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
Fluoxetine
Cymbalta vs. Fluoxetine Dosage
Cymbalta
Fluoxetine
| 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 |
| 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
| 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
| 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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