Two medicines, side by side
Duloxetine vs milnacipran
Duloxetine and milnacipran are both labeled for nerve pain and fibromyalgia. Drugs@FDA records approvals of duloxetine since 2004 and of milnacipran since 2009. Pharmacies paid $0.102 per duloxetine HCl DR 30 mg capsule and $2.82 per milnacipran HCl 100 mg tablet (NADAC, October 7, 2026); the strengths differ, so the two prices are not like for like. How each works, in its label's words: 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 …”; Milnacipran, “The exact mechanism of the central pain inhibitory action of milnacipran and its ability to improve the symptoms of fibromyalgia in humans are unknown.”
Check it at the source: the duloxetine FDA label on DailyMed (effective May 14, 2024); the milnacipran FDA label on DailyMed (effective September 10, 2025).
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
Highlights of the milnacipran record
Milnacipran (Savella) · label of September 10, 2025
SUICIDALITY AND ANTIDEPRESSANT DRUGS SAVELLA is a selective serotonin and norepinephrine reuptake inhibitor (SNRI), similar to some drugs used for the treatment of depression and other psychiatric disorders. Antidepressants increased the risk compared to placebo of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults in short-term studies of major depressive disorder (MDD) and other psychiatric disorders.
Used for
From the label: indicationsSAVELLA is indicated for the management of fibromyalgia. SAVELLA is not approved for use in pediatric patients [see Use in Specific Populations ( 8.4 )]. SAVELLA ® is a selective serotonin and norepinephrine reuptake inhibitor (SNRI) indicated for the management of fibromyalgia ( 1 ). SAVELLA is not approved for use in pediatric patients ( 1 ).
On the market
- Earliest approval on file
- January 14, 2009
- Generic labelers
- 4 labelers
- Pharmacy cost
- $2.82 per tablet
Supply and safety
- Shortage
- No current entry
- Recalls
- 0
Source: FDA drug labels via openFDA (Duloxetine label of May 14, 2024, Milnacipran label of September 10, 2025); NDC Directory, Drugs@FDA, NADAC, FDA shortages and recalls (October 8, 2026)
How do duloxetine and milnacipran differ on the record?
How each works, in its label's words: 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 …”; Milnacipran, “The exact mechanism of the central pain inhibitory action of milnacipran and its ability to improve the symptoms of fibromyalgia in humans are unknown.”
Both are in FDA's class serotonin and norepinephrine reuptake inhibitors.
Half-life, in each label's words: Duloxetine, “Mean terminal half-life was 12.4 hours (range 7.8 to 22.2 hour) in subjects receiving a single dose DRIZALMA SPRINKLE.”; Milnacipran, “It is excreted predominantly unchanged in urine (55%) and has a terminal elimination half-life of about 6 to 8 hours.”
Both labels carry a boxed warning; the records quote them.
Generics: duloxetine since 2013; milnacipran since 2016 (Drugs@FDA).
| Duloxetine | Milnacipran | |
|---|---|---|
| Labeled for | Depression, Anxiety, Nerve pain and fibromyalgia, Pain | Nerve pain and fibromyalgia |
| Pharmacologic class | Serotonin and Norepinephrine Reuptake Inhibitor | Serotonin and Norepinephrine Reuptake Inhibitor |
| How it works (label) | 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 … | The exact mechanism of the central pain inhibitory action of milnacipran and its ability to improve the symptoms of fibromyalgia in humans are unknown. |
| Half-life (label) | Mean terminal half-life was 12.4 hours (range 7.8 to 22.2 hour) in subjects receiving a single dose DRIZALMA SPRINKLE. | It is excreted predominantly unchanged in urine (55%) and has a terminal elimination half-life of about 6 to 8 hours. |
| Earliest approval on file (Drugs@FDA) | August 3, 2004 | January 14, 2009 |
| First generic approved | December 11, 2013 | January 27, 2016 |
| Generic labelers (NDC) | 45 labelers | 4 labelers |
| Pharmacy cost (NADAC, each one's most listed form; strengths differ) | $0.102 per capsule (Duloxetine HCl DR 30 mg capsule) | $2.82 per tablet (Milnacipran HCl 100 mg tablet) |
| 12-month price change | +31% | n/a |
| Boxed warning | Yes | Yes |
| Shortage now | No current entry | No current entry |
| Recalls recorded | 56 | 0 |
| FAERS reports (a report is not proof of cause; counts follow how widely a medicine is used) | 69,298 | 5,981 |
| 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?
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.
Milnacipran label, warnings and precautionsIncreased risk when co-administered with other serotonergic agents, but also when taken alone.
Source: FDA drug labels via openFDA
What next?
- Alternatives to duloxetine
- every medicine labeled for the same conditions