Pregabalin 50 mg + Duloxetine 20 mgCymvanta-PG

How Cymvanta-PG works

This is a combination, and each component works through a different route. Duloxetine blocks the reuptake of both serotonin and noradrenaline. The noradrenaline component is what gives it an effect on physical pain as well as on mood, because the descending pathways that damp pain signals run on noradrenaline. That is why it is licensed for diabetic neuropathic pain in its own right, and why pairing it with pregabalin covers nerve pain from two directions at once. Pregabalin binds the alpha-2-delta subunit of calcium channels on overactive nerve endings, reducing the release of the neurotransmitters that carry pain signals. Neuropathic pain is not ordinary pain: the nerve itself is damaged and firing without cause, so an ordinary painkiller does very little. Quietening that misfiring is what makes the difference, and it is why this class works where NSAIDs fail. Pregabalin is absorbed far more predictably than gabapentin -- its absorption does not saturate as the dose rises -- so the response is more consistent from patient to patient. Attacking the same problem by two routes usually achieves more at lower doses of each than pushing one component higher.