WARNING

Cymbalta (generic name duloxetine) is a medication primarily used to treat major depressive disorder, generalized anxiety disorder, and other conditions like chronic pain disorders. Like any medication, it carries certain risks and side effects. Here are some potential risks associated with taking Cymbalta:

• Suicidal Thoughts and Behaviors: Antidepressants like Cymbalta may increase the risk of suicidal thoughts, especially in young adults under 25 years old. Close monitoring by healthcare providers is crucial, especially when starting or changing the dosage.
• Serotonin Syndrome: This is a potentially life-threatening condition that can occur when there is too much serotonin in the body. Symptoms include agitation, hallucinations, rapid heartbeat, and unconsciousness. It is important not to take Cymbalta with other medications that increase serotonin levels without consulting a doctor.
• Liver Damage: Cymbalta may cause liver damage or hepatitis, although this is rare. Monitoring of liver function tests may be necessary during treatment.
• Increased Bleeding Risk: Cymbalta can affect platelet function and increase the risk of bleeding, especially when taken with other medications that also affect bleeding risk (such as NSAIDs or blood thinners).
• Withdrawal Symptoms: Abrupt discontinuation of Cymbalta can lead to withdrawal symptoms such as dizziness, nausea, headache, irritability, insomnia, and electric shock-like sensations (paresthesia).
• Sexual Side Effects: Common sexual side effects include decreased libido, erectile dysfunction, and difficulties reaching orgasm.
• Other Side Effects: Other possible side effects include drowsiness, dry mouth, constipation, sweating, and weight changes.

It’s important for individuals considering or currently taking Cymbalta to discuss these risks and any concerns with their healthcare provider. The decision to use Cymbalta should be based on a careful evaluation of the benefits versus the potential risks for each individual patient.

Why is this medication prescribed?

Cymbalta (duloxetine) is prescribed primarily for the treatment of several conditions:

• Major Depressive Disorder (MDD): Cymbalta is approved to treat depression, which includes improving mood and feelings of well-being.
• Generalized Anxiety Disorder (GAD): It is also used to treat GAD, which involves excessive worry and anxiety that lasts for at least six months.
• Chronic Pain Disorders: Cymbalta is sometimes prescribed for chronic pain conditions such as fibromyalgia and neuropathic pain (pain from damaged nerves).
• Other Conditions: In some cases, Cymbalta may be used off-label for conditions like certain types of chronic headaches or stress urinary incontinence.

How should this medicine be used?

Cymbalta is available in delayed-release capsules, typically in strengths of 20 mg, 30 mg, and 60 mg. The dosage prescribed can vary depending on the condition being treated and individual patient response.

• Dosage: It’s important to follow the dosage instructions provided by your healthcare provider. The usual starting dose for adults is 30 mg once daily, but this may be adjusted based on how you respond to the medication.
• Administration: Cymbalta capsules should be swallowed whole with water, and can be taken with or without food. They should not be chewed or crushed.
• Timing: The medication should be taken at approximately the same time each day to maintain a consistent level in your bloodstream.
• Duration: Cymbalta is typically used long-term for chronic conditions like depression or anxiety. It may take several weeks for you to feel the full benefit of the medication.
• Discontinuation: Do not stop taking Cymbalta abruptly, as this can lead to withdrawal symptoms. Your healthcare provider will advise on how to gradually reduce the dose when discontinuing treatment.
• Monitoring: Regular follow-up with your healthcare provider is important to monitor your response to Cymbalta and to adjust the dosage if necessary.

Always inform your doctor about any other medications, supplements, or health conditions you have before starting Cymbalta, to avoid potential interactions or complications. If you have any concerns about how to take Cymbalta or its potential side effects, discuss them openly with your healthcare provider.

Other uses for this medicine

• Pain Management: Besides approved uses like diabetic peripheral neuropathy and fibromyalgia, Cymbalta may be used off-label for chronic musculoskeletal pain, osteoarthritis pain, and chronic lower back pain.
• Migraine Prevention: There is some evidence suggesting that Cymbalta may be effective in preventing migraines in certain individuals.
• Stress Urinary Incontinence: Cymbalta has been studied for its potential to reduce symptoms of stress urinary incontinence, although it is not specifically approved for this use.

What special precautions should I follow?

Special Precautions for Cymbalta:

• Suicidal Thoughts and Behaviors: Like many antidepressants, Cymbalta may increase the risk of suicidal thoughts or behaviors, particularly in young adults under 25 years old. Patients, especially those starting treatment or changing doses, should be closely monitored for worsening depression or unusual changes in behavior.
• Serotonin Syndrome: This is a rare but serious condition that can occur when there is an excessive amount of serotonin in the body. Avoid taking Cymbalta with other medications that increase serotonin levels, such as other antidepressants or certain pain medications, without consulting your healthcare provider.
• Liver Function: Cymbalta can affect liver function, and therefore liver function tests may be recommended periodically, especially during the initial months of treatment.
• Bleeding Risk: Cymbalta may increase the risk of bleeding, especially when taken with other medications that also affect bleeding risk (like NSAIDs or blood thinners). It’s important to inform your doctor if you are taking any other medications, including over-the-counter drugs and supplements.
• Pregnancy and Breastfeeding: The safety of Cymbalta during pregnancy and breastfeeding is not well established. If you are pregnant, planning to become pregnant, or breastfeeding, discuss the risks and benefits of taking Cymbalta with your healthcare provider.
• Glaucoma: Cymbalta may increase eye pressure, which can worsen glaucoma. Inform your eye doctor if you are taking Cymbalta, especially if you have a history of glaucoma or increased eye pressure.
• Hyponatremia: Cymbalta may cause low sodium levels in the blood, especially in elderly patients or those taking diuretics. Symptoms of low sodium include headache, weakness, confusion, and seizures.
• Withdrawal: Abrupt discontinuation of Cymbalta may lead to withdrawal symptoms such as dizziness, nausea, headache, irritability, and insomnia. Your doctor will provide guidance on how to gradually reduce the dose when stopping the medication.

Always follow your healthcare provider’s instructions carefully when taking Cymbalta, and communicate any concerns or unusual symptoms promptly. Regular follow-up appointments are important to monitor your response to the medication and manage any potential side effects.

What special dietary instructions should I follow?

There are no specific dietary restrictions associated with Cymbalta. However, it’s generally recommended to maintain a healthy and balanced diet while taking any medication. Some people may experience changes in appetite or weight while on Cymbalta, so monitoring your diet and eating habits can be beneficial.

What should I do if I forget a dose?

If you miss a dose of Cymbalta, take it as soon as you remember, unless it is close to the time of your next scheduled dose. In that case, skip the missed dose and take your next dose at the regular time. Do not double up on doses to make up for a missed one.

What side effects can this medication cause?

Cymbalta (duloxetine) is an antidepressant medication primarily used to treat major depressive disorder and generalized anxiety disorder. It is also prescribed for conditions like fibromyalgia and chronic pain disorders. Like all medications, Cymbalta can cause side effects, which can vary from person to person. Some common side effects include:

• Nausea: This is one of the most frequently reported side effects when starting Cymbalta.
• Dry mouth: Another common side effect that may occur.
• Headache: Some people may experience headaches, especially early in treatment.
• Fatigue: Feeling tired or sleepy is a common side effect.
• Dizziness: This can occur, especially when standing up quickly.
• Insomnia or sleep disturbances: Cymbalta might affect sleep patterns in some individuals.
• Constipation: Changes in bowel movements can happen.
• Loss of appetite: Some people may experience reduced appetite or weight loss.
• Sexual side effects: This can include decreased libido, difficulty achieving orgasm, or erectile dysfunction.
• Sweating: Increased sweating, particularly at night, has been reported.

Less common but more serious side effects can include:

• Serotonin syndrome: This is a rare but potentially life-threatening condition characterized by high levels of serotonin in the body, which can cause agitation, hallucinations, rapid heartbeat, changes in blood pressure, fever, excessive sweating, shivering or shaking, blurred vision, muscle twitching, and difficulty with coordination.
• Liver toxicity: In rare cases, Cymbalta can cause liver damage. Symptoms can include yellowing of the skin or eyes (jaundice), dark urine, persistent nausea or vomiting, stomach/abdominal pain, and unusual tiredness.

It’s important to note that not everyone experiences these side effects, and many people tolerate Cymbalta well. If you experience any unusual or severe side effects while taking Cymbalta, it’s essential to contact your healthcare provider promptly. They can help assess whether adjustments to your treatment are necessary.

What should I know about storage and disposal of this medication?

Storage and Disposal:

• Storage: Store Cymbalta at room temperature away from light and moisture. Avoid storing it in the bathroom. Keep it tightly closed in its original container.
• Disposal: Do not flush Cymbalta down the toilet or throw it in the trash. Properly dispose of unused or expired medications through a medication take-back program if available. If no take-back program is available, follow FDA guidelines for safe disposal by mixing the medication with an unappealing substance (like dirt or used coffee grounds) in a sealed plastic bag before throwing it away.

In case of emergency/overdose

• Emergency: If you or someone else has overdosed on Cymbalta and is showing severe symptoms such as passing out, trouble breathing, seizures, or severe dizziness, call emergency services immediately (911 in the US) or your local poison control center.
• Overdose Symptoms: Symptoms of overdose may include nausea, vomiting, rapid heartbeat, drowsiness, agitation, seizures, and coma. Prompt medical attention is crucial in cases of overdose.

What other information should I know?

• Medical History: Inform your doctor of your medical history, especially if you have a history of liver disease, kidney disease, seizures, or glaucoma.
• Pregnancy/Breastfeeding: Cymbalta should be used cautiously during pregnancy and breastfeeding, as it may pass into breast milk and potentially harm a nursing infant.
• Interactions: Cymbalta can interact with other medications, including MAO inhibitors, other antidepressants, and certain pain medications. Inform your doctor of all medications you are taking.
• Withdrawal: Do not stop taking Cymbalta abruptly as this can lead to withdrawal symptoms such as dizziness, nausea, headache, irritability, and insomnia. Your doctor will advise on how to safely taper off the medication if necessary.

Always follow your doctor’s instructions carefully when taking Cymbalta. If you have any questions or concerns about your medication, don’t hesitate to reach out to your healthcare provider or pharmacist for clarification.