Compare Cymbalta vs. Wellbutrin Side Effects, Uses and Dosage
Cymbalt vs. Wellbutrin quick comparison of differences
What is Cymbalta? What is Wellbutrin? How do they work?
Cymbalta (duloxetine) is a selective serotonin and norepinephrine reuptake inhibitor (SNRI) antidepressant used for treating depression, anxiety disorders, and pain. Other SNRIs include milnacipran (Savella), venlafaxine (Effexor), and desvenlafaxine (Pristiq).
Cymbalta prevents the reuptake of the neurotransmitters serotonin and epinephrine by nerves after they have been released, thereby increasing the effect of serotonin and norepinephrine in the brain.
Wellbutrin (bupropion) is an antidepressant used for treatingmajor depression and SAD (seasonal affective disorder). Off-label uses for Wellbutrin include post-traumatic stress syndrome (PTSD), attention deficit hyperactivity disorder (ADHD), anxiety, social phobia, and neuropathic pain.
Wellbutrin works by inhibiting the reuptake of the neurotransmitters dopamine, serotonin, and norepinephrine. This results in more of these chemicals available to transmit messages to other nerves. Wellbutrin is unlike other antidepressants in that its major effect is on dopamine, an effect not shared by the selective serotonin reuptake inhibitors (SSRIs) or the tricyclic antidepressants (TCAs).
What are the uses for Cymbalta vs. Wellbutrin?
What are the side effects of Cymbalta vs. Wellbutrin?
Cymbalta side effects
The most common side effects of duloxetine are
Increased blood pressure can occur and should be monitored. Seizures have been reported. Sexual dysfunction (decreased sex drive and delayed orgasm and ejaculation) has been associated with duloxetine.
Some patients may experience withdrawal reactions upon stopping duloxetine. Symptoms of withdrawal include:
The dose of duloxetine should be gradually reduced when therapy is discontinued to prevent symptoms of withdrawal.
Antidepressants increased the risk of suicidal thinking and behavior (suicidality) in short-term studies in children and adolescents with depression and other psychiatric disorders. Anyone considering the use of duloxetine or any other antidepressant in a child or adolescent must balance this risk with the clinical need. Patients who are started on therapy should be closely observed for clinical worsening, suicidality, or unusual changes in behavior.
Wellbutrin side effects
Warning: Four of every 1000 persons who receive bupropion in doses less than 450 mg/day experience seizures. When doses exceed 450 mg/day, the risk increases ten-fold. Other risk factors for seizures include past injury to the head and medications that can lower the threshold for seizures. (See drug interactions.)
Antidepressants increased the risk of suicidal thinking and behavior (suicidality) in short-term studies in children and adolescents with depression and other psychiatric disorders. Anyone considering the use of bupropion or any other antidepressant in a child or adolescent must balance this risk with the clinical need. Patients who are started on therapy should be closely observed for clinical worsening, suicidality, or unusual changes in behavior.
The most common side effects associated with bupropion include:
In some people, the agitation or insomnia is most marked shortly after starting therapy.
Less common side effects include:
What drugs interact with Cymbalta vs. Wellbutrin?
Cymbalta drug interactions
- Duloxetine should not be used in combination with a monoamine oxidase inhibitor (MAOI) such as phenelzine (Nardil), tranylcypromine (Parnate), isocarboxazid (Marplan), and selegiline (Eldepryl), or within 14 days of discontinuing the MAOI. At least 5 days should be allowed after stopping duloxetine before starting an MAOI. Combinations of SNRIs and MAOIs may lead to serious, sometimes fatal, reactions including very high body temperature, muscle rigidity, rapid fluctuations of heart rate and blood pressure, extreme agitation progressing to delirium, and coma. Similar reactions may occur if duloxetine is combined with antipsychotics, tricyclic antidepressants or other drugs that affect serotonin in the brain. Examples include tryptophan, sumatriptan (Imitrex), lithium, linezolid (Zyvox), tramadol (Ultram), and St. John’s Wort.
- Fluoxetine (Prozac, Serafem), paroxetine (Paxil, Paxil CR, Pexeva), fluvoxamine (Luvox), and quinidine increase blood levels of duloxetine by reducing its metabolism in the liver. Such combinations may increase adverse effects of duloxetine.
- Combining duloxetine with aspirin, nonsteroidal antiinflammatory drugs (NSAIDs), warfarin (Coumadin) or other drugs that are associated with bleeding may increase the risk of bleeding, because duloxetine itself is associated with bleeding.
- Duloxetine has an enteric coating that prevents dissolution until it reaches a segment of the gastrointestinal that has a pH higher than 5.5. In theory, drugs that raise the pH in the gastrointestinal system (for example, Prilosec) may cause duloxetine to be released early while conditions that slow gastric empyting (for example, diabetes) may cause premature breakdown of duloxetine. Nevertheless, administration of duloxetine with an antacid or famotidine (Axid) did not significantly affect the absorption of duloxetine.
- Duloxetine may reduce the breakdown of desipramine (Norpramine), leading to increased blood concentrations of desipramine and potential side effects.
Wellbutrin drug interactions
- Bupropion should be used cautiously in patients receiving drugs that reduce the threshold for seizures. Such drugs include prochlorperazine (Compazine), chlorpromazine (Thorazine), and other antipsychotic medications of the phenothiazine class. Additionally, persons who are withdrawing from benzodiazepines [for example, diazepam (Valium), alprazolam (Xanax)] are at increased risk for seizures.
- Carbamazepine (Tegretol) may reduce the effect of bupropion by reducing the blood concentration of bupropion. Monamine oxidase inhibitors should not be combined with bupropion because of the risk of severe reactions. At least 14 days should elapse between discontinuation of an MAOI and initiation of bupropion. Bupropion may affect the action of warfarin (Coumadin).
- Ritonavir (Norvir) may increase the breakdown and elimination of bupropion. In some studies ritonavir reduced the concentration of bupropion in the body by 22% to 66%.
Are Cymbalta and Wellbutrin safe to take if I am pregnant or breastfeeding?
- Duloxetine is excreted into the milk of lactating women. Because the safety of duloxetine in infants is not known, breastfeeding while on duloxetine is not recommended.
- There are no adequate studies of bupropion in pregnant women. In one study, there was no difference between bupropion and other antidepressants in the occurrence of birth defects. Bupropion should only be used in pregnancy if the benefit outweighs the potential risk.
- Bupropion is secreted in breast milk.
REFERENCE: FDA Prescribing Information
Reviewed on 12/12/2017
REFERENCE: FDA Prescribing Information
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