Duloxetine vs. Gabapentin: Differences and Best Uses

Duloxetine and gabapentin are both used for the treatment of diabetic neuropathy and certain types of nerve pain. The medications are similarly effective but have different side effects and may be tolerated differently by certain patients.

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Nerve pain can occur for many different reasons, and this unique type of pain is notoriously difficult to treat due to its link to the brain and central nervous system.

Patients who are suffering from different types of nerve pain responses had few effective analgesic treatment options for pain management prior to 1993, when gabapentin was introduced to the market in the United States. 

While gabapentin revolutionized treating neuropathy pain symptoms, other drugs have since been introduced to the market for the treatment of nerve pain, including duloxetine.

When considering duloxetine vs. gabapentin, there are a number of differences and best uses for each drug. 

Drug Class

Duloxetine is a generic drug that is also sold under the brand name Cymbalta and gabapentin is sold under a number of different brand names, including Neurontin, Gralise, and Horizant.

The two medications belong to different drug classes. Gabapentin actually belongs to its own class of medications called gabapentinoids, which also includes popularly prescribed Lyrics (pregabalin).

The drug is considered an anti-epileptic/anticonvulsant medication. 

Duloxetine belongs to a class of prescription drugs called serotonin-norepinephrine reuptake inhibitors (SNRIs), which are a type of antidepressant that prevent the reuptake of the serotonin and epinephrine neurotransmitters. 

Gabapentin was first approved by the U.S. Food and Drug Administration in late 1993 for use in controlling seizures, but today, approximately 83 percent of patients who have a prescription for gabapentin take the medication for something other than epilepsy.

Cymbalta was approved by the FDA in 2004.

Conditions Treated

Duloxetine and gabapentin are both used to treat a variety of different medical conditions.

While duloxetine is classified as an SNRI and is primarily used for the treatment of mental health conditions such as major depressive disorder and generalized anxiety disorder, gabapentin is most often used to treat various types of nerve pain.  

Both duloxetine and gabapentin are used for the treatment of neuropathy, and their efficacy has been proven in clinical trials, such as blind, randomized controlled trials where some patients were unknowingly given a placebo (unlike open-label studies where all parties are aware of which drugs they are being given). 

Specifically, duloxetine is used for the treatment of diabetic neuropathy, while gabapentin is used for all different types of neuropathy. Duloxetine has also been used to treat diabetic peripheral neuropathic pain.

Neuropathy

Neuropathy is a medical term that is used to describe chronic pain associated with damage to the nerves outside of the brain and spinal cord. There are many different reasons why neuropathy can occur. 

When the nerves in the body become damaged, it is common for patients to experience numbness or weakness in the extremities or other parts of the body; this condition is known as peripheral neuropathy. 

Postherpetic neuralgia is a type of neuropathy that occurs as a result of the shingles virus, which is a disease that affects adults and is caused by the same virus as chickenpox. 

Diabetic neuropathy is a nerve pain syndrome that results from uncontrolled high blood sugar in patients with diabetes; duloxetine is used for the treatment of neuropathic pain in diabetics.  

Neuropathy is notoriously difficult to treat and is often not relieved by short-term pharmacological painkillers, nonsteroidal anti-inflammatory drugs (NSAIDs), opioid pain medication, or other types of baseline pain medicine, so the introduction of drugs like gabapentin and duloxetine to the market marked a significant difference in treatment for neuropathy and showed improved quality of life in patients suffering from a high pain score. 

Other Conditions Treated by Duloxetine

In addition to painful diabetic peripheral neuropathy, duloxetine is also used for the treatment of major depressive disorder, generalized anxiety disorder, and fibromyalgia. It can be used by itself or in conjunction with tricyclic antidepressants.

Major depressive disorder is a mental health condition that is characterized for persistent feelings of intense sadness that last for a minimum of two weeks.

An estimated seven percent of Americans experienced a major depressive episode in the past year, so the condition is considered common.

Symptoms of major depressive disorder include feelings of worthlessness, guilt, and hopelessness; feeling sad, empty or tearful; difficulty concentrating; nervous energy; low energy; loss of interest in activities you used to enjoy; suicidal thoughts or behaviors; and feelings of moving or thinking in slow motion.

Generalized anxiety disorder, or GAD, is a common type of anxiety disorder that causes feelings of severe anxiety to persist for at least six months or more.

The feelings can disrupt a patient’s day to day life, and symptoms include restlessness, rapid breathing, difficulty falling asleep, panic attacks, an increased heart rate ,and trouble concentrating. 

Fibromyalgia is a painful condition that is associated with chronic widespread musculoskeletal pain throughout the body with no obvious cause for the pain.

Doctors do not know exactly what causes fibromyalgia, but common symptoms include fatigue, tension headaches, depression, sleep issues, irritable bowel syndrome (IBS), memory issues, mood issues, temporomandibular joint (TMJ) disorders, and anxiety. 

Other Conditions Treated by Gabapentin

In addition to many different types of neuropathy, gabapentin is also used for the treatment of focal seizures, osteoarthritis, and restless legs syndrome.

The medication may be prescribed off-label for the treatment of anxiety, but it is usually not prescribed on its own for the treatment of anxiety. Instead, it may be used in conjunction with other medications to treat anxiety symptoms in people with depression or bipolar disorder.

Effectiveness

There have been relatively few studies comparing the efficacy of gabapentin to duloxetine for neuropathy. However, a systematic review of the available studies found that duloxetine shows comparable efficacy and tolerability when compared to gabapentin for the treatment of diabetic neuropathy. 

Gabapentin and duloxetine both take time in order to reach full effectiveness, so patients should not get discouraged if their pain doesn’t subside quickly.

Both medications influence the brain chemistry, which does not happen overnight. In fact, patients may need to take their medication for up to four weeks before they achieve the full effects of the drug.  

Side Effects

Gabapentin and duloxetine are both associated with a number of different side effects regardless of what condition they are used to treat. Side effects of gabapentin do vary depending on whether the medication is being used to treat an adult or child.

Patient experiences with duloxetine and gabapentin vary depending on a patient’s specific biochemistry and medical history, so some people may find that they receive better pain relief from one medication than the other. 

Gabapentin

Side effects associated with gabapentin generally fall into two categories: side effects requiring medical attention and side effects that do not require medical attention.

Side effects associated with gabapentin that do not require medical attention include, but are not limited to:

  • Blurred vision
  • Hoarseness
  • Lack or loss of strength
  • Lower back or side pain
  • Swelling of the hands, feet, or lower legs
  • Cold or flu-like symptoms
  • Delusions
  • Dementia
  • Increased appetite
  • Back pain
  • Bloated or full feeling
  • Trembling or shaking
  • Accidental injury
  • Change in vision
  • Change in walking or balance
  • Clumsiness or unsteadiness
  • Body aches or pain
  • Burning, itching or dry eyes
  • Viral infection
  • Fever
  • Nausea and vomiting
  • Congestion
  • Constipation
  • Trouble speaking
  • Hostility
  • Jerky movements
  • Drowsiness

Adverse events associated with gabapentin and requiring medical attention include:

  • Chest pain
  • Chills
  • Cough
  • Clumsiness or unsteadiness
  • Continuous uncontrollable eye movements
  • Black tarry stools
  • Pain or swelling in the extremities
  • Painful or difficult urination
  • Depression, irritability, or other mood or mental changes
  • Fever
  • Loss of memory
  • Swollen glands
  • Unusual bleeding or bruising
  • Trouble breathing
  • Sore throat
  • Sores, ulcers, or white spots on the lips or in the mouth
  • Anxiety in children
  • Concentration issues in children
  • Unusual tiredness or weakness
  • Aggressive behavior in children
  • False sense of security in children
  • Hyperactivity or increase in body movements in children
  • Crying in children
  • Depression in children
  • Restlessness in children
  • Distrust in children
  • Rapidly changing moods in children
  • Overreacting/being overly emotional in children

Duloxetine

Common side effects associated with duloxetine include:

Less common adverse effects that may occur in long-term users of duloxetine include:

  • Sexual dysfunction
  • Frequent urination
  • Colitis
  • Liver disease or damage in individuals who mix the medication with alcohol

If you experience any of these side effects or withdrawal symptoms, seek medical advice from your healthcare provider.

Summary

Gabapentin and duloxetine have been found to be equally effective in the treatment of diabetic neuropathy in patients suffering from this type of nerve pain, and the medications are similarly tolerated.

Both drugs have a wide variety of other applications within neurology and other disciplines and cause different side effects.

Both gabapentin and duloxetine are generic medications for pain reduction that are covered by most types of commercial health insurance, Medicaid and Medicare. 

References, Studies and Sources:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2663537/ 
https://www.medicalnewstoday.com/articles/147963 
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5745655/ 
https://www.mayoclinic.org/diseases-conditions/generalized-anxiety-disorder/symptoms-causes/syc-20360803

medically reviewed and fact checked
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