Key takeaways

Duloxetine is a prescription medicine used to treat a variety of conditions, including depression, anxiety, and certain pain conditions.
Serotonin norepinephrine reuptake inhibitors (SNRIs) are commonly used antidepressant medications that include duloxetine.
Duloxetine can cause nausea, decreased appetite, weight loss, drowsiness, headache, fatigue, and dry mouth.
Alternative antidepressant medications include other SNRIs, selective serotonin reuptake inhibitors (SSRIs), and atypical antidepressants.
Alternative pain medications include Lyrica, gabapentin, cyclobenzaprine, and other antidepressants.

In this article:

Compare duloxetine alternatives
Effexor
Savella
Prozac
Celexa
Lyrica
Natural alternatives
How to switch meds

In this article

Compare duloxetine alternatives
Effexor
Savella
Prozac
Celexa
Lyrica
Natural alternatives
How to switch meds

Duloxetine is a generic prescription medication used to treat depression, anxiety disorders, chronic musculoskeletal pain, fibromyalgia, and nerve pain associated with diabetes mellitus. This medicine is also available as a brand-name medicine called Cymbalta. Duloxetine is available as oral capsules and sprinkle capsules (Drizalma Sprinkle). This medication belongs to a drug class called serotonin-norepinephrine reuptake inhibitors (SNRIs). SNRIs increase the neurotransmitters in the brain, serotonin and norepinephrine, and help regulate mood, pain, and attention. Some SNRIs, like duloxetine, can also increase the neurotransmitter dopamine, which helps with motivation and energy.

What can I take in place of duloxetine?

While an effective treatment for some people, duloxetine may not be the best and safest pharmacological treatment for everyone treating mental health conditions (such as anxiety or depression) or a pain condition (such as nerve pain or fibromyalgia). Common side effects of duloxetine include drowsiness, headache, fatigue, dry mouth, nausea, decreased appetite, and weight loss. This medication may worsen hypertension (high blood pressure) and cause changes in heart rate, so it should be used with caution in people with other cardiovascular conditions. Like many other antidepressants, duloxetine may cause serotonin syndrome, a potentially life-threatening syndrome that occurs when there’s too much serotonin in the body.

There are other options available to treat depression and other pain conditions that do not improve with duloxetine. Depending on the condition, these alternative medications can include other SNRIs, selective serotonin reuptake inhibitors (SSRIs), atypical antidepressants, tricyclic antidepressants (TCAs), and monoamine oxidase inhibitors (MAOIs). Some pain condition treatment options include Lyrica (pregabalin), Neurontin (gabapentin), or cyclobenzaprine. These options may be more suitable for certain individuals due to their different uses, side effect profiles, and dosages.

Compare duloxetine alternatives
Drug name	Uses	Dosage	Savings options
Cymbalta (duloxetine)	-Generalized anxiety disorder -Major depressive disorder (unipolar) -Chronic musculoskeletal pain -Fibromyalgia -Neuropathic pain associated with diabetes mellitus -Migraine prevention	Take 60 to 120 mg by mouth once daily	Cymbalta coupons
Celexa (citalopram)	-Major depressive disorder (unipolar) -Generalized anxiety disorder -Panic disorder -Post-traumatic stress disorder (PTSD) -Binge eating disorder -Obsessive-compulsive disorder (OCD) -Vasomotor symptoms associated with menopause	Take 10 to 40 mg by mouth once daily	Celexa coupons
Cyclobenzaprine	-Muscle spasm -Fibromyalgia	Take 5 to 30 mg by mouth per day	Cyclobenzaprine coupons
Effexor (venlafaxine)	-Generalized anxiety disorder -Major depressive disorder (unipolar) -Panic disorder -Social anxiety disorder -Migraine prevention -Neuropathic pain associated with diabetes mellitus -Obsessive-compulsive disorder (OCD) -Post-traumatic stress disorder -Premenstrual dysphoric disorder -Vasomotor symptoms associated with menopause	Take 37.5 mg to 225 mg by mouth once daily	Effexor coupons
Fetzima (levomilnacipran)	-Major depressive disorder	Take 40 to 120 mg by mouth once daily	Fetzima coupons
Lyrica (pregabalin)	-Fibromyalgia -Neuropathic pain associated with diabetic peripheral neuropathy and spinal cord injury -Postherpetic neuralgia -Focal onset seizures -Generalized anxiety disorders -Restless leg syndrome	Take 75 to 600 mg by mouth in divided doses per day	Lyrica coupons
Neurontin (gabapentin)	-Postherpetic neuralgia -Partial onset seizures -Fibromyalgia -Generalized anxiety disorder -Neuropathic pain -Panic disorder -Depression -Vasomotor symptoms associated with menopause	Take 300 mg to 1,800 mg by mouth daily in divided doses	Neurontin coupons
Pristiq (desvenlafaxine)	-Major depressive disorder -Vasomotor symptoms associated with menopause	Take 50 to 100 mg by mouth once daily	Pristiq coupons
Prozac (fluoxetine)	-Major depressive disorder (unipolar) -Panic disorder -Bipolar disorder -Obsessive-compulsive disorder (OCD) -Bulimia nervosa -Premenstrual dysphoric disorder -Generalized anxiety disorder -Post-traumatic stress disorder (PTSD) -Social anxiety disorder -Fibromyalgia	Take 10 to 60 mg by mouth once daily	Prozac coupons
Savella (milnacipran)	-Fibromyalgia -Major depressive disorder	Take 50 to 100 mg by mouth twice daily	Savella coupons
Wellbutrin (bupropion)	-Major depressive disorder (unipolar) -Seasonal affective disorder -Smoking cessation -Bipolar disorder	Take 100 to 450 mg by mouth per day in divided doses for 12-hour formulations and once daily for 24-hour formulations	Wellbutrin coupons
Zoloft (sertraline)	-Major depressive disorder (unipolar) -Panic disorder -Obsessive-compulsive disorder (OCD) -Post-traumatic stress disorder (PTSD) -Social anxiety disorder -Premenstrual dysphoric disorder -Generalized anxiety disorder	Take 25 to 200 mg by mouth once daily	Zoloft coupons

Other alternatives to duloxetine

Other alternatives for treating depression include SSRIs, atypical antidepressants, TCAs, and MAOIs.

Selective Serotonin Reuptake Inhibitors (SSRIs):

Lexapro (escitalopram)
Luvox (fluvoxamine)
Paxil (paroxetine)

Atypical Antidepressants:

Remeron (mirtazapine)
Trazodone
Trintellix (vortioxetine)
Viibryd (vilazodone)

Tricyclic Antidepressants (TCAs):

Amitriptyline
Doxepin
Imipramine
Norpramin (desipramine)
Pamelor (nortriptyline)

Monoamine Oxidase Inhibitors (MAOIs):

Emsam (selegiline)
Marplan (isocarboxazid)
Nardil (phenelzine)
Parnate (tranylcypromine)

Top 5 duloxetine alternatives

The following are some of the most common alternatives to duloxetine.

1. Effexor (venlafaxine)

Effexor is a brand-name antidepressant that is also available as a generic called venlafaxine. Effexor is similar to duloxetine as they are both SNRI antidepressants. Venlafaxine can treat depression and anxiety disorders. It can also be used off-label for several conditions, including nerve pain associated with diabetes mellitus, migraine prevention, and symptoms of menopause. The drug therapy recommendations to treat depression usually prefer treatment with an SNRI or an SSRI as they are generally well tolerated and have good safety profiles. Even though venlafaxine is used off-label for diabetic neuropathy (nerve pain), the American Diabetes Association recommends venlafaxine as a suitable treatment option for pain associated with distal symmetric polyneuropathy, the most common subtype of peripheral neuropathy (damaged nerves in hands, feet or arms). Venlafaxine can be taken once a day or two to three times a day, depending on the formulation. Some common side effects include nausea, decreased appetite, dry mouth, increased sweating, dizziness, drowsiness, and trouble sleeping. Venlafaxine may be a suitable alternative for those who have not had improvement with duloxetine.

2. Savella (milnacipran)

Savella is currently only available as a brand-name medication that is also an SNRI. Savella is FDA-approved to treat fibromyalgia (a chronic pain condition) and can be used off-label for depression. However, Savella is unique because it is more selective for norepinephrine than serotonin. While both of these chemicals affect pain signals, the overall clinical advantage of Savella over medications like duloxetine and venlafaxine is not yet known. The American College of Rheumatology states Savella is a commonly used treatment for fibromyalgia as it can ease widespread pain. Savella is typically taken twice a day and may cause nausea, headache, constipation, and insomnia. This may be a well-suited alternative for those treating fibromyalgia and depression.

3. Prozac (fluoxetine)

Prozac is a brand-name antidepressant that is conveniently available as a generic drug called fluoxetine. Prozac belongs to the other commonly used class of antidepressants called SSRIs. Like duloxetine, Prozac can be used for depression and fibromyalgia. In addition, Prozac is used for several other conditions, including bipolar disorder, bulimia nervosa, panic disorder, and obsessive-compulsive disorder (OCD). SSRIs are one of the preferred groups of medications for treating depression. While SSRIs like Prozac are not typically used first for treating fibromyalgia, Prozac has been shown to reduce pain, depression, fatigue, and overall symptoms in people with fibromyalgia. Like duloxetine, fluoxetine is conveniently taken once a day. Possible adverse effects include diarrhea, nausea, dry mouth, drowsiness, headache, insomnia, and sexual dysfunction. Prozac may be a useful alternative for those who haven’t had success with duloxetine.

4. Celexa (citalopram)

Celexa is a brand-name antidepressant that is also available as a generic medication called citalopram. This antidepressant is similar to Prozac as they are both SSRIs. Citalopram is commonly used for not only depression but a variety of other off-label conditions, including anxiety disorders, binge eating disorder, OCD, and post-traumatic stress disorder (PTSD). Healthcare providers widely prescribe citalopram, and is generally well-tolerated. Like other antidepressants, citalopram takes a few weeks to start noticing improvement (typically about 4 to 6 weeks). Citalopram is conveniently taken just once per day, and common side effects include nausea, dry mouth, drowsiness, and increased sweating. Citalopram may be a well-suited alternative for those who have tried an SNRI like duloxetine and had no improvement.

5. Lyrica (pregabalin)

Lyrica is an anti-seizure medication also available as a generic medicine called pregabalin. While Lyrica is used to treat certain types of seizures, it is also commonly used for certain pain conditions. Lyrica can help manage fibromyalgia and nerve pain associated with diabetes, shingles, and spinal cord injury. The use of Lyrica in these pain conditions is well supported in clinical guidelines. The American Diabetes Association recommends Lyrica for diabetic nerve pain as it can improve pain symptoms. While the American College of Rheumatology includes Lyrica as a helpful fibromyalgia medication for pain relief. Depending on the dose formulation, Lyrica is typically taken once to three times per day. Common Lyrica side effects include dizziness, drowsiness, fatigue, headache, weight gain, dry mouth, and swelling in arms and legs (peripheral edema). Lyrica may be a suitable alternative for those with fibromyalgia or a nerve pain condition.

Natural alternatives to duloxetine

Alternative remedies for duloxetine depend on the condition being treated. For depression, natural alternatives include therapy and lifestyle changes. Other remedies for fibromyalgia include exercise and changes in habits.

When managing depression, it’s important to regularly participate in activities that help overall well-being. These activities can include walking, swimming, dancing, and exercising outdoors. It’s also important to maintain a healthy lifestyle by eating a healthy diet, limiting alcohol intake, and getting regular sleep. Individual and group mindfulness-based cognitive therapy can help people increase their awareness and recognition of thoughts and feelings rather than changing them.

The American College of Rheumatology stresses the importance of self-care when managing fibromyalgia. Regular exercise is important, but start off slow and easy. Recommended activities include walking, stretching, yoga, and swimming. Rest and relaxation, which can include deep breathing or meditation techniques, are additional parts of self-care.

How to switch to a duloxetine alternative

1. Discuss all health conditions with a healthcare provider

A healthcare provider must be aware of all medical history and conditions before switching from duloxetine to an alternative medication. Certain alternatives should be used with caution or avoided with some medical conditions.

2. Do not suddenly stop taking duloxetine without medical advice

Duloxetine may cause withdrawal symptoms if suddenly discontinued. It’s important only to stop taking duloxetine if the prescribing healthcare provider has given instructions to stop the medication. As a medication that affects the central nervous system (CNS), many withdrawal symptoms impact this area of the body. Withdrawal symptoms may include dizziness, nausea, headache, vomiting, and irritability. It’s recommended to gradually reduce the duloxetine dose to no less than two weeks before discontinuing the medicine.

3. Discuss all prescription and over-the-counter medications with a healthcare provider

A healthcare provider must review a complete medication list, including prescription drugs, OTC (over-the-counter) medications, and supplements. This should be done before switching from duloxetine to an alternative medication and with any other medication changes, as certain alternatives have dangerous drug interactions that must be avoided.

Duloxetine alternatives: What can I take instead of duloxetine?