Highlights:
- Duloxetine, also known as Cymbalta, is a serotonin-norepinephrine reuptake inhibitor (SNRI) used to treat depression and anxiety.
- Duloxetine can also be used to manage chronic pain, diabetic neuropathy, fibromyalgia, and more.
- As with any medication, there is a potential for side effects and drug interactions, some of which may be serious.
- Antidepressants are powerful medications that should only be used with close medical supervision.
Mental health impacts one in five American adults and touches the lives of countless more. Many people are able to manage conditions like depression and anxiety with a combination of therapy and medications — including duloxetine.
This medication, also sold under the brand name Cymbalta, can improve the quality of life for people managing mental health conditions as well as people with chronic pain. Learn about duloxetine and understand the risks and benefits as part of your treatment plan.
What Is Cymbalta (Duloxetine) and What Is It Used For?
Duloxetine is a common drug used to treat depression and anxiety disorders. Approved by the FDA in the early 2000s, duloxetine is often used as a first-line treatment for mental health conditions, along with therapy and lifestyle changes.
Duloxetine is a versatile medication with off-label uses that include chronic pain management, chemotherapy-induced peripheral neuropathy treatment, and even relief from stress urinary incontinence. The term “off-label” means that this drug has not been approved for these conditions and may not be effective.
How Does Duloxetine Work?
Duloxetine belongs to a class of drugs known as serotonin-norepinephrine reuptake inhibitors (SNRIs). Serotonin and norepinephrine are chemical messengers that help regulate emotions, pain perception, and many other signals in the brain. Duloxetine works by preventing the reabsorption (reuptake) of these neurotransmitters, leaving more of these chemicals available to send positive signals in the brain.
By balancing these neurotransmitters and preventing their reabsorption back into the nerve cells, Cymbalta helps elevate mood, ease anxiety, and reduce the intensity of pain.
What Formulas Are Available for Duloxetine?
Duloxetine is available in delayed-release capsule form with varying dosages. It comes in three strengths: 20, 30, and 60 milligrams. The capsules are designed to release the medication slowly over time, which can help reduce side effects like nausea and upset stomach.
Duloxetine Dosage and Administration
The normal starting dose for duloxetine is typically 20 milligrams per day. This can be increased up to 60 milligrams per day if needed but will vary based on the condition being treated, age, and other factors. Always follow your healthcare provider’s instructions on how to take medication.
How Should I Take Duloxetine?
Your doctor will provide specific instructions about duloxetine and how to take it appropriately. Most people take it once or twice a day, with or without food.
Regardless of the way you take duloxetine, be sure to take this medication consistently at the same time each day to maintain stable levels in your body. Don’t stop Cymbalta suddenly because this can lead to withdrawal symptoms or worsening depression.
What Are the Potential Side Effects of Duloxetine?
Like all medications, Cymbalta may have side effects. Suicidal thoughts and behavior are a known risk with this medication, especially for young adults. It’s critically important to seek professional help if you experience these effects.
If you experience any of the side effects on the lists below, talk to your doctor about your experience and have your treatment plan adjusted as necessary.
Common Side Effects of Duloxetine
- Nausea
- Dry mouth
- Drowsiness
- Fatigue
- Dizziness
- Headache
- Constipation
- Insomnia
- Sweating
- Loss of appetite
Less Common but More Serious Side Effects
- Severe skin reactions
- Increased blood pressure
- Glaucoma
- Urinary changes
- Increased or unexplained bruising or bleeding
- Severe gastrointestinal issues
- Liver damage
What Should I Avoid When Taking Duloxetine?
Duloxetine can cause drowsiness or dizziness, so there are some precautions you should follow when taking this drug. You should avoid or reduce alcohol because it can increase this medication’s sedative effects. Be careful when driving or operating machinery until you know how your medication affects you.
What Should I Do If I Miss a Dose of Duloxetine?
If you miss a dose of duloxetine, take it as soon as you remember. However, if it’s almost time for your next dose, skip the missed one and continue with your regular schedule. Don’t take an extra dose to make up for a missed one.
What Should I Do If I Overdose on Duloxetine?
If you suspect an overdose, seek emergency medical assistance or call your local poison control center right away.
Symptoms of an overdose can include:
- Nausea, diarrhea, or vomiting
- Fever
- Muscle spasms or jerking extremities
- Seizures
- Shivering
- Sweating
- Fainting
- Irregular heartbeat
What Precautions Should I Take With Duloxetine?
Before taking Cymbalta, there are several special precautions to discuss with your doctor.
- Allergy check. Inform your doctor about any allergies to duloxetine and any other medicines.
- MAOI interactions. Tell your doctor if you’re taking or have recently taken monoamine oxidase inhibitors (MAOIs) or thioridazine. MAOI/duloxetine interactions can be life-threatening. These medications should not be mixed with duloxetine, and there should be a waiting period between stopping MAOIs and beginning duloxetine.
- Complete medication list. Provide your doctor with a list of all your current prescriptions, over-the-counter medications, and vitamins. Let your doctor know about any supplements or herbal products you use, especially St. John’s wort or tryptophan.
- Medical and lifestyle history. Disclose any history of heavy alcohol use, drug or substance misuse, and medical conditions like high blood pressure, heart attack, or diabetes.
- Pregnancy and breastfeeding. Duloxetine can affect unborn babies and newborns, so be sure to inform your doctor if you are pregnant, may become pregnant, or breastfeeding.
- Surgery or dental procedures. Notify your healthcare providers if you’re planning on having surgery while taking Cymbalta. This drug can interact with anesthesia.
- Awareness of duloxetine’s effects. Understand that this drug can cause drowsiness, dizziness, or affect your judgment and coordination. Be cautious with activities like driving.
- Postural hypotension. Duloxetine can cause a sudden drop in blood pressure when standing. Your doctor may recommend rising slowly from lying positions to prevent these side effects.
- Risk of angle-closure glaucoma. Patients with a history of glaucoma should be monitored because duloxetine can increase the risk of angle-closure glaucoma, a rare but serious side effect. Consider having an eye exam before starting duloxetine and understand your risk. Notify your doctor if you notice symptoms like nausea, eye pain, vision changes, or eye redness.
- Risk of worsening depression or suicidal thoughts. In some people, especially young adults, duloxetine (Cymbalta) can increase suicidal thoughts and actions. If you experience these effects, seek professional help right away.
Contraindications
Some people should not take duloxetine. Others should use it with caution under close medical supervision.
Keep in mind that these lists are general guidelines. In special cases, doctors may feel the benefits of a particular medication outweigh the risks, so if you are in one of these groups, talk to your doctor about your personal situation.
Who Should Not Take Duloxetine?
- People with a known allergy to duloxetine or its ingredients
- People with uncontrolled or untreated narrow-angle glaucoma
- People who are taking or have recently taken monoamine oxidase inhibitors (MAOIs)
Who Should Take Duloxetine With Caution?
- People with a history of liver or kidney disease
- People with high blood pressure or heart disease
- People with a history of bipolar disorder or mania
- People with a history of bleeding disorders and those who are taking blood thinners
- Pregnant and breastfeeding women
- People with a history of alcohol abuse
Are There Any Other Potential Drug Interactions With Duloxetine?
Duloxetine can interact with several other medications. The severity of these interactions can vary, and some may require dosage adjustments or avoiding certain medications altogether.
Here are some categories of medications and other substances to be aware of.
Medications
- Monoamine oxidase inhibitors (MAOIs). This is a serious and potentially life-threatening interaction. Avoid taking MAOIs within two weeks of stopping duloxetine and at least five weeks before starting duloxetine. Examples include isocarboxazid, phenelzine, and tranylcypromine.
- Serotonin and norepinephrine reuptake inhibitors (SNRIs). Combining duloxetine with other SNRIs, including venlafaxine, desvenlafaxine, and levomilnacipran, can increase the risk of serotonin syndrome, a potentially serious condition with symptoms like fever, confusion, and muscle tremors.
- Selective serotonin reuptake inhibitors (SSRIs). Similar to SNRIs, combining duloxetine with SSRIs like fluoxetine, paroxetine, and sertraline can increase the risk of serotonin syndrome.
- Nonsteroidal anti-inflammatory drugs (NSAIDs). Taking NSAIDs like ibuprofen, naproxen, or aspirin with duloxetine can increase the risk of bleeding.
- Opioids: Combining duloxetine with opioids like oxycodone, morphine, or codeine can increase the risk of drowsiness, dizziness, and difficulty breathing.
- Anticoagulants. Duloxetine can increase the effects of anticoagulant medications (blood thinners) like warfarin, heparin, and rivaroxaban, leading to an increased risk of bleeding.
- Antipsychotics. Duloxetine can increase the levels of some antipsychotic medications, such as haloperidol and risperidone, potentially leading to side effects like drowsiness and dizziness.
- Cimetidine. This medication can increase the levels of duloxetine in the body, increasing the risk of side effects.
Other Substances
- Alcohol: Duloxetine can intensify the effects of alcohol, increasing the risk of drowsiness, dizziness, and liver damage.
- St. John’s wort: This herbal supplement can interact with duloxetine and increase the risk of serotonin syndrome.
No list of potential drug interactions is complete, so let your provider know if you experience any new or unusual symptoms after taking this medication. For a complete list of known interactions with this medication, visit the Drugs.com Drug Interaction Checker.
Duloxetine Can Support Mental Health and Pain Management
Whether you’re managing mental health conditions like depression or anxiety, or living with the chronic pain of diabetic neuropathy or fibromyalgia, you may find relief with duloxetine (Cymbalta).
However, duloxetine has the potential for serious side effects and interactions. Always seek professional medical advice before taking this or any medication. If you’re taking duloxetine, be sure to inform your provider right away if you experience any new or unusual symptoms.
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This information is intended for general informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or medication.
