Medication and Treatment Reviews

Cymbalta

Generic Name: Duloxetine HCL

Uses

Cymbalta is a once-daily serotonin and norepinephrine reuptake inhibitor (SNRI) medication primarily used to treat depression and anxiety disorders in adolescents and adults. Its safety has not been established for children.

It may help to relieve common symptoms of depression including disinterest in typical activities, impaired concentration, change in weight or appetite, and insomnia.

Cymbalta is also used to treat nerve pain from diabetes, fibromyalgia, and chronic musculoskeletal pain.

How to Use Cymbalta

Before starting or refilling a Cymbalta prescription, read the medication guide included with your pills, as it may be updated with new information.

This guide should not replace a conversation with your doctor, who has a holistic view of your medical history, other diagnoses, and other prescriptions. If you have questions, ask your doctor or pharmacist before you begin taking the medication.

Dosage

As with all medications, follow your Cymbalta prescription instructions exactly. Cymbalta is taken orally, with or without food, once daily, in the morning or evening. Capsules should be swallowed whole with water or other liquids. Capsules should never be opened, crushed, or chewed. If you are unable to swallow the capsule, discuss a different medication with your doctor.

Capsules are available in 20mg, 30mg, and 60mg dosages.

The optimal dosage varies based on the condition treated, but should not exceed 120mg per day. If you are over 60 years of age, or have certain health conditions, your doctor may recommend a lower dosage.

Your doctor may incrementally adjust your daily dosage until you experience the best response — that is, until you find the lowest dosage at which you experience the greatest improvement in symptoms without side effects.

During treatment, your doctor should evaluate an adolescent’s height and weight because Cymbalta can cause changes in appetite. If any problems are found, your doctor may recommend discontinuing treatment.

When discontinuing treatment, or decreasing dosage, patients should work with a doctor to gradually taper the level of medication. Stopping Cymbalta suddenly can create withdrawal symptoms including dizziness, nausea, headache, anxiety, fatigue, sleep disturbance, and prickling sensations in hands or feet.

Side Effects

The most common side effects of Cymbalta are similar to those associated with other SNRIs, like Effexor, and are as follows: nausea, dry mouth, sleepiness, fatigue, loss of appetite, increased sweating, and dizziness.

Other serious side effects include increased risk of suicidality or manic episode, vision problems, seizures, changes in blood pressure, low salt levels in the blood, trouble with urination, and changes in appetite or weight. Patients should be monitored and observed closely for worsening depression, changes in behavior, or suicidality, especially when starting treatment or changing dosage.

Taking Cymbalta may impair your or your teenager’s ability to drive, operate machinery, or perform other potentially dangerous tasks. This side effect usually wears off with time. If side effects are bothersome, or do not go away, talk to your doctor.

Most people taking this medication do not experience any of these side effects.

Disclose to your physician all mental health issues including any family history of suicide, bipolar disorder, mania, or depression. The FDA recommends evaluating patients for bipolar disorder prior to the administration of Cymbalta to avoid inducing a manic episode. Cymbalta may create new or exacerbate existing behavior problems, bipolar disorder, or suicidal ideation, especially in the first few months of treatment or after a dosage change. Call your doctor immediately if you or your child experiences new or worsening mental health symptoms including reckless behavior, hallucinations, or sudden excessive happiness or irritability.

Heavy alcohol use while taking Cymbalta increases your risk of acute liver damage. Some patients have experienced liver failure while taking Cymbalta. Contact your doctor immediately if you experience itching, right upper abdominal pain, dark urine, yellow skin or eyes, or increased liver enzymes.

Cymbalta increases serotonin levels in the brain, and can rarely lead to life-threatening serotonin syndrome, or toxicity. If you or your child experiences changes in mental status, coordination problems, muscle twitching, racing heartbeat, high or low blood pressure, sweating, vomiting or diarrhea, seek medical help immediately.

Discuss any bleeding disorders or irregular sodium levels with your doctor. Cymbalta can cause abnormal bleeding for some patients, and low salt concentration in the blood. The elderly may be at greater risk for these problems.

The above is not a complete list of potential side effects. If you notice any health changes not listed above, discuss them with your doctor or pharmacist.

Precautions and Safety

Store Cymbalta in a secure place out of the reach of children, and at room temperature. Do not share your Cymbalta prescription with anyone, even another person with depression. Sharing prescription medication is illegal, and can cause harm.

You should not take Cymbalta if you have taken a monoamine oxidase inhibitor (MAOI) within 14 days, or have narrow-angle glaucoma.

You should use caution when taking any SNRIs, including Cymbalta, and speak with your doctor if you have liver or kidney problems, diabetes, seizures, bipolar disorder, low blood sodium levels, a history of stroke or high blood pressure, or a history of bleeding problems.

If you’re thinking of becoming pregnant, discuss the use of Cymbalta with your doctor. It is not known if Cymbalta can cause fetal harm during pregnancy. It is recommended that mothers do not nurse while taking Cymbalta, as its safety for infants is unknown.

Interactions

Before taking Cymbalta, discuss all other active prescription medications with your doctor. Cymbalta can have a dangerous, possibly fatal, interaction with antidepressants including MAOIs. Taking Cymbalta while taking blood thinners like Coumadin, ibuprofen, or aspirin can increase the risk of abnormal bleeding. Using Cymbalta concurrently with medication that increases serotonin – like St. John’s wort, SSRIs, tryptophan, or street drugs like MDMA – can increase the risk of serotonin syndrome.

Share a list of all vitamin or herbal supplements, and prescription and non-prescription medications, you take with the pharmacist when you fill your prescription, and let all doctors and physicians know you are taking Cymbalta before having any surgery or laboratory tests.

Some medications and supplements that can interact with Cymbalta include: cimetidine; triptans for migraines; medicines used to treat mood, anxiety, and thought disorders; and tramadol.

The above is not a complete list of all possible drug interactions.

Sources:

http://www.fda.gov/downloads/drugs/drugsafety/ucm088579.pdf
http://www.accessdata.fda.gov/drugsatfda_docs/label/2010/022516lbl.pdf

3 reviews

  1. For my daughter, ADHD means not only that her mind goes a mile a minute, leading to distractibility, but also that once her interest is piqued, she will hyperfocus to the exclusion of all else. Combine that with the high school experience, where kids must take six and seven courses every day. Not only is she dealing with the distractibility, not to mention great problems transitioning from one class and subject to another in the space of less than ten minutes, but they’re also expecting her to manage several projects and homework assignments in many subjects every day. No wonder she became anxious to the point of paralysis! We thought originally that it was a motivational thing, but what it turned out to be was extreme anxiety that eventually led to depression. Starting her on Cymbalta made a big difference, but that didn’t take care of everything.

  2. I have tried Cymbalta and it’s just too much fatigue and sedation amongst a host of the other SSRIs. It’s just not that helpful, it curbs anxiety but the sacrifice of lack of attention and de-motivation in addition to mental decline that follows SSRIs is really a struggle. I’ve tried all the SSRIs and Celexa was and is probably the only one that I could tolerate. It did give me a lot of fatigue; the afternoons were impossible so I had to stop.

  3. I was 47 when I was officially diagnosed. Impulsive decisions have cost me jobs and respect. I spent my life with ADHD and no medication. Now I’m on medications and I don’t crave pain pills to numb my depression. Thanks to Cymbalta, sedatives and 10mgs of Adderall I am finishing my GED and paralegal degree.

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