From the Guidelines
The patient should immediately stop taking Cymbalta and contact their healthcare provider due to the adverse reaction suggested by the symptoms of hot flashes, dizziness, chest tightness, headache, and nausea that occurred shortly after starting the medication. These symptoms are consistent with potential side effects of selective serotonin norepinephrine reuptake inhibitors (SSNRIs) like Cymbalta, as noted in the study 1, which mentions that the most common adverse effect of duloxetine (the active ingredient in Cymbalta) is nausea. While the study 1 discusses the efficacy and safety of duloxetine in the treatment of neuropathic pain and other conditions, it also highlights the importance of monitoring for adverse effects, particularly in the initial stages of treatment.
The patient's symptoms, such as dizziness and nausea, could be related to the autonomic nervous system reactions caused by the medication's effect on serotonin and norepinephrine levels in the brain. It is crucial for the patient to rest, stay hydrated, and monitor their symptoms while waiting to speak with their healthcare provider. If the chest tightness worsens, breathing becomes difficult, or other severe symptoms like confusion or extreme dizziness develop, the patient should seek emergency medical attention immediately.
The healthcare provider may recommend an alternative antidepressant from a different class that might be better tolerated, considering the patient's adverse reaction to Cymbalta. As mentioned in the study 1, other options for treating neuropathic pain include tricyclic antidepressants (TCAs), calcium channel α-δ ligands (such as gabapentin or pregabalin), and topical lidocaine. The choice of alternative medication will depend on the patient's specific condition, medical history, and the severity of their symptoms.
In the context of real-life clinical practice, prioritizing the patient's safety and well-being is paramount, especially when dealing with potential adverse reactions to medications. Therefore, immediate discontinuation of Cymbalta and consultation with a healthcare provider are the most appropriate steps to ensure the patient's morbidity, mortality, and quality of life are not compromised.
From the FDA Drug Label
Adverse reactions reported as a reason for discontinuation and considered to be drug-related (as defined above) included nausea (duloxetine delayed-release capsules 2.0%, placebo 0.5%), headache (duloxetine delayed-release capsules 1.2%, placebo 0.3%), somnolence (duloxetine delayed-release capsules 1. 1%, placebo 0%), and fatigue (duloxetine delayed-release capsules 1.1%, placebo 0.1%). The most commonly observed adverse reactions in duloxetine delayed-release capsules-treated patients (as defined above) were: ... nausea, somnolence, decreased appetite, constipation, hyperhidrosis, and dry mouth Adverse Reactions in Pooled MDD and GAD Trials in Adults ... nausea, dry mouth, constipation, somnolence, decreased appetite, hyperhidrosis, and agitation. Adverse reactions in the DPNP, FM, OA, and CLBP adult trials ... Nausea, headache, somnolence, dizziness
The patient's symptoms of hot flashes, dizziness, chest tightness, headache, and nausea are consistent with potential adverse reactions to duloxetine.
- Nausea is a common adverse reaction to duloxetine, reported in 23% of patients in clinical trials 2.
- Dizziness is also a common adverse reaction, reported in 9% of patients in clinical trials 2.
- Headache is another common adverse reaction, reported in 14% of patients in clinical trials 2. However, hot flashes and chest tightness are not explicitly mentioned in the provided drug label as common adverse reactions to duloxetine. It is essential to consult the patient's healthcare provider to determine the best course of action and to assess whether these symptoms are related to the medication or another underlying condition.
From the Research
Patient Symptoms
- Hot flashes
- Dizziness
- Chest tightness
- Headache (h/a)
- Nausea The patient reports that these symptoms began after starting a new medication, Cymbalta (duloxetine) 3, 4.
Medication Side Effects
- The patient's symptoms may be related to the initiation of duloxetine, as this medication can cause side effects such as nausea, dizziness, and headache 3, 4.
- Duloxetine is a serotonin-norepinephrine reuptake inhibitor (SNRI) that can also cause vasomotor symptoms, including hot flashes 3, 4.
Treatment of Hot Flashes
- SNRIs, such as duloxetine and venlafaxine, have been shown to be effective in reducing the frequency and severity of hot flashes in menopausal women 5, 6.
- However, the patient's symptoms may be related to the initiation of duloxetine, rather than the treatment of hot flashes 3, 4.
- Other medications, such as selective serotonin reuptake inhibitors (SSRIs), may also be effective in reducing hot flashes, but may have different side effect profiles 5, 6.