From the Guidelines
Cymbalta (duloxetine) can cause several serious side effects, including liver problems, severe skin reactions, and serotonin syndrome, which require immediate medical attention. Common side effects of Cymbalta include nausea, dry mouth, constipation, decreased appetite, fatigue, drowsiness, increased sweating, and dizziness, as reported in a study published in the Journal of the American Academy of Child and Adolescent Psychiatry 1. These side effects typically appear within the first few weeks of treatment and often improve with time. More serious side effects that require medical attention include suicidal thoughts (particularly in young adults and adolescents), unusual changes in behavior or mood, liver problems (yellowing of skin/eyes, dark urine, upper abdominal pain), severe skin reactions, eye pain or swelling, and serotonin syndrome (agitation, hallucinations, rapid heart rate, fever, muscle stiffness).
Key Side Effects to Monitor
- Suicidal thoughts and behavior
- Liver problems, such as jaundice or elevated transaminase levels
- Severe skin reactions, including erythema multiforme and Stevens-Johnson syndrome
- Serotonin syndrome, characterized by agitation, hallucinations, and rapid heart rate
- Blood pressure increases, which may require regular monitoring
Management of Side Effects
When stopping Cymbalta, it should be tapered gradually under medical supervision to avoid withdrawal symptoms like dizziness, irritability, headaches, and "brain zaps" 1. Patients should be closely monitored for signs of liver dysfunction, and the medication should be discontinued if jaundice or other evidence of clinically significant liver dysfunction occurs.
Important Considerations
Cymbalta can interact with other medications, including MAOIs, and may require dosage adjustments or careful monitoring when used concomitantly with certain drugs, as noted in a study published in the Mayo Clinic Proceedings 1. Medical education, training, and experience are necessary to safely and effectively prescribe antidepressant medications like Cymbalta.
From the FDA Drug Label
Duloxetine delayed-release capsules may cause serious side effects, including:
- liver damage. Symptoms may include: itching right upper abdominal pain dark urine yellow skin or eyes enlarged liver increased liver enzymes
- changes in blood pressure and falls. 3 Serotonin Syndrome: This condition can be life-threatening and symptoms may include: agitation, hallucinations, coma or other changes in mental status coordination problems or muscle twitching (overactive reflexes) racing heartbeat, high or low blood pressure sweating or fever nausea, vomiting, or diarrhea muscle rigidity dizziness flushing tremor seizures 4 abnormal bleeding: 5 severe skin reactions: 6 discontinuation symptoms: 7 manic episodes:
- visual problems:
- seizures or convulsions
- low salt (sodium) levels in the blood.
- problems with urination The most common side effects of duloxetine delayed-release capsules include:
- nausea
- dry mouth
- sleepiness
- fatigue
- constipation
- loss of appetite
- increased sweating
- dizziness
The possible side effects of Cymbalta (duloxetine) include:
- Serious side effects: liver damage, changes in blood pressure and falls, serotonin syndrome, abnormal bleeding, severe skin reactions, discontinuation symptoms, manic episodes, visual problems, seizures or convulsions, low salt levels in the blood, and problems with urination.
- Common side effects: nausea, dry mouth, sleepiness, fatigue, constipation, loss of appetite, increased sweating, and dizziness. 2 2 2
From the Research
Cymbalta Side Effects
- The most common side effects of Cymbalta include nausea, dry mouth, headache, constipation, dizziness, and fatigue 3, 4, 5, 6
- Sexual dysfunction is also a common side effect of Cymbalta 4
- Duloxetine may cause discontinuation-emergent adverse events, such as nausea and dizziness, when treatment is stopped abruptly 3, 4
- Serious adverse events, including attempted suicide and completed suicide, have been reported in patients taking Cymbalta, although these events are rare 3
- Cymbalta may also cause dysosmia (distorted sense of smell) and dysgeusia (distorted sense of taste) in some patients 7
Gastrointestinal Side Effects
- Nausea is a common side effect of Cymbalta, especially when treatment is initiated 3, 4, 5, 6
- Dry mouth is also a common side effect of Cymbalta 3, 4, 5, 6
- Constipation is a possible side effect of Cymbalta 3
Neurological Side Effects
- Headache is a common side effect of Cymbalta 3, 4, 5, 6
- Dizziness is a common side effect of Cymbalta, especially when treatment is initiated 3, 4, 5, 6
- Fatigue is a common side effect of Cymbalta 3, 4, 5, 6
- Somnolence (drowsiness) is a possible side effect of Cymbalta 4