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Drug overview & main differences | Conditions treated | Efficacy | Insurance coverage and cost comparison | Side effects | Drug interactions | Warnings | FAQ
Cymbalta (duloxetine) and Effexor (venlafaxine) are brand-name medications used to treat psychiatric conditions such as depression and anxiety. They are usually prescribed as antidepressants to help relieve the symptoms of major depressive disorder. Symptoms of major depressive disorder may include persistent sadness and a severe loss of interest in daily activities.
Cymbalta and Effexor both belong to a class of drugs called serotonin and norepinephrine reuptake inhibitors (SNRIs). They work by increasing the availability of serotonin and norepinephrine in the brain. These chemicals, or neurotransmitters, are believed to play a role in the occurrence of mental health disorders.
For the purposes of this comparison, the name Effexor may also refer to Effexor XR, the only brand-name Effexor currently available on the market.
What are the main differences between Cymbalta and Effexor?
Cymbalta
Cymbalta is the brand name for duloxetine. It is available as an oral delayed-release capsule with strengths of 20 mg, 30 mg, or 60 mg. It is usually dosed as one capsule by mouth once daily depending on the condition being treated. The maximum dose per day is 120 mg although there is no evidence that doses greater than 60 mg provide a significant increase in benefit.
Cymbalta has a half-life of around 12 hours. It is primarily metabolized and eliminated through the liver and kidneys. Its use should be avoided in those with severe liver or kidney impairment.
Effexor
Effexor is the brand name for venlafaxine. However, brand-name Effexor is only available as Effexor XR, or venlafaxine extended-release tablets. Immediate-release Effexor was discontinued because it needs to be dosed multiple times throughout the day and causes more nausea than the extended-release version.
Effexor XR comes in oral capsules with strengths of 37.5 mg, 75 mg, and 150 mg. Dosing may vary depending on the condition being treated. However, Effexor XR is usually taken once daily with a target daily dose of 75 mg and a maximum daily dose of 225 mg.
Like Cymbalta, Effexor is metabolized in the liver and has a total half-life of up to 11 hours. It can be used in those with liver or kidney impairment if lower doses are taken.
| Main differences between Cymbalta and Effexor | ||
|---|---|---|
| Cymbalta | Effexor | |
| Drug class | Serotonin and norepinephrine reuptake inhibitor (SNRI) | Serotonin and norepinephrine reuptake inhibitor (SNRI) |
| Brand/generic status | Brand and generic version available | Brand and generic version available |
| What is the generic name? | Duloxetine | Venlafaxine |
| What form(s) does the drug come in? | Oral capsule, extended-release | Oral capsule, extended-release |
| What is the standard dosage? | 60 mg once daily | 75 mg once daily |
| How long is the typical treatment? | Long-term | Long-term |
| Who typically uses the medication? | Adults and adolescents | Adults and adolescents |
Conditions treated by Cymbalta and Effexor
Cymbalta is FDA approved to treat major depressive disorder (MDD) and generalized anxiety disorder (GAD). It can also be used to treat pain from fibromyalgia and diabetic neuropathy, as well as general pain in the muscles, tendons, ligaments, and bones. Cymbalta may sometimes be used off-label for other anxiety disorders.
Effexor XR is FDA approved to treat major depressive disorder (MDD), generalized anxiety disorder (GAD), social anxiety disorder (SAD), and panic disorder (PD). It is also sometimes used off-label to treat obsessive-compulsive disorder (OCD), premenstrual dysphoric disorder (PMDD), and pain.
| Condition | Cymbalta | Effexor |
| Major depressive disorder | Yes | Yes |
| Generalized anxiety disorder | Yes | Yes |
| Social anxiety disorder | Off-label | Yes |
| Panic disorder | Off-label | Yes |
| Diabetic peripheral neuropathic pain | Yes | Off-label |
| Fibromyalgia | Yes | Off-label |
| Chronic musculoskeletal pain | Yes | Off-label |
| Obsessive-compulsive disorder | No | Off-label |
| Premenstrual dysphoric disorder | No | Off-label |
Is Cymbalta or Effexor more effective?
The effectiveness of Cymbalta or Effexor depends on the condition being treated. Very few studies have directly compared Cymbalta and Effexor. However, when compared to placebo, Cymbalta and Effexor are both more effective for treating conditions like major depression.
One study pooled several clinical trials and found that venlafaxine is a better short-term treatment option for major depression than duloxetine. Venlafaxine, the active ingredient of Effexor, may also be preferred for those who don’t respond well to initial treatment with selective serotonin reuptake inhibitors (SSRIs) or tricyclic antidepressants (TCAs). However, the study found that there were no significant differences in response and response rate between duloxetine and venlafaxine.
Another systematic review compared venlafaxine, duloxetine, and other antidepressants like paroxetine, fluoxetine, and fluvoxamine. Compared to the other options, venlafaxine was found to be one of the more effective antidepressants. However, both venlafaxine and duloxetine were ranked as some of the least tolerable antidepressants, regarding side effects.
Consult a healthcare provider who specializes in psychiatry for the best treatment option for you.
Coverage and cost comparison of Cymbalta vs. Effexor
Cymbalta is a brand-name prescription drug used for depression. The generic version, duloxetine, is usually covered by Medicare and insurance plans. For a 30-day supply, the average retail price can more than $470. With a SingleCare Cymbalta coupon, the price for the generic version starts at $15 at participating pharmacies.
Effexor XR tablets are available for purchase with a prescription. Generic Effexor XR tablets are often covered by Medicare and insurance plans. With an average price of around $145, Effexor XR is cheaper than Cymbalta. However, using an Effexor XR coupon from SingleCare can bring the cost down even further. Ask your pharmacist for the generic and get it for approximately $15.
| Cymbalta | Effexor | |
| Typically covered by insurance? | Yes | Yes |
| Typically covered by Medicare Part D? | Yes | Yes |
| Quantity | 30 tablets | 30 tablets |
| Typical Medicare copay | $0–$89 | $0–$1 |
| SingleCare cost | $15+ | $15+ |
Common side effects of Cymbalta vs. Effexor
The most common side effects of Cymbalta include nausea, headache, dry mouth, somnolence or drowsiness, constipation, and fatigue. Cymbalta may also cause diarrhea, decreased appetite, increased sweating, and abdominal pain, among other side effects.
The most common side effects of Effexor are nausea, headache, dry mouth, weakness, and somnolence. Effexor may also cause insomnia, constipation, dizziness, diarrhea, and decreased appetite.
Both Cymbalta and Effexor can also cause decreased sex drive (libido). However, Effexor has been shown to cause more sexual dysfunction problems than Cymbalta.
See the table below for other common side effects of Cymbalta and Effexor.
| Cymbalta | Effexor | |||
| Side effect | Applicable? | Frequency | Applicable? | Frequency |
| Nausea | Yes | 23% | Yes | 4% |
| Headache | Yes | 14% | Yes | 2% |
| Dry mouth | Yes | 13% | Yes | 15% |
| Somnolence | Yes | 10% | Yes | 2% |
| Weakness | No | – | Yes | 2% |
| Fatigue | Yes | 9% | No | – |
| Insomnia | Yes | 9% | Yes | 2% |
| Constipation | Yes | 9% | Yes | 9% |
| Dizziness | Yes | 9% | Yes | 16% |
| Diarrhea | Yes | 9% | Yes | 8% |
| Decreased appetite | Yes | 7% | Yes | * |
| Increased sweating | Yes | 6% | Yes | 1% |
| Abdominal pain | Yes | 5% | Yes | * |
| Decreased libido | Yes | 3% | Yes | 5% |
| Abnormal vision | Yes | 3% | Yes | 4% |
| Heart palpitations | Yes | 2% | Yes | 2% |
*not reported
Frequency is not based on data from a head-to-head trial. This may not be a complete list of adverse effects that can occur. Please refer to your doctor or healthcare provider to learn more.
Source: DailyMed (Cymbalta), DailyMed (Effexor)
Drug interactions of Cymbalta vs. Effexor
Cymbalta and Effexor should not be used with monoamine oxidase inhibitors (MAOIs) such as selegiline and phenelzine. Cymbalta or Effexor should not be used within 14 days of discontinuing an MAOI. Otherwise, there is an increased risk of serotonin syndrome, a severe condition that may require emergency medical attention.
There may also be a risk of serotonin syndrome when Cymbalta or Effexor is taken alongside another serotonergic drug. Serotonergic drugs include selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs). Caution should be used when using serotonergic drugs with Cymbalta or Effexor.
Drugs like paroxetine or fluoxetine can interfere with the metabolism of Cymbalta and increase its blood levels. This could lead to an increased risk of serious side effects with Cymbalta.
Cymbalta and Effexor should be used with caution or avoided with nonsteroidal anti-inflammatory drugs (NSAIDs) and anticoagulants. Using these drugs together can increase the risk of bleeding.
| Drug | Drug class | Cymbalta | Effexor |
| Selegiline Phenelzine Rasagiline |
Monoamine oxidase inhibitors (MAOIs) | Yes | Yes |
| Paroxetine Sertraline Fluoxetine |
Selective serotonin reuptake inhibitors (SSRIs) | Yes | Yes |
| Amitriptyline Clomipramine Nortriptyline |
Tricyclic antidepressants (TCAs) | Yes | Yes |
| Aspirin Ibuprofen Naproxen Diclofenac |
Nonsteroidal anti-inflammatory drugs (NSAIDs) | Yes | Yes |
| Warfarin | Anticoagulants | Yes | Yes |
Consult a healthcare professional for other possible drug interactions
Warnings of Cymbalta and Effexor
Liver failure has been reported with the use of Cymbalta. In those with a history of alcohol abuse or liver dysfunction, Cymbalta should be avoided. The use of Cymbalta should be discontinued in those who develop signs of liver failure, such as jaundice.
The use of Cymbalta or Effexor carries a risk of serotonin syndrome, which occurs when there is an excess of serotonin in the brain. Symptoms of serotonin syndrome may include fast heart rate, increased blood pressure, sweating, tremors, and fever.
Cymbalta and Effexor can cause an increase in blood pressure. Those with a history of high blood pressure should be monitored while on treatment with Cymbalta or Effexor.
Cymbalta and Effexor should be used with caution in those with a history of bipolar disorder or seizures. These antidepressants may activate mania, hypomania, or seizures in some people.
Consult a healthcare provider for other possible warnings and precautions with Cymbalta and Effexor.
Frequently asked questions about Cymbalta vs. Effexor
What is Cymbalta?
Cymbalta is the brand name of duloxetine. It is used for the treatment of major depression and anxiety disorders. It is also used to treat pain from diabetic neuropathy and fibromyalgia. Cymbalta is available in extended-release capsules in strengths of 20 mg, 30 mg, or 60 mg.
What is Effexor?
Effexor is the brand name of venlafaxine. It is used for the treatment of major depressive disorder, generalized anxiety disorder, social anxiety disorder, and panic disorder. Regular Effexor has been discontinued; however, Effexor XR tablets are available in strengths of 37.5 mg, 75 mg, and 150 mg.
Are Cymbalta and Effexor the same?
Cymbalta and Effexor are both serotonin and norepinephrine reuptake inhibitors (SNRIs). But they are not the same drug. In addition to treating major depression and anxiety, Cymbalta is also FDA approved to treat certain types of nerve pain. On the other hand, Effexor is FDA approved to treat panic attacks and social anxiety.
Is Cymbalta or Effexor better?
The better antidepressant depends on the condition being treated and other medications a person may be taking. Venlafaxine may be a more effective short-term treatment option for depression. However, it may have a lower tolerability than Cymbalta in terms of side effects, such as sexual dysfunction.
Can I use Cymbalta or Effexor while pregnant?
No conclusive studies have shown that Cymbalta or Effexor may be safe during pregnancy. An antidepressant should only be used during pregnancy if the benefits outweigh the potential risks. In some cases, Cymbalta or Effexor may need to be used to control symptoms of depression during pregnancy. Consult a healthcare provider for medical advice before using Cymbalta or Effexor while pregnant.
Can I use Cymbalta or Effexor with alcohol?
Alcohol in moderation is likely safe while taking Cymbalta or Effexor. However, drinking alcohol while starting treatment with Cymbalta or Effexor may lead to increased dizziness or drowsiness. It may be advised to discontinue drinking alcohol until it has been a few days after starting treatment.
Does Effexor affect memory?
There is no evidence that Effexor directly affects memory. Effexor XR has been known to cause hyponatremia, or low sodium levels in the blood, especially if diuretics are also being taken. Signs and symptoms of hyponatremia include headache, confusion, and memory impairment. Your doctor may recommend stopping Effexor XR until the hyponatremia resolves.
What is a good alternative to Cymbalta?
Cymbalta is a selective serotonin and norepinephrine reuptake inhibitor (SNRI). Other SNRIs include Effexor (venlafaxine), Pristiq (desvenlafaxine), and Savella (milnacipran). Talk to a healthcare provider about potential antidepressant treatment options for you.
How bad is Effexor withdrawal?
The dose of Effexor should be slowly tapered to help prevent serious withdrawal symptoms. Abrupt discontinuation of Effexor can lead to symptoms like nausea, dizziness, vomiting, nightmares, irritability, and headaches. Effexor withdrawal symptoms may also include paresthesias, or tingling sensations on the skin.
