Two medicines, side by side
Desvenlafaxine vs duloxetine
Desvenlafaxine and duloxetine are both labeled for depression. Drugs@FDA records approvals of desvenlafaxine since 2008 and of duloxetine since 2004. Pharmacies paid $0.396 per unit (Desvenlafaxine succnt ER 50 mg) and $0.102 per duloxetine HCl DR 30 mg capsule (NADAC, October 7, 2026); the strengths differ, so the two prices are not like for like. How each works, in its label's words: Desvenlafaxine, “The exact mechanism of the antidepressant action of desvenlafaxine is unknown, but is thought to be related to the potentiation of serotonin and norepinephrine in the central nervous system, through …”; Duloxetine, “Although the exact mechanisms of the antidepressant, central pain inhibitory and anxiolytic actions of duloxetine in humans are unknown, these actions are believed to be related to its potentiation …”
Check it at the source: the desvenlafaxine FDA label on DailyMed (effective January 27, 2023); the duloxetine FDA label on DailyMed (effective May 14, 2024).
Highlights of the desvenlafaxine record
Desvenlafaxine (Pristiq) · label of January 27, 2023
SUICIDAL THOUGHTS AND BEHAVIORS Antidepressants increased the risk of suicidal thoughts and behavior in children, adolescents, and young adults in short-term studies. These studies did not show an increase in the risk of suicidal thoughts and behavior with antidepressant use in patients over age 24; there was a reduction in risk with antidepressant use in patients aged 65 and older [see Warnings and Precautions (5.1)].
Used for
From the label: indicationsDesvenlafaxine, a serotonin and norepinephrine reuptake inhibitor (SNRI), is indicated for the treatment of major depressive disorder (MDD) [see Clinical Studies (14) and Dosage and Administration (2.1)]. The efficacy of desvenlafaxine has been established in four short-term (8-week, placebo-controlled studies) of outpatients who met DSM-IV criteria for major depressive disorder. […]
On the market
- Earliest approval on file
- February 29, 2008
- Generic labelers
- 20 labelers
- Pharmacy cost
- $0.396 per unit
Supply and safety
- Shortage
- No current entry
- Recalls
- 2
Highlights of the duloxetine record
Duloxetine (Cymbalta) · label of May 14, 2024
SUICIDAL THOUGHTS AND BEHAVIORS Antidepressants increased the risk of suicidal thoughts and behavior in pediatric and young adult patients in short-term studies. Closely monitor all antidepressant-treated patients for clinical worsening, and for emergence of suicidal thoughts and behaviors [see Warnings and Precautions (5.1)]. WARNING: SUICIDAL THOUGHTS AND BEHAVIORS See full prescribing information for complete boxed warning.
Used for
From the label: indicationsDRIZALMA SPRINKLE is indicated for the treatment of: • Major Depressive Disorder in adults • Generalized Anxiety Disorder in adults and pediatric patients 7 years of age and older • Diabetic Peripheral Neuropathy in adults • Fibromyalgia in adults • Chronic Musculoskeletal Pain in adults Additional pediatric use information is approved for Eli Lilly and Company, Inc.’s CYMBALTA (duloxetine delayed-release capsules). […]
On the market
- Earliest approval on file
- August 3, 2004
- Generic labelers
- 45 labelers
- Pharmacy cost
- $0.102 per capsule
Supply and safety
- Shortage
- No current entry
- Recalls
- 56
Source: FDA drug labels via openFDA (Desvenlafaxine label of January 27, 2023, Duloxetine label of May 14, 2024); NDC Directory, Drugs@FDA, NADAC, FDA shortages and recalls (October 8, 2026)
How do desvenlafaxine and duloxetine differ on the record?
How each works, in its label's words: Desvenlafaxine, “The exact mechanism of the antidepressant action of desvenlafaxine is unknown, but is thought to be related to the potentiation of serotonin and norepinephrine in the central nervous system, through …”; Duloxetine, “Although the exact mechanisms of the antidepressant, central pain inhibitory and anxiolytic actions of duloxetine in humans are unknown, these actions are believed to be related to its potentiation …”
Both are in FDA's class serotonin and norepinephrine reuptake inhibitors.
Half-life, in each label's words: Desvenlafaxine, “The mean terminal half-life (t 1/2 ) was prolonged from 11.1 hours in the control subjects to approximately 13.5, 15.5 …”; Duloxetine, “Mean terminal half-life was 12.4 hours (range 7.8 to 22.2 hour) in subjects receiving a single dose DRIZALMA SPRINKLE.”
Both labels carry a boxed warning; the records quote them.
Generics: desvenlafaxine since 2015; duloxetine since 2013 (Drugs@FDA).
| Desvenlafaxine | Duloxetine | |
|---|---|---|
| Labeled for | Depression | Depression, Anxiety, Nerve pain and fibromyalgia, Pain |
| Pharmacologic class | Serotonin and Norepinephrine Reuptake Inhibitor | Serotonin and Norepinephrine Reuptake Inhibitor |
| How it works (label) | The exact mechanism of the antidepressant action of desvenlafaxine is unknown, but is thought to be related to the potentiation of serotonin and norepinephrine in the central nervous system, through inhibition of their reuptake. | Although the exact mechanisms of the antidepressant, central pain inhibitory and anxiolytic actions of duloxetine in humans are unknown, these actions are believed to be related to its potentiation of serotonergic and noradrenergic … |
| Half-life (label) | The mean terminal half-life (t 1/2 ) was prolonged from 11.1 hours in the control subjects to approximately 13.5, 15.5, 17.6, and 22.8 hours in mild, moderate, severe renal impairment and ESRD subjects, respectively. | Mean terminal half-life was 12.4 hours (range 7.8 to 22.2 hour) in subjects receiving a single dose DRIZALMA SPRINKLE. |
| Earliest approval on file (Drugs@FDA) | February 29, 2008 | August 3, 2004 |
| First generic approved | June 29, 2015 | December 11, 2013 |
| Generic labelers (NDC) | 20 labelers | 45 labelers |
| Pharmacy cost (NADAC, each one's most listed form; strengths differ) | $0.396 per unit (Desvenlafaxine succnt ER 50 mg) | $0.102 per capsule (Duloxetine HCl DR 30 mg capsule) |
| 12-month price change | -6% | +31% |
| Boxed warning | Yes | Yes |
| Shortage now | No current entry | No current entry |
| Recalls recorded | 2 | 56 |
| FAERS reports (a report is not proof of cause; counts follow how widely a medicine is used) | 26,842 | 69,298 |
| DEA schedule | none | none |
Source: Drugs@FDA, FDA NDC Directory, CMS NADAC of October 7, 2026, FDA shortages and recalls, FAERS via openFDA (FDA files October 8, 2026)
What do the labels say about using others of their kind?
Desvenlafaxine label, warnings and precautionsSerotonin syndrome has been reported with SSRIs and SNRIs, including with desvenlafaxine extended-release tablets, both when taken alone, but especially when co-administered with other serotonergic agents (including triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone, amphetamines, and St. John's Wort).
Duloxetine label, drug interactionsExamples Selegiline, tranylcypromine, isocarboxazid, phenelzine, linezolid, intravenous methylene blue Other Serotonergic Drugs Clinical Impact Concomitant use of duloxetine with other serotonergic drugs increases the risk of serotonin syndrome.
Source: FDA drug labels via openFDA
What next?
- Alternatives to desvenlafaxine
- every medicine labeled for the same conditions