Fetzima vs Cymbalta – Comparison of Side Effects  & Uses

Fetzima

It is the brand name of a drug called levomilnacipran, which belongs to a group of drugs called serotonin-norepinephrine reuptake inhibitors (SNRIs).

Mechanism of Action

It works by increasing norepinephrine and serotonin levels in the brain to improve mood and maintain mental balance.

Uses

This prescription medication used to treat depression, a serious mental illness.

According to the DSM-5, you have depression when you have 5 or more of these symptoms for at least 14 days:

  • you have lost or gained weight;
  • you feel restless or slowed down;
  • a depressed mood during most of the day;
  • you think often about death or suicide;
  • you feel tired or have a lack of energy almost every day;
  • you have almost no interest in many activities nearly every day;
  • you sleep too much almost every day;
  • you have a hard time focusing;
  • you feel worthless.

Dosage

For depression, the usual initial recommended dose is 20 mg orally once per day for 2 days. After the initial treatment, the dosage is increased to 40 mg orally once per day.

The maintenance dosage is 40 to 120 mg orally once per day.

Note – do not give this medicine to anyone younger than 18 years old without the advice of a doctor.

Side Effects

Common side effects may include:

  • fast heart rate;
  • constipation;
  • increased sweating;
  • vomiting;
  • difficulty having an orgasm;
  • vision changes;
  • decreased sex drive;
  • nausea.

Rare side effects may include:

  • purple or red pinpoint spots under your skin;
  • seeing halos around lights;
  • fluttering in your chest;
  • eye pain or swelling;
  • shallow breathing;
  • tunnel vision;
  • pounding heartbeats;
  • blurred vision;
  • feeling unsteady;
  • painful urination;
  • loss of coordination;
  • seizure (convulsions);
  • severe weakness;
  • unusual bleeding (nose, mouth, vagina, or rectum);
  • slurred speech.
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Precautions

Before taking this serotonin-norepinephrine reuptake inhibitor, tell your healthcare provider if you have:

  • low levels of sodium in your blood;
  • heart rhythm disorder;
  • if you use migraine headache medicine;
  • high blood pressure;
  • if you drink large amounts of alcohol;
  • take a diuretic;
  • heart disease;
  • bladder obstruction;
  • kidney disease;
  • a blood clotting disorder such as hemophilia;
  • seizures or epilepsy;
  • narrow-angle glaucoma;
  • bipolar disorder (manic depression).

Alcoholalcohol

Avoid drinking alcoholic beverages while taking this serotonin-norepinephrine reuptake inhibitor since alcohol use can substantially increase the risk of side effects.

Drug Interactions

It may negatively interact with other medications, especially:

  • Cymbalta (duloxetine);
  • Abilify (aripiprazole);
  • Seroquel (quetiapine);
  • Adderall (amphetamine/dextroamphetamine);
  • trazodone;
  • Aleve (naproxen);
  • Zoloft (sertraline);
  • aspirin;
  • Wellbutrin (bupropion);
  • bupropion;
  • Vyvanse (lisdexamfetamine);
  • BuSpar (buspirone);
  • tramadol;
  • Ibuprofen;
  • Prozac (fluoxetine);
  • Lexapro (escitalopram).

Pregnancy & Breastfeeding

It is not known whether this serotonin-norepinephrine reuptake inhibitor passes into breast milk or if it could harm a nursing infant. Do not breast-feed while using this medicine.

It is not known whether this medication will harm a developing fetus. Tell your doctor if you are pregnant before using this serotonin-norepinephrine reuptake inhibitor.

Cymbalta

It is the brand name of a medication called duloxetine, that is part of a family of medications known as selective serotonin and norepinephrine reuptake inhibitors.

Uses

This prescription medication is used to treat generalized anxiety disorder, osteoarthritis pain, the major depressive disorder, and painful peripheral neuropathy.

Mechanism of Action

It works by changing the balance of norepinephrine and serotonin in the brain to improve mood and maintain mental balance.

Pregnancy & Breastfeedingpregnant

This selective serotonin and norepinephrine reuptake inhibitor is known to pass into breast milk and its effects on the breastfed infant are unknown.

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There are no studies to determine whether this selective serotonin and norepinephrine reuptake inhibitor is safe to use during pregnancy. Tell your doctor that you are pregnant before using this medication.

Alcohol

Avoid drinking alcoholic beverages while taking this selective serotonin and norepinephrine reuptake inhibitor since alcohol use can increase the risk of side effects.

Dosage

Important note – it may take 1 week to 1 month or even longer before you feel the full benefits of this medication.

For depression, the usual recommended dosage is 60 mg once a day. The maximum recommended dosage is 120 mg per day.

Side Effects and Precautions

Common side effects may include:

  • sleepiness;
  • increased blood pressure;
  • constipation;
  • sexual dysfunction (delayed ejaculation and orgasm and decreased sex drive);
  • seizures;
  • fatigue;
  • dizziness;
  • dry mouth;
  • nausea;
  • difficulty sleeping.

Less common side effects may include:

  • tremor;
  • irregular heart rhythm;
  • rash;
  • decreased appetite;
  • hives;
  • bleeding problems;
  • hot flashes;
  • diarrhea;
  • suicidal thoughts;
  • pneumonia;
  • glaucoma (an eye disorder which causes damage to the optic nerve);
  • liver damage;
  • vomiting.

Drug Interactions

It may negatively interact with other medications, especially:

  • antibiotics, such as – enoxacin or ciprofloxacin (Cipro);
  • diuretics (water pills);
  • prescription pain medications, such as – fentanyl (Abstral);
  • monoamine oxidase inhibitors, like – linezolid or isocarboxazid (Marplan);
  • drugs used to treat mental illness, such as – lithium or Paxil;
  • durezol;
  • medications used to treat heartburn, like – lansoprazole or cimetidine (Tagamet);
  • heart and blood pressure medications, such as – amiodarone (Cordarone);
  • blood thinners, like – warfarin (Coumadin);
  • OTC pain medications, such as – ibuprofen or naproxen (Aleve);
  • other antidepressants, such as – clomipramine (Anafranil), Xanax, and fluoxetine (Prozac);
  • medications used to treat migraines, like – eletriptan or almotriptan (Axert).
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Bottom Line – Fetzima vs Cymbalta

Fetzima (active ingredient – levomilnacipran) is a selective serotonin and norepinephrine reuptake inhibitor antidepressant that affects chemicals in the brain which may be unbalanced in patients with depression.

Cymbalta (active ingredient – duloxetine) is a selective serotonin and norepinephrine reuptake inhibitor antidepressant which affects chemicals in the brain which may be unbalanced in patients with depression.

In conclusion, both medications are used to treat depression and are part of the same class of drugs. Both have a similar mechanims of action. Both have plenty of side effects.

Regarding their price, the average retail price for 30 capsules of Fetzima 80mg is $360, while the average retail price for 30 capsules of Cymbalta 20mg is $210.

References

https://www.ncbi.nlm.nih.gov/pubmed/25345508
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5265686/
https://www.ncbi.nlm.nih.gov/pubmed/27536449

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