Generic name: duloxetine (du LOX e teen)
Brand name: Cymbalta, Irenka
Cymbalta (duloxetine) is a selective serotonin and norepinephrine reuptake inhibitor antidepressant (SSNRI). Duloxetine affects chemicals in the brain that may be unbalanced in people with depression.
Cymbalta is used to treat major depressive disorder in adults. It is also used to treat general anxiety disorder in adults and children who are at least 7 years old.
Cymbaltais also used in adults to treat nerve pain caused by diabetes (diabetic neuropathy), or chronic muscle or joint pain (such as low back pain and osteoarthritis pain).
Cymbaltais also used to treat fibromyalgia (a chronic pain disorder) in adults and children at least 13 years old.
Warnings
Do not take Cymbalta within 5 days before or 14 days after you have used a MAO inhibitor, such as isocarboxazid, linezolid, phenelzine, rasagiline, selegiline, or tranylcypromine, or methylene blue injection.
Cymbalta should not be used if you have narrow angle glaucoma.
Some young people have thoughts about suicide when first taking an antidepressant. Stay alert to changes in your mood or symptoms. Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.
Do not stop using Cymbalta without first talking to your doctor.
Before taking this medicine
You should not use Cymbalta if you are allergic to duloxetine.
Do not take Cymbalta within 5 days before or 14 days after you have used an MAO inhibitor, such as isocarboxazid, linezolid, phenelzine, rasagiline, selegiline, tranylcypromine, or methylene blue injection. A dangerous drug interaction could occur.
Some medicines can interact with duloxetine and cause a serious condition called serotonin syndrome. Be sure your doctor knows if you also take stimulant medicine, opioid medicine, herbal products, or medicine for depression, mental illness, Parkinson's disease, migraine headaches, serious infections, or prevention of nausea and vomiting. Ask your doctor before making any changes in how or when you take your medications.
To make sure Cymbalta is safe for you, tell your doctor if you have ever had:
- heart problems, high blood pressure;
- liver or kidney disease;
- seizures or epilepsy;
- a bleeding or blood clotting disorder;
- high blood pressure;
- narrow-angle glaucoma;
- bipolar disorder (manic depression);
- drug addiction or suicidal thoughts; or
- if you drink large amounts of alcohol.
Some young people have thoughts about suicide when first taking an antidepressant. Your doctor should check your progress at regular visits. Your family or other caregivers should also be alert to changes in your mood or symptoms.
Ask your doctor about taking Cymbalta if you are pregnant. Taking this medicine during late pregnancy may cause excessive bleeding during childbirth, or serious medical complications in the baby. However, if not treated during pregnancy, conditions such as depression or fibromyalgia may cause complications in the baby or the mother.
Tell your doctor right away if you become pregnant while taking Cymbalta. Do not start or stop taking this medicine without your doctor's advice. Your name may be listed on a pregnancy registry to track the effects of duloxetine on the baby.
If you are breastfeeding, tell your doctor if you notice drowsiness, feeding problems, and slow weight gain in the nursing baby.
How should I take Cymbalta?
Take Cymbalta exactly as prescribed by your doctor. Follow all directions on your prescription label. Do not take this medicine in larger or smaller amounts or for longer than recommended.
You may take Cymbalta with or without food.
Do not crush, chew, break, or open an extended-release capsule. Swallow it whole.
It may take up to 4 weeks before your symptoms improve. Keep using the medication as directed and tell your doctor if your symptoms do not improve.
Your blood pressure will need to be checked often.
Do not stop using Cymbalta suddenly, or you could have unpleasant symptoms (such as dizziness, vomiting, agitation, sweating, confusion, numbness, tingling, or electric shock feelings). Ask your doctor how to safely stop using this medicine.
Store Cymbalta at room temperature away from moisture and heat.
What happens if I miss a dose?
Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.
What happens if I overdose?
Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.
Overdose symptoms may include vomiting, dizziness or drowsiness, seizures, fast heartbeats, fainting, or coma.
What to avoid
Avoid driving or hazardous activity until you know how duloxetine will affect you. Your reactions could be impaired. Dizziness or fainting can cause falls, accidents, or severe injuries.
Avoid getting up too fast from a sitting or lying position, or you may feel dizzy.
Avoid drinking alcohol. It may increase your risk of liver damage.
Ask your doctor before taking a nonsteroidal anti-inflammatory drug (NSAID) such as aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib (Celebrex), diclofenac, indomethacin, meloxicam, and others. Using an NSAID with duloxetine may cause you to bruise or bleed easily.
Cymbalta side effects
Get emergency medical help if you have signs of an allergic reaction to Cymbalta: skin rash or hives; difficulty breathing; swelling of your face, lips, tongue, or throat.
Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.
Call your doctor at once if you have:
- a light-headed feeling, like you might pass out;
- vision changes, eye pain or swelling, eye redness;
- easy bruising, unusual bleeding;
- painful or difficult urination;
- a seizure;
- manic episodes - racing thoughts, increased energy, decreased need for sleep, risk-taking behavior, being agitated or talkative.
- right-sided upper stomach pain, itching, dark urine, yellowing of the skin or eyes (signs of liver problems);
- headache, confusion, slurred speech, severe weakness, vomiting, loss of coordination, feeling unsteady (signs of low levels of sodium in the body); or
- severe skin reaction - fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain, followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling.
Seek medical attention right away if you have symptoms of serotonin syndrome, such as:agitation, hallucinations, fever, sweating, shivering, fast heart rate, muscle stiffness, twitching, loss of coordination, nausea, vomiting, or diarrhea.
Older adults may be more sensitive to the side effects of this medicine.
Common Cymbalta side effects may include:
- dry mouth;
- drowsiness, dizziness;
- tired feeling;
- nausea, constipation, loss of appetite, weight loss; or
- increased sweating.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
What other drugs will affect Cymbalta?
Many drugs can interact with duloxetine. Not all possible interactions are listed here. Tell your doctor about all your current medicines and any you start or stop using, especially:
- any other antidepressant;
- cimetidine;
- St. John's wort;
- theophylline;
- tryptophan (sometimes called L-tryptophan);
- an amphetamine - Adderall, Focalin, Vyvanse, Ritalin, Concerta, Strattera, and others;
- an antibiotic - ciprofloxacin, enoxacin;
- a blood thinner - warfarin, Coumadin, Jantoven;
- heart rhythm medication - flecainide, propafenone, quinidine, and others;
- opioid medicine - fentanyl, tramadol;
- medicine to treat mood disorders, thought disorders, or mental illness - buspirone, lithium, thioridazine, and many others; or
- migraine headache medicine - sumatriptan, rizatriptan, zolmitriptan, and others.
This list is not complete and many other drugs can interact with duloxetine. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Give a list of all your medicines to any healthcare provider who treats you.