Originally Posted by Dr House
Id suggest Cymbalta over Effexor XR, cause of the terrible withdrawals and short half life of Effexor XR. Both are SNRIs though Cymbalta can be pricey if you don't got insurance.
Personally I'd favour Effexor XR over Cybalta for the following reasons;
1. Cymbalta is potentially liver toxic, Effexor is not.
2. Effexor is stronger (probably due in part to the fact that it has an active metabolite desvenlafaxine which also acts as an SNRI) Cymbalta by contrast lacks any active metabolites.
3. The XR version should route out the half life problem, for me it takes approximately 30 hours for withdrawls to start kicking in. Cymbalta also has a short half life and comes as a controlled release formula, so it offers no benefit over this.
4. effexor has a more favourable drug-drug interaction profile, due to it's lack of inhibition of CYP enzyme system and it's low protein binding. Cymbalta by contrast is highly protein bound and is an inhibitor of certain CYP enzymes.
5. Effexor is cheaper due to the fact that generic versions are available.
6. Effexor has been around for alot longer, and hence there is alot more medical and clinical experience with it and it's possible long term outcomes and effects. Cymbalta by contrast is relatively new.