking at Cymbalta vs. Prozac.

You should give your doctor information on all drugs that you are currently using. Using these drugs together or with any medication that increases serotonin levels in the blood can increase the risk of serotonin syndrome occurring.

It Is Important For the Doctor to Know Whether the Patient Is on Any of the Following as Well, as Caution Is Required:

The side effects that Prozac can cause include impotence, abnormal ejaculation, decreased libido, tremors, abdominal pain, abnormal dreams, and insomnia. One peculiar side effect is yawning. The shared side effects that occur commonly include nausea, loss of appetite, drowsiness, and sweating.

In terms of the efficacy of Cymbalta vs. Prozac, information gained from a study showed that there was no difference in the effectiveness between these two drugs.

Zoloft vs. Cymbalta

Zoloft is the branded version of the drug sertraline, a selective serotonin reuptake inhibitor (SSRI). Major depressive disorder is the only indication that these two drugs share. Zoloft can also be used in the treatment of OCD, PTSD, panic disorder, social anxiety disorder, and premenstrual dysphoric disorder.

It is important to avoid using these drugs together or with other serotonergic medications as it can increase the risk of serotonin syndrome occurring. Like some of the other alternatives to Cymbalta, it shouldn’t be used with anticoagulants as that can increase the risk of bleeding. It can also result in cardiac symptoms, such as arrhythmias when it is used with pimozide.

A study done in 2016 provided information on the effectiveness of these two drugs compared to each other in the treatment of depression. There was found to be no statistically significant distinction in how these drugs treated the condition. However, they did seem to improve some symptoms better than the others did. For instance, slowed motion, somatic symptoms, and sexual side effects were better handled by duloxetine, while agitation and anxiety resolved more with Zoloft.

Other Alternatives to Cymbalta

Apart from the above drugs, which are considered mainstream substitutes for duloxetine, other alternatives to Cymbalta can be considered. However, their efficacy in treating the main indications for its use, such as depression and anxiety, may be in question.

Cymbalta vs. Lyrica

Lyrica can be the right choice for people who are looking for alternatives to Cymbalta for pain management. It is used to relieve pain caused by diabetes, fibromyalgia, and spinal cord injuries. Still, pregabalin adverse reactions can be more severe than those of duloxetine, and it is not recommended for patients with heart or kidney problems. In Lyrica versus Cymbalta comparison, Lyrica would also lose by being significantly more expensive than duloxetine.

Cymbalta vs. Wellbutrin

Switching from Cymbalta to Wellbutrin might be beneficial for patients who suffer from weight gain and Duloxetine sexual side effects. The stimulant properties of Wellbutrin can help with ADHD symptoms and depression. Duloxetine is an SNRI that affects serotonin in the brain, while Wellbutrin is a norepinephrine-dopamine reuptake inhibitor.

Man holding two pills in hand, is going to take them.

NDRIs are known to cause agitation, meaning that duloxetine is a better choice for people with anxiety and panic disorders. Wellbutrin is also more likely than duloxetine to cause seizures.

Cymbalta vs. Pristiq

Switching from duloxetine to Pristiq can help increase energy levels since desvenlafaxine is less sedating than most other antidepressants. It is also usually taken only once a day, while patients have to ingest Cymbalta twice a day.

The Primary Downsides of Pristiq as an Alternative to Duloxetine Are:

  • Its significant price
  • Extensive sexual side effects
  • A considerable amount of time between the initial intake of the drug and its first noticeable health effects

Cymbalta vs. Celexa

Celexa is an effective antidepressant that causes less drowsiness than duloxetine does. It is also cheaper than duloxetine, so patients who cannot afford the medication or have trouble obtaining Cymbalta coupons may consider switching to Celexa. At the same time, Celexa is not recommended to people with liver and heart problems. It can also cause minor weight gain.

Cymbalta vs. Paxil

Paxil works similarly to duloxetine and is suitable for the treatment of both depression and anxiety. It can be taken once a day, which makes it more convenient than duloxetine. The use of Paxil is not recommended for older patients and those who have dementia. It also presents more sexual side effects than duloxetine does.

Cymbalta vs. Gabapentin

Switching from this medication to Gabapentin only makes sense for patients who suffer from nerve pain related to diabetes and fibromyalgia. Unlike duloxetine, Gabapentin is not used to treat mental health disorders. Its downsides that duloxetine lacks include memory problems, drowsiness, and confusion. There is also a high risk of seizures if the use of Gabapentin stops abruptly.

Cymbalta vs. Savella

Savella is almost exclusively used for fibromyalgia treatment, and it can be a replacement for duloxetine when a person doesn’t tolerate the drug well. At the same time, Savella has an extremely narrow range of uses and is significantly more expensive than duloxetine.

Cymbalta vs. Trintellix

Switching from duloxetine to Trintellix may help with sexual adverse reactions and improve memory. The drug is exclusively used to treat depression and has fewer side effects than duloxetine has. The major downsides of Trintellix are persistent stomach issues and its price.

Female doctor hand holding a pack of different pills.

It is essential to be armed with the information that there are alternatives available for this drug. Still, a user should never change their medications without the express permission or awareness of their physician. A doctor is the only one who should prescribe an alternative to duloxetine, whether due to insufficient efficacy or adverse reactions. Self-medicating is dangerous, particularly with drugs that act in the CNS, as they can cause severe side effects and can be potentially fatal.

Natural Alternatives To Cymbalta For Fibromyalgia

Fibromyalgia is a condition associated with anxiety and depression, meaning that some of the best duloxetine substitutes will resemble the natural remedies suggested for these mental disorders. Sufficient exercise and sleep can reduce fatigue and anxiety.

A healthy, gluten-free diet can help manage the pain. It is also essential to identify other potentially inflammatory foods and exclude them from a person’s diet. If a patient doesn’t tolerate duloxetine well and does not respond to other fibromyalgia pain medicines, medical cannabis might be a solution as well.

Finally, many adverse health effects originate from the interaction of other drugs and certain foods with duloxetine. Therefore, another important form of alternative treatment is being aware of what not to take with Cymbalta. For instance, alcohol interacts with duloxetine and they act as a stimulant and depressant, respectively.

Medical Advice On Alternatives Use

Numerous Cymbalta alternative medications exist for people who don’t respond to duloxetine well. The most effective alternative antidepressants include Prozac and Zoloft. Patients suffering from nerve pain might benefit from Gabapentin, Savella, and Lyrica. Certain natural remedies such as regular exercise and a healthy diet might help with pain as well. It is vital to refrain from discontinuing the antidepressant without medical consultation. Individuals should always talk to a doctor or consult in the drug facility about any duloxetine side effects and potential alternative treatment.

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Published on: May 30th, 2019

Updated on: June 16th, 2021

About Author

Sharon Levy, MD, MPH

After successful graduation from Boston University, MA, Sharon gained a Master’s degree in Public Health. Since then, Sharon devoted herself entirely to the medical niche. Sharon Levy is also a certified addiction recovery coach.

Medically Reviewed by

Michael Espelin APRN

8 years of nursing experience in wide variety of behavioral and addition settings that include adult inpatient and outpatient mental health services with substance use disorders, and geriatric long-term care and hospice care.  He has a particular interest in psychopharmacology, nutritional psychiatry, and alternative treatment options involving particular vitamins, dietary supplements, and administering auricular acupuncture.