What is the difference between Cymbalta (duloxetine) vs. Effexor XR (venlafaxine)?
- Cymbalta (duloxetine) and Effexor XR (venlafaxine) are selective serotonin and norepinephrine reuptake inhibitor (SNRI) antidepressants used for treating depression and anxiety disorders.
- Cymbalta also is used for the treatment of diabetic peripheral neuropathic pain, fibromyalgia, and chronic musculoskeletal pain.
- Cymbalta and Effexor XR have similar side effects, for example:
- Anxiety
- Nausea
- Dry mouth
- Difficulty sleeping (insomnia)
- Dizziness
- Increased blood pressure
- Seizures
- Headaches
- Sexual dysfunction (decreased sex drive or erectile dysfunction)
- Side effects of Cymbalta that do not occur with Effexor XR include:
- Side effects of Effexor XR that are different from Cymbalta include:
- Drowsiness
- Loss of appetite
- Sweating
- Weight loss
- If you stop taking Cymbalta or Effexor XR suddenly (abruptly) you may have withdrawal symptoms, which may include:
- Cymbalta (duloxetine) is the generic name for Cymbalta. Effexor XR is the brand name available in the US. The brand Effexor is no longer available.
What is Cymbalta? What is Effexor XR? How do they work?
Cymbalta (duloxetine) and Effexor XR (venlafaxine) are selective serotonin and norepinephrine reuptake inhibitor (SNRI) antidepressants. Cymbalta and Effexor XR are both used for the treatment of pain and major depressive and anxiety disorders (for example, general anxiety, panic, and social disorders). Cymbalta also treats diabetic peripheral neuropathy, fibromyalgia, and chronic musculoskeletal pain. Other SNRIs include milnacipran (Savella) and desvenlafaxine (Pristiq).
Cymbalta prevents 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. Effexor XR works in the same way as Cymbalta; however, it prevents the reuptake of the neurotransmitters serotonin and norepinephrine.
What are the uses for Cymbalta vs. Effexor XR?
Cymbalta (duloxetine) uses
Cymbalta is used for the treatment of:
- Depression
- Generalized anxiety disorder
- Diabetic peripheral neuropathy pain
- Fibromyalgia
- Chronic musculoskeletal pain
Effexor XR (venlafaxine) uses
Effexor XR is used for the treatment of depression, depression with associated symptoms of anxiety, generalized anxiety disorder, and social anxiety disorder; and for the treatment of adults with panic disorder.
What are the side effects of Cymbalta and Effexor XR?
Cymbalta (duloxetine) side effects
WARNING
Suicidal Thoughts and Behaviors in Children, Adolescents, and Young Adults
- Patients with major depressive disorder (MDD), both adult and pediatric, may experience worsening of their depression and/or the emergence of suicidal ideation and behavior (suicidality) or unusual changes in behavior, whether or not they are taking antidepressant medications, and this risk may persist until significant remission occurs.
- Suicide is a known risk of depression and certain other psychiatric disorders, and these disorders themselves are the strongest predictors of suicide.
- There has been a long-standing concern, however, that antidepressants may have a role in inducing worsening of depression and the emergence of suicidality in certain patients during the early phases of treatment.
The most common side effects of duloxetine include:
Effexor XR (venlafaxine) side effects
Effexor XR, like most antidepressants, can cause:
- Nausea
- Headaches
- Anxiety
- Insomnia
- Loss of appetite
- Other side effects that can occur are
- Dizziness
- Ejaculation disorder (erectile dysfunction, impotence)
- Sweating
- Dry mouth
- Weight loss
Cymbalta and Effexor XR serious side effects
- Sexual dysfunction (decreased sex drive and delayed orgasm and ejaculation)
- Seizures
- An increase in blood pressure, blood pressure should be monitored.
- Antidepressants increased the risk of suicidal thinking and behavior (suicidality) in short-term studies in children, adolescents, and young adults with depression and other psychiatric disorders. Anyone considering the use of venlafaxine 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.
What are the withdrawal symptoms of Cymbalta and Effexor XR?
Cymbalta, Effexor XR, and any other antidepressants can cause withdrawal symptoms if they are stopped suddenly (abruptly) without gradually reducing the dosage. Withdrawal symptoms may occur even if a few doses are missed. Withdrawal symptoms include:
- Dizziness
- Headache
- Nausea
- Changes in mood
- Changes in the sense of smell and taste

SLIDESHOW
Learn to Spot Depression: Symptoms, Warning Signs, Medication See SlideshowWhat is the dosage of Cymbalta vs. Effexor XR?
Cymbalta dosage
- The recommended dose for treating depression is 20 or 30 mg twice daily or 60 mg once daily. Patients may be started with 30 mg once daily for one week before increasing the dose to 60 mg daily because it may help patients adjust to the drug.
- The recommended dose is 60 mg daily for anxiety disorder, pain associated with diabetic neuropathy, fibromyalgia, or chronic musculoskeletal pain.
- There is no evidence that doses greater than 60 mg/day provide additional benefits. However, the maximum dose for depression or anxiety disorder is 120 mg/day.
Effexor XR dosage
Venlafaxine should be taken with food at doses specifically directed by a doctor since individual doses can vary greatly.
- The antidepressant effects are not maximal for 1-2 weeks. The dose of Effexor XR gradually should be reduced under the direction of a doctor to avoid withdrawal symptoms.
- For people with difficulty swallowing tablets or capsules, Effexor XR capsules can be opened and the contents sprinkled onto a spoonful of applesauce or other food; however, removing the capsule contents will immediately release of the drug, so it is no longer extended release.
- The dose for treatment of depression using the immediate release formulation is 75 to 375 mg daily divided in 2 or 3 doses and given every 8 or 12 hours. The extended release dose is 37.5 mg to 225 mg once daily. Dosing is usually begun with low initial concentrations and adjusted as needed by the treating doctor.
- Generalized anxiety and panic disorder are treated with 37.5 mg to 225 mg once daily using the extended release formulation.
- Social anxiety is treated with 75 mg daily using the extended release formulation.
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What are the drug interactions of Cymbalta vs. Effexor XR?
Cymbalta (duloxetine) 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, Sarafem), 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 anti-inflammatory 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 emptying (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 (Norpramin), leading to increased blood concentrations of desipramine and potential side effects.
Effexor XR (venlafaxine) drug interactions
- Venlafaxine 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 venlafaxine 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 venlafaxine 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.
- Combining venlafaxine with aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), warfarin (Coumadin) or other drugs that are associated with bleeding may increase the risk of bleeding, because venlafaxine is associated with bleeding.
- Most medications affecting the brain such as venlafaxine have the potential to slow reflexes or impair judgment. Therefore, caution is advised especially early in the course of treatment.
- Safety has not been established in children below the age of 18 years.
Are Cymbalta or Effexor XR safe to take if I am pregnant or breastfeeding?
Cymbalta safety
- 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.
Effexor XR safety
- The effects of venlafaxine on the fetus during pregnancy are unknown.
- It is not known if venlafaxine is secreted in breast milk, and therefore, if it may have an effect on nursing infants.
Summary
Cymbalta, brand name duloxetine, and Effexor XR brand name venlafaxine (Effexor has been discontinued) are antidepressants belonging to a drug class called selective serotonin and norepinephrine reuptake inhibitors (SNRIs). Cymbalta and Effexor XR are used for the treatment of chronic depression, anxiety disorders (for example, general or social), and pain. Cymbalta also treats fibromyalgia, and musculoskeletal or diabetic neuropathy (nerve pain). Similar side effects of Cymbalta and Effexor include headaches, insomnia, anxiety, nausea, and dry mouth.
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Pain Management: Neuropathic Pain
Neuropathic pain is chronic pain resulting from injury to the nervous system. The injury can be to the central nervous system (brain and spinal cord) or the peripheral nervous system (nerves outside the brain and spinal cord).
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What Is the Best Treatment for Anxiety?
The best treatment for anxiety is typically a combination of psychotherapy and medication. However, lifestyle modifications can also help manage symptoms.
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Is Depression a Medically Treatable Disorder?
Depression is a medically treatable disorder because it is caused by chemical imbalances in the brain. Learn about treatment options.
Treatment & Diagnosis
- Anxiety
- Depression
- Postpartum Depression: Behind the Smile
- Illness Anxiety Disorder (Hypochondria)
- Postpartum Depression
- Generalized Anxiety Disorder
- Anxiety Treatment with Virtual Reality Exposure
- Teen Depression
- Depression
- Anxiety, Panic, and Phobias: Seeking Help
- Depression Drug Warning: Signs of Suicide
- Depression: Beating the Holiday Blues
- Anxiety: Facing Fear and Anxiety -- Jonathan Davidson, MD
- Depression FAQs
- Fibromyalgia FAQs
- Pain FAQs
- Panic Attacks Disorder FAQs
- Diabetic Neuropathy FAQs
- Does Depression Cause Obesity or Does Obesity Cause Depression?
- Depression - St. John's Wort
- Miscarriage - Depression Risk Increased
- Accutane (isotretinoin) for Acne linked to birth defects, depression and suicide
- Depression and Women
- Hot Flashes: Anxiety Worsens Hot Flashes
- Is Depression a Side Effect of Celebrex?
- Do Statins Cause Depression?
- What Is CNS Depression?
- 11 Common Depression Symptoms
- Diet and Depression: How Food Can Help with Depression Symptoms
Medications & Supplements
- Antidepressants (Depression Medications)
- Sertraline (Zoloft) vs. Venlafaxine (Effexor)
- Cymbalta vs. Wellbutrin Comparison
- Celexa vs. Cymbalta (Comparison of Differences and Similarities)
- Cymbalta (duloxetine)
- venlafaxine, Effexor XR (Effexor has been discontinued in the US)
- Lexapro vs. Effexor
- desvenlafaxine (Pristiq, Khedezla)
- Savella (milnacipran)
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Top Cymbalta duloxetine and Effexor XR venlafaxine Related Articles
Anxiety
Anxiety is a feeling of apprehension and fear characterized by symptoms such as trouble concentrating, headaches, sleep problems, and irritability. Anxiety disorders are serious medical illnesses that affect approximately 19 million American adults. Treatment for anxiety may incorporate medications and psychotherapy.How Does Cognitive Behavioral Therapy Treat Depression?
Cognitive behavioral therapy (CBT) uses cognitive strategies to help people change patterns in the way they think and behavioral strategies to help people change behaviors that aren't helpful. CBT can help people with mild-to-moderate major depressive disorder.Depression
Depression is an illness that involves the body, mood, and thoughts and affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. The principal types of depression are major depression, dysthymia, and bipolar disease (also called manic-depressive disease).Learn to Spot Depression: Symptoms, Warning Signs, Medication
Know when you or someone else is depressed. Get information on depression symptoms, signs, tests, and treatments for many types of depression chronic depression and postpartum depression.Depression Quiz
Many people do not recognize the symptoms and warning signs of depression and depressive disorders in children and adults. With proper diagnosis, treatments and medications are available. Take this quiz to learn more about recovery from depression.Diabetes Symptoms in Men
Diabetes mellitus is a disease in which a person's blood sugar (blood glucose) is either too high (hyperglycemia) or too low (hypoglycemia) due to problems with insulin regulation in the body. There are two main types of diabetes mellitus, type 1 and type 2. Type 1 diabetes usually occurs during childhood, while type 2 diabetes usually occurs during adulthood, however, rates of both types of diabetes in children, adolescents, and teens is increasing. More men than women have diabetes in the US, and the disease can affect men differently than women.Warning symptoms of diabetes that men have and women do not include low testosterone (low-t), sexual problems, impotence (erectile dysfunction), decreased interest in sex, and retrograde ejaculation.
Type 1 and type 2 diabetes symptoms and signs that are the same in men and women include skin infections, numbness or tingling in the feet or hands, nausea, excessive thirst or hunger, fatigue, irritability, blurred vision, weight gain, weight loss, urinary tract infections (URIs), and kidney problems.
Treatment for type 1 diabetes is insulin, and treatment for type 2 diabetes are lifestyle changes like eating a healthy diet, getting exercise daily, and if necessary, diabetes medications.
Diabetes Symptoms in Women
Diabetes symptoms in women include vaginal itching, pain, or discharge, loss if interest or pain after having sex, polycystic ovarian syndrome (POS), and urinary tract infections or UTIs (which are more common in women.Symptoms of diabetes that are the same in women and men are excessive thirst and hunger, bad breath, and skin infections, darkening of skin in areas of body creases (acanthosis nigricans), breath odor that is fruity, sweet, or acetone, and tingling or numbness in the hands or feet, blurred vision, fatigue, tingling or numbness in the hands or feet, wounds that heal slowly, irritability, and weight loss or gain.
Complications of type 1 and type 2 diabetes are the same, for example, skin, eye, and circulation problems, low blood sugar (hypoglycemia), high blood sugar (hyperglycemia), ketoacidosis, and amputation. If diabetes is not managed a person may not survive.
Fibromyalgia Picture
A syndrome characterized by chronic pain, stiffness, and tenderness of muscles, tendons, and joints without detectable inflammation. See a picture of Fibromyalgia and learn more about the health topic.Anxiety Slideshow
Learn about generalized anxiety disorder (GAD). See if your worries are normal or something more by learning about symptoms, diagnosis, and treatments of anxiety disorders.Pain Management
Pain management and treatment can be simple or complex, according to its cause. There are two basic types of pain, nociceptive pain and neuropathic pain. Some causes of neuropathic pain include:- complex regional pain syndrome,
- interstitial cystitis,
- and irritable bowel syndrome.
Pain Quiz
Is pain all in the brain? Take the Pain Quiz to learn everything you've ever wanted to know about the unpleasant sensation we call pain.Pain Management: Surprising Causes of Pain
What's causing your pain? Learn the common causes of lower back pain, as well as pain in the knee, stomach, kidney, shoulder, chest, gallbladder, heel, sciatic nerve, neck, hip, foot and other parts of the body. Find pain management tips that work to help lower pain triggers, as well as other pain treatments.Panic Attacks Quiz
Could you suffer a panic attack? Take this Panic Attacks Quiz to learn causes, symptoms, and treatments for panic disorder. Use this quiz to learn to recognize the main elements of this serious, yet common disorder known as panic attacks.Panic Attacks
Panic attacks are sudden feelings of terror that strike without warning. These episodes can occur at any time, even during sleep. A person experiencing a panic attack may believe that he or she is having a heart attack or that death is imminent. The fear and terror that a person experiences during a panic attack are not in proportion to the true situation and may be unrelated to what is happening around them. Most people with panic attacks experience several of the following symptoms: racing heartbeat, faintness, dizziness, numbness or tingling in the hands and fingers, chills, chest pains, difficulty breathing, and a feeling of loss or control. There are several treatments for panic attacks.Phobias Slideshow
What are you afraid of? Learn about phobias such as agoraphobia, claustrophobia, arachnophobia, zoophobia, and more. Discover some of the symptoms, treatments, and medications of phobias.Type 1 vs. Type 2 Diabetes: Differences
Diabetes mellitus is a metabolic condition in which a person's blood sugar (glucose) levels are too high. Over 29.1 million children and adults in the US have diabetes. Of that, 8.1 million people have diabetes and don't even know it. Type 1 diabetes (insulin-dependent, juvenile) is caused by a problem with insulin production by the pancreas. Type 2 diabetes (non-insulin dependent) is caused by:
Eating a lot of foods and drinking beverages with simple carbohydrates (pizza, white breads, pastas, cereals, pastries, etc.) and simple sugars (donuts, candy, etc.)
- Consuming too many products with artificial sweeteners (We found out that they are bad for us!)
- Lack of activity
- Exercise
- Stress
- Genetics
While the signs and symptoms of both types of diabetes are the same, which include:
- Increased urination
- Increased hunger
- Increased thirst
- Unexplained weight loss.
However, the treatments are different. Type 1 diabetes is insulin dependent, which means a person with this type of diabetes requires treatment with insulin. People with type 2 diabetes require medication, lifestyle changes like eating a healthy diet, and getting regular exercise.
What Are 4 Major Causes of Depression?
Depression is not a condition that has one specific cause. It can happen for many different reasons and have many triggers. Depression is a serious condition with a spectrum of diagnoses and a wide range of severity.What Happens During an Anxiety Attack?
Anxiety can occur during everyday life, it could be fleeting or it could persist and build. But if you have an anxiety disorder, you may feel your anxiety or panic overwhelm you with intense anxiety and fear.