Can Cymbalta (duloxetine) be taken with hepatitis (liver inflammation)?

From the Guidelines

You should not take Cymbalta (duloxetine) if you have liver inflammation, as it can increase the risk of hepatic failure and other severe liver-related adverse effects. Cymbalta is associated with hepatic failure presenting as abdominal pain, hepatomegaly, and elevation of transaminase levels, as well as cholestatic jaundice 1. The medication should be discontinued and not restarted in patients who develop jaundice or other evidence of clinically significant liver dysfunction.

When considering treatment with Cymbalta, it is essential to weigh the potential benefits against the risks, particularly in patients with pre-existing liver conditions. The medication's label warns about the risk of severe liver injury, including hepatic failure, which can be fatal. Given the potential for severe liver-related adverse effects, alternative antidepressants with less hepatic metabolism might be safer options for those with liver inflammation.

Key considerations for patients with liver inflammation who are prescribed Cymbalta include:

• Informing their healthcare provider about their liver condition and any other medications they're taking
• Undergoing liver function tests before initiating treatment and periodically during therapy
• Monitoring for symptoms of liver problems, such as yellowing of the skin or eyes, dark urine, upper right abdominal pain, or unusual fatigue
• Considering alternative antidepressants with less hepatic metabolism if liver inflammation is a concern.

It is crucial to prioritize caution when prescribing Cymbalta to patients with liver inflammation, given the potential for severe liver-related adverse effects, as highlighted in the clinical practice guideline for the assessment and treatment of children and adolescents with anxiety disorders 1.

From the FDA Drug Label

1. 2 Hepatotoxicity There have been reports of hepatic failure, sometimes fatal, in patients treated with duloxetine delayed-release capsules. These cases have presented as hepatitis with abdominal pain, hepatomegaly, and elevation of transaminase levels to more than twenty times the upper limit of normal (ULN) with or without jaundice, reflecting a mixed or hepatocellular pattern of liver injury Duloxetine delayed-release capsules should be discontinued in patients who develop jaundice or other evidence of clinically significant liver dysfunction and should not be resumed unless another cause can be established. Because it is possible that duloxetine delayed-release capsules and alcohol may interact to cause liver injury or that duloxetine delayed-release capsules may aggravate pre-existing liver disease, duloxetine delayed-release capsules should not be prescribed to patients with substantial alcohol use or evidence of chronic liver disease.

Duloxetine and Liver Inflammation

• Duloxetine delayed-release capsules should not be prescribed to patients with substantial alcohol use or evidence of chronic liver disease.
• The drug should be discontinued in patients who develop jaundice or other evidence of clinically significant liver dysfunction.
• Duloxetine delayed-release capsules may aggravate pre-existing liver disease.

It is not recommended to take Cymbalta (duloxetine) if you have liver inflammation, as it may worsen the condition or cause further liver damage 2.

From the Research

Liver Inflammation and Cymbalta

• Cymbalta, also known as duloxetine, is a selective serotonin and norepinephrine reuptake inhibitor used to treat major depressive disorder, diabetic peripheral neuropathic pain, and stress urinary incontinence 3.
• According to a study published in 2013, antidepressants, including duloxetine, can cause hepatotoxicity, which is a potentially life-threatening condition 4.
• Another study published in 2022 found that duloxetine can cause liver injury, and the mechanisms associated with this toxicity are not yet fully understood 5.
• Patients with liver inflammation should exercise caution when taking Cymbalta, as it may exacerbate the condition 3.
• In fact, the study published in 2005 recommends that patients with hepatic impairment avoid taking duloxetine 3.

Precautions and Recommendations

• Monitoring of liver function tests is crucial when taking Cymbalta, especially for patients with pre-existing liver conditions 4.
• Immediate discontinuation of the medication is recommended if abnormal lab findings or signs and symptoms of liver dysfunction occur 4.
• Patients with liver inflammation should consult their doctor before taking Cymbalta, and their doctor will weigh the potential benefits and risks of the medication 3.
• Alternative treatments may be considered for patients with liver inflammation, as Cymbalta may not be the best option for them 3.