Cymbalta vs. Wellbutrin Comparison

  • Medical Reviewer: John P. Cunha, DO, FACOEP
    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.

Cymbalt vs. Wellbutrin quick comparison of differences

What is Cymbalta? What is Wellbutrin? How do they work?

Cymbalta

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

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).

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What are the uses for Cymbalta vs. Wellbutrin?

Cymbalta uses

Wellbutrin uses

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:

  • dizziness,
  • anxiety,
  • nausea,
  • vomiting,
  • nervousness,
  • diarrhea,
  • irritability, and
  • insomnia.

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 is the dosage for Cymbalta vs. Wellbutrin?

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 the dose is advanced to 60 mg daily.
  • The recommended dose for anxiety disorder, pain associated with diabetic neuropathy, fibromyalgia, or chronic musculoskeletal pain is 60 mg daily. Starting at 30 mg daily for one week before increasing to 60 mg daily may help patients adjust to the drug.
  • 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.

Wellbutrin dosage

  • Bupropion immediate release tablets are usually given in one, two or three daily doses. For immediate-release tablets, no single dose should exceed 150 mg and each dose should be separated by 6 hours.
  • For depression the recommended dose of immediate-release tablets is 100 mg 3 times daily (300 mg/day); maximum dose is 450 mg daily. The initial dose is 100 mg twice daily. The dose may be increased to 100 mg 3 times daily after three days and 150 mg 3 times daily after several weeks if the initial response is not adequate.
  • The initial dose of sustained-release tablets is 150 mg daily; target dose is 150 mg twice daily; maximum dose is 200 mg twice daily.
  • The initial dose of extended-release tablets is 150 mg daily; target dose is 300 mg daily; maximum dose is 450 mg daily. Extended release tablets are administered once daily.
  • Some patients with depression may be switched from bupropion hydrochloride (Wellbutrin, for example) to bupropion hydrobromide (Aplenzin) while others may need doses higher than those listed above. The correct dose of these medications for you should be determined by your doctor.
  • When used for smoking cessation, bupropion (Zyban) usually is started as 150 mg once daily for three days, and then the dose is increased to 150 mg twice daily for 7 to 12 weeks if the patient tolerates the starting dose. Smoking is discontinued two weeks after starting bupropion therapy.
  • The dose for seasonal affective disorder is 150 mg once daily up to 300 mg daily using bupropion hydrochloride extended release tablets (for example, Wellbutrin XL). Alternatively, treatment may be started with 174 mg bupropion hydrobromide (Aplenzin) daily and increased to a target dose of 348 mg day. Start treatment in the autumn prior to onset of seasonal depressive symptoms and continue through the winter season.

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?

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.

Wellbutrin safety

  • 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

Summary

Cymbalta (duloxetine) is an antidepressant that belongs to the drug class called selective serotonin and norepinephrine reuptake inhibitors (SNRIs). Cymbalta affects the chemicals that nerves within the brain make and release in order to communicate with each other. Wellbutrin (bupropion) also is an antidepressant, however, it works differently than any other antidepressant because it also affects the chemical dopamine.

Cymbalta is used to treat depression, general anxiety disorder (GAD), pain associated with diabetic neuropathy, fibromyalgia, and musculoskeletal pain. Wellbutrin is used to manage major depression and seasonal affective disorder. Off-label uses for Wellbutrin include attention deficit hyperactivity disorder (ADHD), post-traumatic stress disorder (PTSD), social phobias, and nerve pain.

Cymbalta and Wellbutrin have similar side effects like nausea, dry mouth, and constipation. Side effects unique to Cymbalta include diarrhea, fatigue, increased blood pressure, and sexual dysfunction. Side effects unique to Wellbutrin include weight loss, sweating, tinnitus, stomach pain, muscle pan, and a fast heart beat. Serious side effects of Wellbutrin include suicidal thoughts and seizures.

Dosage depends upon the patient, any other medical issue he or she has, and the condition being treated. Both Cymbalta and Wellbutrin interact with other drugs. Neither drug is recommended during pregnancy or while breastfeeding.

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Reviewed on 12/12/2017
References
REFERENCE: FDA Prescribing Information

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