SNRI Drugs List: What to Know About Popular SNRIs Like Cymbalta

Serotonin and norepinephrine reuptake inhibitors (SNRIs) are a class of antidepressant medications commonly used to treat anxiety and depression. Certain SNRIs can also treat nerve-related pain conditions, such as diabetic neuropathy, fibromyalgia, and musculoskeletal pain.

SNRIs work by interacting with two brain chemicals: serotonin and norepinephrine. Also known as neurotransmitters or hormones, they’re responsible for regulating some of your body’s core functions. If your levels of serotonin or norepinephrine are too low, it can cause or contribute to emotional and behavioral disorders. SNRIs can step in and provide symptomatic relief by making these hormones more abundant.

Five SNRIs are currently available in the U.S. They all come in pill form, and some are also available as lower-cost generics. Below, we’ll break down the SNRI drugs list.

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1. Duloxetine

Duloxetine (Cymbalta) was FDA approved in 2004. It’s one of the most prescribed SNRIs on the market. Out of all SNRIs, duloxetine is approved to treat the most health conditions:

• Major depressive disorder (“depression”) in adults

• Generalized anxiety disorder (“anxiety”) in adults and children ages 7 and older

• Chronic musculoskeletal pain in adults

• Diabetic neuropathy in adults

• Fibromyalgia in adults and children ages 13 and older

You can find duloxetine as both a brand-name and generic product. It’s manufactured as a delayed-release (DR) capsule in 20 mg, 30 mg, and 60 mg doses.

Duloxetine is taken once or twice per day with or without food. The recommended duloxetine dosage depends on your age and the reason you’re taking the medication.

Keep in mind that these dosages are general recommendations. Some providers may prescribe higher doses for treating depression or anxiety, although it’s unclear if doses above 60 mg provide any additional benefit. Your healthcare provider will take into account your other conditions and potential drug interactions to determine the best dosage for you. Duloxetine should also be avoided if you have severe liver or kidney problems.

2. Venlafaxine

Venlafaxine (Effexor) is the original SNRI — it was FDA approved back in 1993. It’s the second most frequently prescribed SNRI after duloxetine. It’s approved to treat the following conditions in adults:

• Depression

• Anxiety

• Social anxiety disorder

• Panic disorder

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Venlafaxine is sometimes also a treatment option for fibromyalgia, diabetic neuropathy, and chronic musculoskeletal pain. However, taking venlafaxine for these types of pain is considered an off-label use.

Venlafaxine comes as immediate-release (IR) tablets and extended-release (XR) capsules. Only the XR version of venlafaxine, Effexor XR, is available as a brand name. The brand name for venlafaxine IR, Effexor, is no longer available, but it’s still supplied as a generic. Venlafaxine is available in the following doses:

• 25 mg IR tablet

• 37.5 mg IR tablet and XR capsule

• 50 mg IR tablet

• 75 mg tablet and XR capsule

• 100 mg IR tablet

• 150 mg XR capsule

Venlafaxine IR is usually taken two to three times daily. Venlafaxine XR is typically taken once daily because it lasts longer in your body. Both forms of venlafaxine are recommended to be taken with food. Your venlafaxine dosage will depend on your condition, but dosages tend to range from 37.5 mg to 225 mg daily. 

If you have liver or kidney problems, your healthcare provider may consider starting you on a lower dose of venlafaxine. Venlafaxine interactions can also make a difference.

3. Desvenlafaxine

Desvenlafaxine (Pristiq) was the third SNRI to become available. Approved in 2008, it’s approved to treat depression in adults. It’s also prescribed off-label to treat anxiety and hot flashes during menopause.

Desvenlafaxine only comes in ER tablets. It’s available as both a brand and generic product in 25 mg, 50 mg, and 100 mg doses.

The typical starting dosage of desvenlafaxine is 50 mg once daily, which is also usually the daily dose you stay on. Although doses up to 400 mg per day have been studied, for depression it’s unclear if there is any additional benefit for doses above 50 mg. You can take desvenlafaxine with or without food.

Desvenlafaxine, when compared to duloxetine and venlafaxine, may be a better SNRI if you have liver issues. Desvenlafaxine also has a lower risk of interactions.

4. Milnacipran

Milnacipran (Savella) was FDA approved in 2009. Unlike other SNRIs, Savella is the only SNRI that isn’t approved to treat depression. For adults, it’s approved for fibromyalgia, a chronic pain disorder.

At this time, Savella is only available as a brand-name medication. It comes as a tablet that’s taken twice daily, with or without food. The recommended dosage is 100 mg per day, but your healthcare provider may slowly increase (titrate) your dosage every few days to make sure you don’t have any unwanted side effects. For this reason, Savella is available in a starter titration pack as well as individual tablets. It’s manufactured in doses ranging from 12.5 mg to 100 mg.

Although Savella isn’t approved to treat depression in the U.S., other countries have used it for this reason. In fact, studies have shown that Savella might improve depression symptoms. Savella is also used off-label to treat musculoskeletal pain.

5. Levomilnacipran

Levomilnacipran (Fetzima) is the most recent SNRI to hit pharmacy shelves. Approved in 2013, Fetzima is similar in structure to Savella. But it’s approved for depression — not fibromyalgia.

Fetzima is made as an ER capsule that’s taken once daily with or without food. It’s a brand-name-only product that comes in four doses for adults:

• 20 mg

• 40 mg 

• 80 mg

• 120 mg

The recommended Fetzima dosage is 40 mg to 120 mg per day. Similar to Savella, it’s suggested to start taking a lower dose initially and then increase as needed. Fetzima is supplied in a starter titration pack and individual tablets. It may also have fewer interactions than other SNRIs.

However, if you have kidney problems, your Fetzima dosage will likely be lower. The maximum dose of Fetzima is 40 mg or 80 mg per day depending on your kidney health.

How do I know which SNRI is right for me?

When compared to each other, one SNRI isn’t generally considered better than the rest. It really depends on your symptoms and medical history. Each SNRI works a little differently, and they all can take a few weeks for you to see noticeable symptom improvements. 

Your healthcare provider will help you choose the best SNRI for you based on your treatment goals and preferences. Oftentimes, finding the best SNRI sometimes comes down to trial and error, affordability, and seeing what’s covered by your insurance plan (if applicable).

What are the common side effects of SNRIs?

Like other antidepressants, SNRIs can cause side effects. The most common side effects of SNRIs are:

• Constipation

• Dizziness

• Drowsiness

• Dry mouth

• Fatigue

• Increased blood pressure

• Nausea and vomiting

• Sexual problems

• Sweating

Venlafaxine is the SNRI with the highest risk of raising blood pressure, so it’s a good idea to use caution and monitor your blood pressure more frequently if you have been diagnosed with high blood pressure (hypertension) or another heart-related health condition.

If you experience any bothersome side effects while taking a SNRI, talk with your healthcare provider or pharmacist.

How to save on SNRIs

There are many ways to save on your SNRI medication. GoodRx can help you navigate your options, which may include GoodRx discounts, copay savings cards, and patient assistance programs. You can find SNRI prices as low as $9 with a free GoodRx discount.

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Written by:

Sheila McAdoo, PharmD

Sheila McAdoo, PharmD, is a licensed pharmacist in Virginia, New York, and the District of Columbia. She has worked in the pharmacy industry for 12 years and currently works as a community pharmacist.

Edited by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

Reviewed by:

Tegan Smedley, PharmD, APh

Tegan Smedley, PharmD, APh, has 10 years of experience as a pharmacist. She has worked in a variety of settings, including retail, hospital, and ambulatory care.

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