Review of Duloxetine and Venlafaxine in Depression

Abstract

Objectives: To compare the efficacy and pharmacologic, pharmacokinetic, drug interaction and adverse effect profiles of duloxetine and venlafaxine. Methods: A systematic review of the literature pertaining to duloxetine and venlafaxine was conducted using a computer-aided search of MEDLINE and EMBASE for the period January 1988 to May 2008 with the following search terms: venlafaxine and duloxetine and depression, clinical studies, pharmacology, drug interactions, pharmacokinetics, adverse effects, safety, case reports and review articles. Results: Duloxetine and venlafaxine have comparable efficacy and share similar pharmacologic profiles but differ somewhat in their pharmacokinetic profiles, drug interactions and adverse effects. Both agents block the reuptake of serotonin and norepinephrine and both are substrates for the cytochrome P450 2D6 isoenzyme; however, duloxetine inhibits these enzymes to a moderate extent, whereas venlafaxine is only a weak inhibitor. Furthermore, duloxetine is more extensively bound to protein than venlafaxine. Venlafaxine is more likely to elevate blood pressure in a dose-related manner. Both duloxetine and venlafaxine have the potential to cause hepatic injury. Conclusions: Although venlafaxine and duloxetine have similar efficacy in the treatment of depression, differences in their adverse effects and pharmacokinetic profiles suggest that one agent may be preferred over the other in certain patient groups.

Duloxetine

“…Displacement of one of the drugs may occur, which can lead to higher serum concentrations of the unbound medication causing enhanced pharmacological or toxic effects. 27 Such an interaction has been documented with warfarin. 28 Duloxetine is extensively metabolized to form oxidative and conjugated metabolites.…”

“…27 It is also more costly than generic venlafaxine extended release, which is approximately $1.33 for 150 mg/d. 27 The relative cost of duloxetine is nearly equal to or slightly less than gabapentin, depending on the maximum dose of gabapentin administered (900Y3600 mg/d).…”

“…27 It is also more costly than generic venlafaxine extended release, which is approximately $1.33 for 150 mg/d. 27 The relative cost of duloxetine is nearly equal to or slightly less than gabapentin, depending on the maximum dose of gabapentin administered (900Y3600 mg/d). The clinical analgesic efficacy observed in trials for DPNP has prompted several investigators to evaluate the cost-effectiveness of duloxetine among the alternative neuropathic pain agents.…”

Antidepressants Modify Cryptic Behavior in Juvenile Cuttlefish at Environmentally Realistic Concentrations

“…It has thus been extensively studied by ecotoxicologists (Fong and Ford 2014; Sehonova et al 2018), which is why it served as the reference antidepressant in the present study. Nearly one decade later, the first SNRIs, with venlafaxine, were commercialized (Zerjav et al 2009). Both antidepressants are commonly detected in aquatic animals (Schultz et al 2010; Fong and Ford 2014; Silva et al 2016), even if their concentrations in water are below detection limits (Klosterhaus et al 2013; Meador et al 2016).…”