Cymbalta Vs Lyrica Vs Neurontin: Duloxetine Vs Pregabalin Vs Gabapentin

Cymbalta (Duloxetine) Vs Lyrica (Pregabalin) Vs Neurontin (Gabapentin) is a comparison of the three commonly used drugs in the treatment of patients with diabetic neuropathy, anxiety, depression, and low back pain.

Cymbalta Vs Lyrica Vs Neurontin

Duloxetine (Cymbalta) is prescribed for the treatment of patients with diabetic neuropathy, depression, and chronic pain. Lyrica (Pregabalin) is a pain medication that treats a variety of conditions, including neuropathic pain.

Lyrica (Pregabalin) has been approved to treat diabetic neuropathy, depression, fibromyalgia, pain after shingles, restless legs syndrome, and pain from shingles. Lyrica is also used in the treatment of neuropathic pain in patients with HIV/AIDS.

Neurontin (Gabapentin) is used to treat chronic pain. It was approved for the treatment of neuropathic pain in December 2000. Neurontin is also used to treat fibromyalgia.

Approved Indications of Cymbalta, Lyrica, and Neurontin:

Fibromyalgia

Cymbalta Approved for the management of fibromyalgia
Lyrica
Neurontin Not approved

Generalized Anxiety Disorder (GAD)

Cymbalta Approved for the management of GAD
Lyrica Not approved
Neurontin

Major Unipolar Depression

Cymbalta Approved for the management of Depression
Lyrica Not approved
Neurontin

Chronic Pain including Osteoarthritis and Low back pain

Cymbalta Approved for the treatment of chronic low back pain and osteoarthritis
Lyrica Not approved
Neurontin

Neuropathic pain in diabetes mellitus

Cymbalta Approved for the management of painful diabetic neuropathy
Lyrica
Neurontin Not approved

Post-herpetic Neuralgia

Cymbalta Not approved
Lyrica Approved for the treatment of post-herpetic neuralgia in adults
Neurontin

Seizures

Cymbalta Not approved
Lyrica Approved for adults and children older than 4 years of age with focal partial-onset seizures
Neurontin Approved for the treatment of partial-onset seizures in adults and children older than 3 years of age without secondary generalization

MOA of Cymbalta, Lyrica, And Neurontin

Duloxetine is a selective serotonin-norepinephrine reuptake inhibitor, which suppresses the reabsorption of serotonin and norepinephrine in the brain. It has a weak effect on the dopaminergic nerves but little effect on the muscarinic cholinergic, alpha-2, and H-1 receptors.

Pregabalin is related to GABA but does not bind to GABA or benzodiazepines receptors. It binds to the voltage-gated calcium channels and modulates its release in the brain. It inhibits most excitatory neurons in the brain including serotonin, norepinephrine, glutamate, substance P, dopamine, and calcitonin gene-related peptide.

Neurontin inhibits the release of excitatory neurotransmitters in the brain that carries pain and seizures stimuli.

The efficacy of Cymbalta Vs Lyrica vs Neurontin in different Conditions:

Fibromyalgia

Cymbalta Both duloxetine and pregabalin have been approved for the management of fibromyalgia. Both the drugs are commonly used to treat patients with fibromyalgia. The side effects profile of one over the other is one of the deciding factors to use one drug or the other.

In the latest clinical trial, duloxetine was found to be superior to pregabalin in terms of improvement in the Widespread Pain Index (WPI), Beck Depression Inventory-II, and Fibromyalgia Impact Questionnaire-Revised and 12-Item Short Form Survey.

It is not rare that physicians combine the two drugs in highly symptomatic patients and in cases where increasing the dose of one rather than adding a drug will increase the incidence of adverse events [Ref].

Lyrica
Neurontin Not approved

Generalized Anxiety Disorder (GAD)

Cymbalta Approved for the management of GAD. Duloxetine has been found in clinical trials to improve wellbeing and functional disability in patients with GAD. The efficacy of duloxetine was found to be comparable to venlafaxine and with the added benefit of a greater improvement in the pain score [Ref]
Lyrica Not approved
Neurontin

Major Unipolar Depression

Cymbalta Cymbalta has been approved for the management of major unipolar depression. Duloxetine was studied in eight clinical trials. It was found to be superior in all the clinical trials when used in doses of 60 mg per day or more. The study also compared duloxetine with paroxetine.

It was found that duloxetine in a dose of 40 mg per day was superior to paroxetine 20 mg per day. It was also noted that duloxetine has minimal effect on ECG, heart rate, weight, and blood pressure [Ref].

Lyrica Not approved
Neurontin

Chronic Pain including Osteoarthritis and Low back pain

Cymbalta Duloxetine has been approved for the treatment of patients with osteoarthritis and chronic low back pain. Patients who have chronic low back pain with a neuropathic component had superior efficacy compared to placebo [Ref].
Lyrica Not approved
Neurontin

Neuropathic pain in diabetes mellitus

Cymbalta Cymbalta and Lyrica have both been approved for the management of painful diabetic neuropathy. One meta-analysis found no clear difference in the efficacy of the two drugs.

It was observed that pain relief was better controlled with pregabalin compared to duloxetine, however, a greater number of patients in the pregabalin group reported dizziness and somnolence [Ref]. Other latest trials have concluded a superior pain control with duloxetine compared to pregabalin.

It is generally best to use duloxetine in patients who have concomitant symptoms of anxiety and depression. In patients with painful diabetic neuropathy who have difficulty sleeping and without mood disorders can benefit more from pregabalin.

Lyrica
Neurontin Not approved

Post-herpetic Neuralgia

Cymbalta Not approved
Lyrica Pregabalin and Gabapentin have been approved for the treatment of post-herpetic neuralgia in adults. Most physicians use pregabalin for the treatment of post-herpetic neuralgia because of its rapid onset of action and prolonged duration of symptoms relief.

In clinical trials, the analgesic effects of pregabalin were observed to be six times greater than gabapentin with comparable side effects. Pedal edema was however seen in a greater number of patients using pregabalin [Ref].

Neurontin

Seizures

Cymbalta Not approved
Lyrica Both drugs have been approved for the treatment of partial focal-onset seizures without secondary generalization. Although, it is generally perceived that pregabalin is more effective (at least 10% more effective) than gabapentin, the results of recent studies have been conflicting.

A recent study published in Neurology compared Pregabalin and gabapentin as an adjunctive treatment in patients with partial-onset seizures. The authors concluded that both the drugs were equally effective and safe in patients with focal partial-onset seizures [Ref].

Neurontin

Conclusion:

Duloxetine acts via a different pathway than pregabalin and gabapentin. While Pregabalin and Gabapentin are primarily used for the treatment of neuropathic pains, Duloxetine is used in a variety of conditions including neuropathic pains, low back pains, depression, anxiety, and fibromyalgia.

Pregabalin is preferred in patients with fibromyalgia and painful diabetic neuropathy when the patients have sleep problems while duloxetine is preferred in patients with concomitant symptoms of anxiety and depression.

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