Cymbalta

The active ingredient in Cymbalta is duloxetine. It works by increasing the levels of serotonin and norepinephrine in the brain, which helps regulate mood and emotions. In addition to the ones listed above, Cymbalta can also be prescribed for peripheral neuropathy due to diabetes, and chronic muscle or joint pain (such as low back pain and osteoarthritis pain).

Follow all directions given by your doctor and read all documents provided, including the full prescribing information, FDA-approved product labeling, Instructions for Use, and Medication Guide before using Cymbalta. However, the following is a synopsis of the general guidelines for the use of Cymbalta:

• You can take the delayed-release capsules of Cymbalta with or without food. Do not crush, chew, or split the tablets in any way before taking the medication.
• Speak to your doctor if you have difficulty swallowing the medication. They may be able to help.
• It is common that you would feel dizzy when you first start taking Cymbalta. This is known as orthostatic hypotension, or a change in blood pressure when you stand up too soon. Be careful with sudden movements or operating machinery before you know how Cymbalta affects you.
• Monitor for any mood changes, and contact your doctor as soon as you or your caregiver notice anything concerning.
• Monitor for trouble urinating, vision changes, and changes in your blood sugar (if you have high blood sugar or diabetes).
• If you miss a dose, take your missed dose as soon as you remember. However, if it is closer in time to your next dose, skip this dose, and take your next dose at the scheduled time.

The most common side effects of Cymbalta seen in clinical trials as compared to placebo include:

• Nausea
• Dry mouth
• Headache
• Drowsiness
• Feeling tired
• Trouble sleeping
• Dizziness
• Constipation
• Diarrhea
• Low appetite
• Increased sweating
• Stomach pain
• Increased blood pressure

Other possible less common side effects include:

• Blurry vision
• Abnormal heart rate
• Tremor
• Vomiting
• Sexual dysfunction, such as abnormal ejaculation
• Yawning
• Change in weight
• Pediatric patients are at a greater risk of weight loss.

Some individuals may experience serious side effects while using Cymbalta. These side effects may require immediate medical attention. If you experience any of the following, contact your healthcare provider or seek emergency medical help:

• Suicidal thoughts and behaviors
• This is more likely to occur during your first months of treatment. Make sure you are monitoring for any signs of worsening depression.
• Liver damage, which in rare cases could be fatal.
• Look out for jaundice (yellowing of your skin or eyes), right-sided upper stomach pain, and dark urine.
• Severe bleeding or bruising
• Serotonin syndrome
• Low sodium levels (hyponatremia)
• Severe skin reactions, such as Stevens-Johnson
• Seizures
• Severe allergic reaction
• Withdrawal symptoms
• Abrupt discontinuation of Cymbalta could create withdrawal symptoms such as nausea, upset stomach, anxiety, irritation, confusion, trouble sleeping, dizziness, and headache.

These are not all of the possible side effects of Cymbalta. You should always seek medical advice from your healthcare provider for any questions or concerns about your medical condition or treatment. Read all patient information, medication guides, or drug information sheets that come with this medication. You can also report adverse effects to the Food and Drug Administration at www.fda.gov/medwatch or 1-800-FDA-1088.

Before starting Cymbalta, it is crucial to discuss any existing health conditions with your healthcare provider. You should be sure that your healthcare provider is aware of all your medical conditions, including if you have:

• High blood pressure or other heart problems
• Kidney disease
• Liver disease or liver problems
• Had a seizure or seizure issues
• Bipolar disorder (manic depression) or other psychiatric disorders
• Drug addiction or suicidal thoughts
• A history of drinking large amounts of alcohol
• Narrow-angle glaucoma
• Bleeding problems
• Sexual issues

Boxed warnings

Cymbalta carries a boxed warning. See the prescribing information for the full information, but a synopsis of the warning includes:

• In children, adolescents, and young adults, there is an increased risk of suicidal thoughts and suicidal behaviors.
• Monitoring should occur in this group for worsening or new suicidal thoughts and behaviors.

• Use of an MAOI antidepressant while taking Cymbalta.

• Taking Cymbalta within 14 days of ending treatment with an antidepressant.

Cymbalta typically begins to show effects within 1 to 2 weeks of starting the medication, but it may take up to 4 to 6 weeks to experience the full therapeutic benefits, especially for conditions like depression and anxiety. Individual responses can vary, so it's important to communicate with your healthcare provider about how you're feeling during this period.

When Cymbalta is taken with other prescription drugs, over-the-counter medications, vitamins, and supplements, it may cause drug interactions and change how they work or increase the frequency or severity of side effects. Make sure that you tell your healthcare professional about anything that you are taking, including:

• Monoamine oxidase inhibitors (MAOIs)
• Cymbalta should not be taken within two weeks of an MAOI medication.
• Examples include linezolid, metaxalone, and methylene blue
• Potent inhibitors of CYP1A2 should be avoided
• Potent inhibitors of CYP2D6 have the potential to increase Cymbalta concentrations
• Cymbalta is a moderate inhibitor of CYP2D6
• Ciprofloxacin and fluvoxamine
• Aspirin, warfarin, ibuprofen, naproxen, and other nonsteroidal anti-inflammatory drugs (NSAIDs) or blood thinners
• These could increase the risk of bleeding.
• St. John's wort
• Certain antidepressants (including SSRIs such as paroxetine/ fluoxetine, other SNRIs such as desvenlafaxine/venlafaxine, and amitriptyline)
• Antipsychotics (such as thioridazine)
• Pain medications or opioids, such as tramadol
• Migraine medications called “triptans”
• Amphetamines

Cymbalta comes as a delayed-release capsule in the following forms:

• 20 mg
• 30 mg
• 60 mg

There are different recommended doses depending on which condition Cymbalta is helping to treat.

Cymbalta should be stored at room temperature, away from excessive heat or moisture.

Cymbalta is manufactured by Eli Lilly.

Currently, there are lower-cost generics available for Cymbalta.

To stop taking Cymbalta, it's important to consult your healthcare provider first, as they can guide you on the best tapering schedule to minimize withdrawal symptoms. Generally, a gradual dose reduction is recommended rather than stopping abruptly. Monitor your symptoms closely and communicate with your doctor throughout the process to address any concerns or side effects that may arise.

Talk to your doctor if you are already pregnant or if you have any plans to become pregnant. They will know or recommend what is best for you. Using Cymbalta while you are pregnant may cause complications for your newborn baby. If you are pregnant while taking Cymbalta, there is a pregnancy exposure registry that monitors the effects of duloxetine on you and your unborn baby.

Talk to your doctor if you are already breastfeeding or if you have any plans to breastfeed. They will know or recommend what is best for you. Currently, there is evidence that Cymbalta passes into breast milk. Side effects on your infant include poor weight gain, poor feeding, and sleepiness.