Cymbalta vs. Fluoxetine

See how Cymbalta and Fluoxetine compare on approved uses, dosing, side effects, and cost.

Key Takeaways

  • Cymbalta is an SNRI approved for depression, anxiety, and chronic pain conditions like fibromyalgia and diabetic neuropathy, while fluoxetine is an SSRI approved for depression, OCD, panic disorder, and bulimia.

  • Both carry a boxed warning for increased suicidal thinking in children and young adults, but fluoxetine has decades more safety data and is much less expensive.

  • Cymbalta can require twice-daily dosing at higher doses, while fluoxetine offers a once-weekly maintenance option after patients are stable on a daily dose.

Cymbalta vs. Fluoxetine Drug Summary

Cymbalta

Cymbalta (duloxetine) is a serotonin and norepinephrine reuptake inhibitor (SNRI) used to treat major depressive disorder, generalized anxiety disorder, and chronic pain conditions like fibromyalgia and diabetic nerve pain. It comes as a delayed-release capsule, taken once daily at lower doses and split into two daily doses at the highest dose.

Fluoxetine

Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) used to treat major depressive disorder, obsessive-compulsive disorder, panic disorder, and bulimia nervosa. It is available as a capsule, tablet, or oral solution, usually taken once daily, with an option to switch to a once-weekly dose once stable.

Cymbalta vs. Fluoxetine Side Effects

Cymbalta

Most common
nausea (up to 30%)
somnolence (up to 21%)
headache (up to 18%)
dizziness (up to 17%)

Fluoxetine

Most common
nausea (up to 21%)
somnolence (up to 13%)
headache (up to 21%)
insomnia (up to 33%)

Cymbalta vs. Fluoxetine Dosage

Cymbalta

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 30 mg once daily Week 1
Maximum dose 60 mg twice daily If needed
Dose changes 2 increases Every week

Fluoxetine

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 10 mg once daily Week 1
Maximum dose 90 mg once weekly If needed
Dose changes 4 increases Every week

Cymbalta vs. Fluoxetine Indications

Cymbalta

Cymbalta is approved for both psychiatric and chronic pain conditions, making it a common choice for people with depression or anxiety who also have fibromyalgia or nerve pain. It is not typically used in children outside a few specific approved indications.

  • Major depressive disorder

  • Generalized anxiety disorder

  • Diabetic peripheral neuropathic pain

  • Fibromyalgia

  • Chronic musculoskeletal pain

Fluoxetine

Fluoxetine covers a broad range of psychiatric conditions, including depression, OCD, panic disorder, and bulimia nervosa. It is also approved for children with depression and OCD, and can be paired with olanzapine for treatment-resistant depression or bipolar depression.

  • Major depressive disorder

  • Obsessive-compulsive disorder

  • Bulimia nervosa

  • Panic disorder

  • Bipolar depression (with olanzapine)

Cymbalta vs. Fluoxetine Pros and Cons

Cymbalta

Cymbalta's ability to treat chronic pain alongside mood or anxiety symptoms sets it apart from most antidepressants, but it comes with more restrictions around liver and kidney disease. It is also generally pricier than older generic antidepressants like fluoxetine.

Pros

  • Also treats chronic pain conditions like diabetic neuropathy and fibromyalgia

  • Approved for chronic musculoskeletal pain, not covered by most antidepressants

  • Useful for patients with overlapping mood and pain symptoms

Cons

  • Should be avoided in liver disease or severe kidney impairment

  • Typically costs more, roughly $130 to $500 per month without insurance

  • Requires twice-daily dosing once the dose reaches the maximum

Fluoxetine

Fluoxetine has the longest track record of any SSRI and is widely available at low cost due to generic competition. It lacks Cymbalta's pain-related approvals, but its flexible dosing and low price make it accessible for many patients.

Pros

  • One of the least expensive antidepressants, roughly $25 to $60 per month

  • Long half-life makes missed doses less likely to cause withdrawal symptoms

  • Offers a once-weekly maintenance dosing option after stabilization

Cons

  • Not approved for any chronic pain condition

  • Contraindicated with MAOIs and certain antipsychotics like pimozide

  • Long half-life means drug interactions can persist for weeks after stopping

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