Comparative Pharmacology
Head-to-head clinical analysis: CYMBALTA versus SAVELLA.
Peer-Reviewed Evidence
Head-to-head clinical analysis: CYMBALTA versus SAVELLA.
CYMBALTA vs SAVELLA
Comparing the clinical profiles, pharmacokinetic behaviors, and safety indices of these two therapeutic agents.
Selective serotonin and norepinephrine reuptake inhibitor (SNRI); increases extracellular levels of serotonin and norepinephrine by inhibiting their reuptake into presynaptic neurons.
Selective serotonin and norepinephrine reuptake inhibitor (SNRI); also weakly inhibits dopamine reuptake. Binds to serotonin and norepinephrine transporters, increasing their extracellular concentrations.
60 mg orally once daily, without regard to meals; some patients may benefit from a starting dose of 30 mg once daily for 1 week before increasing to 60 mg once daily.
100 mg orally twice daily; may initiate at 50 mg twice daily and increase to 100 mg twice daily after 1 week.
None Documented
None Documented
Terminal elimination half-life is approximately 12 hours (range 8–17 hours); supports once-daily dosing with consistent drug levels.
Approximately 11 hours for milnacipran (SAVELLA). In the context of twice-daily dosing, steady state is reached within 2-3 days.
Renal: approximately 70% as metabolites (duloxetine glucuronide conjugates and sulfate conjugates), 20% as unchanged drug in urine; fecal: approximately 20% as metabolites; biliary: minor contribution.
Renal excretion of unchanged drug and metabolites accounts for approximately 51-58% of the dose. Fecal excretion accounts for about 19-22%. The remainder is eliminated via other routes (e.g., oxidative metabolism and subsequent conjugation).
Category C
Category C
SNRI Antidepressant
SNRI Antidepressant