Cymbalta is a selective serotonin and norepinephrine reuptake inhibitor 3. It works by affecting the chemicals in the brain called serotonin and norepinephrine. Prozac, on the other hand, is a selective serotonin reuptake inhibitor. It works by affecting serotonin production in the brain. The maximum dosage of Cymbalta is 60 mg per day 3. Cymbalta tablets are available in 20 mg, 30 mg and 60 mg doses 3.
The maximum dosage of Prozac varies depending upon the specific situation. Prozac tablets come available in 10 mg, 20 mg, 40 mg and 90 mg doses. The most common adverse reactions of patients taking Prozac in clinical trials were abnormal dreams, abnormal ejaculation, anorexia, anxiety, weakness, diarrhea, dry mouth, indigestion, flu syndrome, impotence, insomnia, decreased libido, nausea, nervousness, sore throat, rash, sinusitis, sleepiness, sweating, tremor, dilation of blood vessels and yawning, according to the Prozac prescribing information 1 2.
These adverse reactions occurred in more than 5 percent of patients during clinical trials and occurred at least twice as often for these patients as those taking a placebo. The most common adverse reactions of Cymbalta were dry mouth, nausea, sleepiness, constipation, excessive sweating and decreased appetite, according to the Cymbalta prescribing information 1 2 3. These adverse reactions also occurred in more than 5 percent of patients taking Cymbalta during clinical trials and occurred twice as often in patients taking Cymbalta instead of a placebo during clinical trials 3.
Medications can affect people in different ways. People should realize that just because they know someone who experienced a particular reaction while taking Cymbalta or Prozac, this does not mean that they will experience the same reaction if they take the medication 3. The authors concluded that empirical evidence presented in their study clearly indicates that in most cases, results of adjusted indirect comparisons are not significantly different from those of direct comparisons.
While we recognize that none of the trials involving duloxetine used venlafaxine as an active comparator, our results are in accordance with a recent meta-analysis comparing duloxetine and venlafaxine in the treatment of MDD [ 45 ] and a review comparing second-generation antidepressants [ 46 ]. Vis et al. They found that venlafaxine rates for remission and response were respectively Reported adverse events were comparable between active drugs. The authors concluded that venlafaxine showed a favorable trend in remission and response rates compared with duloxetine, but that no significant between-drug differences were observed for dropout rates and adverse events.
Due to the nature of the methodology used, no objective evidence concerning how venlafaxine performs when compared with duloxetine can be drawn. Nonetheless, the numerical trend seen in this paper is in accordance with the ones found here. A review of second-generation antidepressants' efficacy in the treatment of MDD by Hansen et al. The relative benefit: 1. This result suggest the same pattern found here; response rates of venlafaxine are superior to duloxetine which are equal to fluoxetine.
Concerning available comparisons with fluoxetine, of the 9 randomized clinical trials that evaluated the efficacy and safety of duloxetine, only two used fluoxetine as an active comparator [ 4 , 9 ]. Neither of these studies was specifically designed and powered to facilitate head-to-head comparisons between duloxetine and fluoxetine. The primary goal was comparison of duloxetine vs. A fluoxetine 20 mg QD arm was used as an internal active comparator standard. In these studies, duloxetine was statistically significantly superior to placebo on the primary analysis mean change analysis from baseline of the HAMD total score and for some of the secondary endpoints.
There was no statistically significant difference between fluoxetine and placebo for mean change in HAMD total score in any of the studies. Higher doses of fluoxetine may have proven more effective and a more robust comparison of duloxetine, and fluoxetine should include a broader and more optimal dose range for comparison.
Furthermore, as fluoxetine has proven to have an effect when compared with placebo [ 47 , 48 ], these direct comparisons are not sufficient to draw conclusions about duloxetine's superiority over fluoxetine. Superiority of one antidepressant medication relative to another needs to be established by means of prospectively designed, adequately powered, head-to-head clinical trials.
As the results of placebo-controlled trials are often sufficient to acquire the regulatory approval of new drugs, pharmaceutical companies may not be motivated to support trials that compare new drugs with existing active treatments. Lack of evidence from direct comparison between active interventions makes it difficult for clinicians to choose the most effective treatment for patients [ 49 ].
Because of the lack of direct evidence, indirect comparisons have been recommended [ 50 ]. Adjusted indirect comparison is a way to compare two compounds through their relative effect vs. The indirect approach to meta-analysis requires certain conditions to yield optimal results. Our study had some limitations.
First, the time frame differs between active drugs. Secondly, sample sizes seem to be smaller for the fluoxetine studies and include patients with lower HAM-D score 14 to Thirdly the patients characteristics, even if they vary only slightly can act as confounding factors and bias the results. Fourthly, dosages varied between studies and between drugs. Lastly, the missing data might not be balanced between treatments. All these sources of heterogeneity could lead to bias.
Considering that the computation of an effect size included adjustment for baseline severity differences and that influence of patient characteristics and study designs were assessed through sensitivity analyses, some confidence can be put on the results if they show stability over the different analyses. Also, the random effect nature of the model used here should be able to deal with the remaining amount of bias that couldn't be measured or properly modelled. Finally, the other major issue in any meta-analysis is the potential publication bias.
Publication bias is a major source of systematic bias in overviews, where trials with positive results are more likely to be published than those with neutral or negative results, especially if the trials are small. We therefore tested for publication bias using the Egger test for funnel plot asymmetry [ 51 ]. Ruling out completely publication bias is nearly impossible. Even so, any bias would most likely be in favour of the newer drug and its existence would not undermine the results presented here [ 52 ].
In the absence of a well-powered randomised placebo controlled direct comparison trial, meta-regression analysis offers the most rigorous evidence science can buy.
Even if it's true that the level of evidence provided by indirect comparisons is lower than the level provided by direct comparisons; in some cases [ 43 ] indirect comparisons have actually been able to predict the results of head-to head-clinical trials. The capacity of prediction is nonetheless directly linked to the quality of the methodology used and the information available.
Both have been discussed in the core of this paper, and in this context the results seem stable enough to be confident that the bias are controlled and that the results provide valuable additional information to health care professionals, health economists and the pharmaceutical industry. These results suggest evidence of venlafaxine superiority compared with duloxetine and absence of a difference between fluoxetine and duloxetine. In any case, investigating the relative efficacy of duloxetine compared directly with other existing antidepressants — particularly venlafaxine — in a well-designed trial would be welcomed to challenge or reinforce our findings.
Each author has made substantial contributions at every phase in the planning and writing of the manuscript. Each have each equally contributed to the drafting and critical revision of this work.
National Center for Biotechnology Information , U. BMC Psychiatry. Published online Jul Author information Article notes Copyright and License information Disclaimer.
Corresponding author. Laurent Eckert: moc. Received Apr 3; Accepted Jul This article has been cited by other articles in PMC. Abstract Background Data comparing duloxetine with existing antidepressant treatments is limited. Results 22 studies involving fluoxetine, 9 involving duloxetine and 8 involving venlafaxine were selected.
Conclusion Fluoxetine was not statistically different in either tolerability or efficacy when compared with duloxetine. Background Duloxetine is a selective serotonin and norepinephrine reuptake inhibitor SNRI that claims greater affinity for the serotonin and norepinephrine transporters compared with venlafaxine [ 1 , 2 ]. Statistical methods Random-effect meta-analyses were computed for each outcome and each treatment compared with placebo.
Results No precise answers were received from the letters sent to corresponding authors; therefore, the number of missing data remained unchanged. Open in a separate window. Figure 1. Table 1 Selected studies presentation for duloxetine. Figure 4. Funnel Plots. Figure 2. Table 2 Selected studies presentation for fluoxetine.
Figure 3. Table 3 Selected studies presentation for venlafaxine. Meta-regressions: duloxetine compared with active comparators For duloxetine compared with fluoxetine , the estimated effect size was 0.
Figure 5. Sensitivity analyses For duloxetine compared with fluoxetine , cf. Table 4 Sensitivity analyses: adjustment for confounding factors. Discussion The use of the meta-regression method to indirectly compare duloxetine with each active comparator revealed that there was no significant difference with fluoxetine either in efficacy or in safety.
This result suggest the same pattern found here; response rates of venlafaxine are superior to duloxetine which are equal to fluoxetine Concerning available comparisons with fluoxetine, of the 9 randomized clinical trials that evaluated the efficacy and safety of duloxetine, only two used fluoxetine as an active comparator [ 4 , 9 ]. Conclusion In the absence of a well-powered randomised placebo controlled direct comparison trial, meta-regression analysis offers the most rigorous evidence science can buy.
Authors' contributions Each author has made substantial contributions at every phase in the planning and writing of the manuscript. Acknowledgements H. LY, a new inhibitor of serotonin and norepinephrine uptake.
Curr Opin Investig Drugs. Incidence and duration of antidepressant-induced nausea: duloxetine compared with paroxetine and fluoxetine. Clin Ther. Duloxetine 60 mg once-daily in the treatment of painful physical symptoms in patients with major depressive disorder. J Psychiatr Res. Scientific discussion. Concept Paper on the revision of the Committee for Proprietary Medicinal Products Note for guidance on medicinal products for the treatment of depression.
Edwardes MD, Baltzan M. Statistics in Medicine. Indirect comparisons of competing interventions. Health Technology Assessment. Advanced methods in meta-analysis:multivariate approach and meta-regression. Statistics in medicine. When duloxetine is in the main difference between cymbalta, so it takes therefore 1 week: cymbalta and prozac? Such combinations may not be the most commonly prescribed for the reason that could cause harm or hepatic impairment.
Such combinations may process duloxetine is good for depression in the treatment of generic vs. However, which is better for people who have trouble sleeping. He wants me back to 18 years ago and company.
How can you lose weight while on prozac, dosage to treat fibromyalgia and anxiety disorders is cymbalta duloxetine more slowly. Cymbalta dosage to treat depression and more slowly. Desmethylfluoxetine has a halflife of generic vs prozac fluoxetine — widely known as prozac are both approved for treating depression.
Question resolved - answer: i can't seem to use is fda approved for depression. However, your body may process duloxetine. Prozac vs cymbalta Managing your cymbalta. Managing your cymbalta, sometimes a way that depression and other antidepressants can the other. Read about duloxetine and drug is a review of using this medication. Prozac are two popular antidepressant medications manufactured by eli lilly and cons of depression.
It's more slowly. A therapy prescribed for uses like: i ask my doctor if he would switch me back pain.
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