Two medicines, side by side
Duloxetine vs nortriptyline
Duloxetine and nortriptyline are both labeled for depression. Drugs@FDA records approvals of duloxetine since 2004 and of nortriptyline since 1964. Pharmacies paid $0.102 per duloxetine HCl DR 30 mg capsule and $0.113 per nortriptyline HCl 10 mg capsule (NADAC, October 7, 2026); the strengths differ, so the two prices are not like for like. In FDA's classes, duloxetine is a serotonin and norepinephrine reuptake inhibitor and nortriptyline a tricyclic antidepressant.
Check it at the source: the duloxetine FDA label on DailyMed (effective May 14, 2024); the nortriptyline FDA label on DailyMed (effective December 4, 2024).
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 nortriptyline record
Nortriptyline (Pamelor) · label of December 4, 2024
Suicidality and Antidepressant Drugs 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. Anyone considering the use of nortriptyline hydrochloride or any other antidepressant in a child, adolescent, or young adult must balance this risk with the clinical need.
Used for
From the label: indicationsPamelor™ (nortriptyline HCl) is indicated for the relief of symptoms of depression. Endogenous depressions are more likely to be alleviated than are other depressive states.
On the market
- Earliest approval on file
- November 6, 1964
- Generic labelers
- 25 labelers
- Pharmacy cost
- $0.113 per capsule
Supply and safety
- Shortage
- No current entry
- Recalls
- 2
Source: FDA drug labels via openFDA (Duloxetine label of May 14, 2024, Nortriptyline label of December 4, 2024); NDC Directory, Drugs@FDA, NADAC, FDA shortages and recalls (October 8, 2026)
How do duloxetine and nortriptyline differ on the record?
In FDA's classes, duloxetine is a serotonin and norepinephrine reuptake inhibitor and nortriptyline a tricyclic antidepressant.
Both labels carry a boxed warning; the records quote them.
Generics: duloxetine since 2013; nortriptyline since 1992 (Drugs@FDA).
| Duloxetine | Nortriptyline | |
|---|---|---|
| Labeled for | Depression, Anxiety, Nerve pain and fibromyalgia, Pain | Depression |
| Pharmacologic class | Serotonin and Norepinephrine Reuptake Inhibitor | Tricyclic Antidepressant |
| 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 … | n/a |
| 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. | n/a |
| Earliest approval on file (Drugs@FDA) | August 3, 2004 | November 6, 1964 |
| First generic approved | December 11, 2013 | March 30, 1992 |
| Generic labelers (NDC) | 45 labelers | 25 labelers |
| Pharmacy cost (NADAC, each one's most listed form; strengths differ) | $0.102 per capsule (Duloxetine HCl DR 30 mg capsule) | $0.113 per capsule (Nortriptyline HCl 10 mg capsule) |
| 12-month price change | +31% | -2% |
| Boxed warning | Yes | Yes |
| Shortage now | No current entry | No current entry |
| Recalls recorded | 56 | 2 |
| FAERS reports (a report is not proof of cause; counts follow how widely a medicine is used) | 69,298 | 5,761 |
| 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.
Nortriptyline label, warningsIf concomitant use of Pamelor with other serotonergic drugs, including triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, buspirone, tryptophan, and St. John’s Wort is clinically warranted, patients should be made aware of a potential increased risk for serotonin syndrome, particularly during treatment initiation and dose increases.
Source: FDA drug labels via openFDA
What next?
- Alternatives to duloxetine
- every medicine labeled for the same conditions