Table of ContentsView AllTable of ContentsHow SNRIs Work and Their UsesExamples of Common SNRIsSNRIs vs. SSRIs: Which Work Better?Side Effects of SNRIsSafety PrecautionsWhen to Talk to Your Healthcare ProviderSummary
Table of ContentsView All
View All
Table of Contents
How SNRIs Work and Their Uses
Examples of Common SNRIs
SNRIs vs. SSRIs: Which Work Better?
Side Effects of SNRIs
Safety Precautions
When to Talk to Your Healthcare Provider
Summary
Serotonin-norepinephrine reuptake inhibitors (SNRIs) are a class of antidepressants that block the reuptake of both serotonin and norepinephrine in the body. They are taken to treatdepression,anxietydisorders, nerve pain, muscle pain, andfibromyalgia.
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SNRIs treat various conditions, including:
SNRIs are taken off-label in adults for:
There are several SNRIs. They vary based on how they work and what they treat. Some common SNRIs include:
Cymbalta (duloxetine)and Drizalma Sprinkle (duloxetine)which are used to treat:
Effexor (venlafaxine)and Effexor XR (venlafaxine),which are taken to manage:
Fetzima (levomilnacipran),Pristiq (desvenlafaxine),and Khedezla (desvenlafaxine)are also common SNRIs and are used to treat major depressive disorder. Savella (milnacipran)is another common SNRI and is used to manage fibromyalgia.
Duloxetine RecallStarting in October 2024, over 200,000 bottles of duloxetine delayed-release capsules were recalled over concerns about the presence of nitrosamines, which can increase the risk of cancer.If you take duloxetine, check your medication packaging to see if it was part of the affected lots or call your pharmacist to find out. You should also contact your prescriber, as abruptly stopping a medication like duloxetinecan be dangerous.The recalled lots have expiration dates from November 2024 to December 2025. You can check the lot numbers in the FDA enforcement reports released inOctoberandDecember.
Duloxetine Recall
Starting in October 2024, over 200,000 bottles of duloxetine delayed-release capsules were recalled over concerns about the presence of nitrosamines, which can increase the risk of cancer.If you take duloxetine, check your medication packaging to see if it was part of the affected lots or call your pharmacist to find out. You should also contact your prescriber, as abruptly stopping a medication like duloxetinecan be dangerous.The recalled lots have expiration dates from November 2024 to December 2025. You can check the lot numbers in the FDA enforcement reports released inOctoberandDecember.
Starting in October 2024, over 200,000 bottles of duloxetine delayed-release capsules were recalled over concerns about the presence of nitrosamines, which can increase the risk of cancer.If you take duloxetine, check your medication packaging to see if it was part of the affected lots or call your pharmacist to find out. You should also contact your prescriber, as abruptly stopping a medication like duloxetinecan be dangerous.
The recalled lots have expiration dates from November 2024 to December 2025. You can check the lot numbers in the FDA enforcement reports released inOctoberandDecember.
Based on clinical research, SNRIs show superior antidepressant activity to SSRIs, especially in more severe depression.
SSRIs and SNRIs are both effective in treating anxiety disorders with no significant differences in efficacy.Higher doses of SSRIs within the therapeutic range are associated with greater treatment benefits for anxiety, whereas higher doses of SNRIs are not.
SNRIs are more popular because of their better tolerability and fewer adverse effects than SSRIs.
Research also demonstrates that SNRIs are significantly more effective than SSRIsin treating painful physical symptoms associated with depressionand in treating fibromyalgia.
How Long Do SNRIs Take to Work?
Although SNRIs start working in the body only after a few days to inhibit neurotransmitter reuptake, there is a delay in when patients start to reap clinical benefits.Many don’t notice a change in depression and anxiety symptomsfor several weeks.
The most common side effects seen with SNRIs include:
Of note, there are other potential side effects, so be sure to make note of any significant health changes you may encounter after starting your medication. Contact your healthcare provider or pharmacist for medical advice about side effects.
SNRIs, like all medications, carry certain risks and precautions. Talk to your healthcare provider about the risks and safety precautions associated with SNRIs. Below are some of the risks and precautions your healthcare provider may discuss with you:
Risk of Suicidal Thoughts or Behaviors
SNRIs have aboxed warningfrom the U.S. Food and Drug Administration (FDA) because of their potential to increase the risk of suicidal thoughts and behaviors, especially in some children, teenagers, or young adults within the first few months of treatment or when the dose is changed.
Those who have or have a family history ofbipolar illnessor suicidal thoughts or actions may have a particularly high risk of suicidal thoughts or actions.
Call your healthcare provider (or 911 in cases of emergency) right away if you have any of the following symptoms:
Keep all follow-up visits with your healthcare provider and call between visits if you are worried about symptoms.
If you are experiencing symptoms of depression, talk to your healthcare provider. If you or someone you know is in suicidal crisis or emotional distress, you can call 988 for the Suicide & Crisis Lifeline.The line is open 24 hours a day, seven days a week in the United States, providing free, confidential support. You can also call 911 and go to the nearest emergency room if you or someone you know is in a suicidal crisis.
If you are experiencing symptoms of depression, talk to your healthcare provider. If you or someone you know is in suicidal crisis or emotional distress, you can call 988 for the Suicide & Crisis Lifeline.
The line is open 24 hours a day, seven days a week in the United States, providing free, confidential support. You can also call 911 and go to the nearest emergency room if you or someone you know is in a suicidal crisis.
Serotonin Syndrome
SNRIs carry the risk of a serious condition called serotonin syndrome, particularly when taken with other medicines like:
Use During Pregnancy or Breastfeeding
Pregnancy
Taking SNRIs during pregnancy may also cause an increased risk of bleeding after your delivery, especially if taken within one month before delivery.
Breastfeeding
SNRI Withdrawal
Stopping SNRI use suddenly can lead to adverse effects. That’s why it is important to consult with your doctor about a strategy for gradually stopping your medicine.
Some withdrawal symptoms include:
Ask your doctor before stopping your medicine. Your healthcare provider may want to reduce your dose slowly.
Drug Interactions
There are a number of drug interactions you should take into consideration as you talk with your doctors about starting on SNRIs. For instance, taking SNRIs with MAOIs increases the risk of serotonin syndrome. Therefore, you cannot start MAOIs within seven days of stopping SNRIs. You cannot start SNRIs within 14 days of stopping an MAOI.
Some examples of MAOIs include:
Other drugs that can interact with SNRIs include:
Inform your healthcare provider if you are taking or plan to take any prescription or over-the-counter drugs because there is potential for interactions.
Who Should Avoid Taking SNRIs?
There are some cases in which avoiding SNRIs altogether may be best. If you are allergic to your medicine or any of its ingredients, talk to your doctor about other alternatives.
If you are taking a MAOI, including the antibiotic linezolid or intravenous methylene blue, you should avoid taking SNRIs.
If you are allergic to the medicine or are on MAOI, talk with your doctor to develop a plan.
If you are taking SNRIs and have hallucinations, suicidal thoughts, irregular heartbeat, skin blisters or rash, hives, or chest pain, you should consult your healthcare provider about switching to a different treatment.
It’s important to note that SNRIs may take several weeks to improve your symptoms.It’s crucial to have patience and not abruptly stop using SNRIs, which could lead to unpleasant symptoms.
SNRIs are more effective than SSRIs in treating severe depression, fibromyalgia, and painful physical symptoms associated with depression. They have fewer side effects and better tolerability than SSRIs.However, they carry certain risks and precautions, so it’s important to talk to a healthcare provider before taking SNRIs or any other medication.
14 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Sansone RA, Sansone LA.Serotonin norepinephrine reuptake inhibitors: a pharmacological comparison.Innov Clin Neurosci.2014 Mar;11(3-4):37-42.U.S. Food and Drug Administration.Cymbalta label.U.S. Food and Drug Administration.Drizalma label.U.S. Food and Drug Administration.Effexor label.U.S. Food and Drug Administration.Fetzima label.U.S. Food and Drug Administration.Pristiq label.U.S. Food and Drug Administration.Khedezla label.U.S. Food and Drug Administration.Savella label.Food and Drug Administration.What to Know and Do About Possible Nitrosamines in Your Medication.Machado M, Einarson TR.Comparison of SSRIs and SNRIs in major depressive disorder: a meta-analysis of head-to-head randomized clinical trials.J Clin Pharm Ther.2010 Apr;35(2):177-88. doi: 10.1111/j.1365-2710.2009.01050.x.Stahl SM, Grady MM, Moret C, Briley M.SNRIs: the pharmacology, clinical efficacy, and tolerability in comparison with other classes of antidepressants.CNS Spectrums. 2005;10(9):732-747. doi:10.1017/S1092852900019726Jakubovski E, Johnson JA, Nasir M, et al.Systematic review and meta-analysis: dose–response curve of SSRIs and SNRIs in anxiety disorders.Depress Anxiety. 2019; 36: 198–212. doi: 10.1002/da.22854.Lee YC, Chen PP.A review of SSRIs and SNRIs in neuropathic pain.Expert Opin Pharmacother.2010 Dec;11(17):2813-25. doi: 10.1517/14656566.2010.507192.Sussman N.SNRIs versus SSRIs: mechanisms of action in treating depression and painful physical symptoms.J Clin Psychiatry.2003;5 Suppl 7:19–26
14 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Sansone RA, Sansone LA.Serotonin norepinephrine reuptake inhibitors: a pharmacological comparison.Innov Clin Neurosci.2014 Mar;11(3-4):37-42.U.S. Food and Drug Administration.Cymbalta label.U.S. Food and Drug Administration.Drizalma label.U.S. Food and Drug Administration.Effexor label.U.S. Food and Drug Administration.Fetzima label.U.S. Food and Drug Administration.Pristiq label.U.S. Food and Drug Administration.Khedezla label.U.S. Food and Drug Administration.Savella label.Food and Drug Administration.What to Know and Do About Possible Nitrosamines in Your Medication.Machado M, Einarson TR.Comparison of SSRIs and SNRIs in major depressive disorder: a meta-analysis of head-to-head randomized clinical trials.J Clin Pharm Ther.2010 Apr;35(2):177-88. doi: 10.1111/j.1365-2710.2009.01050.x.Stahl SM, Grady MM, Moret C, Briley M.SNRIs: the pharmacology, clinical efficacy, and tolerability in comparison with other classes of antidepressants.CNS Spectrums. 2005;10(9):732-747. doi:10.1017/S1092852900019726Jakubovski E, Johnson JA, Nasir M, et al.Systematic review and meta-analysis: dose–response curve of SSRIs and SNRIs in anxiety disorders.Depress Anxiety. 2019; 36: 198–212. doi: 10.1002/da.22854.Lee YC, Chen PP.A review of SSRIs and SNRIs in neuropathic pain.Expert Opin Pharmacother.2010 Dec;11(17):2813-25. doi: 10.1517/14656566.2010.507192.Sussman N.SNRIs versus SSRIs: mechanisms of action in treating depression and painful physical symptoms.J Clin Psychiatry.2003;5 Suppl 7:19–26
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Sansone RA, Sansone LA.Serotonin norepinephrine reuptake inhibitors: a pharmacological comparison.Innov Clin Neurosci.2014 Mar;11(3-4):37-42.U.S. Food and Drug Administration.Cymbalta label.U.S. Food and Drug Administration.Drizalma label.U.S. Food and Drug Administration.Effexor label.U.S. Food and Drug Administration.Fetzima label.U.S. Food and Drug Administration.Pristiq label.U.S. Food and Drug Administration.Khedezla label.U.S. Food and Drug Administration.Savella label.Food and Drug Administration.What to Know and Do About Possible Nitrosamines in Your Medication.Machado M, Einarson TR.Comparison of SSRIs and SNRIs in major depressive disorder: a meta-analysis of head-to-head randomized clinical trials.J Clin Pharm Ther.2010 Apr;35(2):177-88. doi: 10.1111/j.1365-2710.2009.01050.x.Stahl SM, Grady MM, Moret C, Briley M.SNRIs: the pharmacology, clinical efficacy, and tolerability in comparison with other classes of antidepressants.CNS Spectrums. 2005;10(9):732-747. doi:10.1017/S1092852900019726Jakubovski E, Johnson JA, Nasir M, et al.Systematic review and meta-analysis: dose–response curve of SSRIs and SNRIs in anxiety disorders.Depress Anxiety. 2019; 36: 198–212. doi: 10.1002/da.22854.Lee YC, Chen PP.A review of SSRIs and SNRIs in neuropathic pain.Expert Opin Pharmacother.2010 Dec;11(17):2813-25. doi: 10.1517/14656566.2010.507192.Sussman N.SNRIs versus SSRIs: mechanisms of action in treating depression and painful physical symptoms.J Clin Psychiatry.2003;5 Suppl 7:19–26
Sansone RA, Sansone LA.Serotonin norepinephrine reuptake inhibitors: a pharmacological comparison.Innov Clin Neurosci.2014 Mar;11(3-4):37-42.
U.S. Food and Drug Administration.Cymbalta label.
U.S. Food and Drug Administration.Drizalma label.
U.S. Food and Drug Administration.Effexor label.
U.S. Food and Drug Administration.Fetzima label.
U.S. Food and Drug Administration.Pristiq label.
U.S. Food and Drug Administration.Khedezla label.
U.S. Food and Drug Administration.Savella label.
Food and Drug Administration.What to Know and Do About Possible Nitrosamines in Your Medication.
Machado M, Einarson TR.Comparison of SSRIs and SNRIs in major depressive disorder: a meta-analysis of head-to-head randomized clinical trials.J Clin Pharm Ther.2010 Apr;35(2):177-88. doi: 10.1111/j.1365-2710.2009.01050.x.
Stahl SM, Grady MM, Moret C, Briley M.SNRIs: the pharmacology, clinical efficacy, and tolerability in comparison with other classes of antidepressants.CNS Spectrums. 2005;10(9):732-747. doi:10.1017/S1092852900019726
Jakubovski E, Johnson JA, Nasir M, et al.Systematic review and meta-analysis: dose–response curve of SSRIs and SNRIs in anxiety disorders.Depress Anxiety. 2019; 36: 198–212. doi: 10.1002/da.22854.
Lee YC, Chen PP.A review of SSRIs and SNRIs in neuropathic pain.Expert Opin Pharmacother.2010 Dec;11(17):2813-25. doi: 10.1517/14656566.2010.507192.
Sussman N.SNRIs versus SSRIs: mechanisms of action in treating depression and painful physical symptoms.J Clin Psychiatry.2003;5 Suppl 7:19–26
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