What is Cymbalta (duloxetine) used for and what are its side effects?

From the Guidelines

Cymbalta (duloxetine) is a medication primarily used to treat depression, anxiety disorders, fibromyalgia, diabetic nerve pain, and chronic musculoskeletal pain, with a typical starting dose of 30 mg once daily, often increased to 60 mg daily after one week, with some conditions requiring up to 120 mg daily divided into two doses. It works as a serotonin-norepinephrine reuptake inhibitor (SNRI), increasing the levels of these neurotransmitters in the brain to help regulate mood and reduce pain signals 1.

Uses of Cymbalta

• Depression
• Anxiety disorders
• Fibromyalgia
• Diabetic nerve pain
• Chronic musculoskeletal pain

Side Effects of Cymbalta

• Common side effects include nausea, dry mouth, constipation, decreased appetite, fatigue, sleepiness, increased sweating, and dizziness 1
• More serious side effects can include increased blood pressure, liver damage, serotonin syndrome, abnormal bleeding, low sodium levels, and suicidal thoughts, particularly in young adults and adolescents 1

Dosage and Administration

• The typical starting dose is 30 mg once daily, often increased to 60 mg daily after one week, with some conditions requiring up to 120 mg daily divided into two doses 1
• Patients should avoid alcohol while taking this medication and inform their doctor about all other medications they're taking to prevent potential interactions 1

Important Considerations

• Cymbalta should not be stopped abruptly as it may cause withdrawal symptoms like dizziness, nausea, headache, and irritability 1
• It typically takes 2-4 weeks to notice improvement in depression or anxiety symptoms, though pain relief may occur sooner 1
• Duloxetine has been associated with hepatic failure presenting as abdominal pain, hepatomegaly, and elevation of transaminase levels, and should be discontinued and not restarted in patients who develop jaundice or other evidence of clinically significant liver dysfunction 1

From the FDA Drug Label

1. Indications and Usage Duloxetine delayed-release capsules are indicated for the treatment of: Major depressive disorder in adults Generalized anxiety disorder in adults and pediatric patients 7 years of age and older Diabetic peripheral neuropathic pain in adults Fibromyalgia in adults Chronic musculoskeletal pain in adults

Cymbalta (duloxetine) Uses:

• Major depressive disorder in adults
• Generalized anxiety disorder in adults and pediatric patients 7 years of age and older
• Diabetic peripheral neuropathic pain in adults
• Fibromyalgia in adults
• Chronic musculoskeletal pain in adults

Duloxetine delayed-release capsules may cause serious side effects, including: See “What is the most important information I should know about duloxetine delayed-release capsules? ” Common possible side effects in people who take duloxetine delayed-release capsules include:

1. liver damage.
2. changes in blood pressure and falls. 3 Serotonin Syndrome: 4 abnormal bleeding: 5 severe skin reactions: 6 discontinuation symptoms: 7 manic episodes:
3. visual problems:
4. seizures or convulsions
5. low salt (sodium) levels in the blood.
6. problems with urination

Cymbalta (duloxetine) 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 (sodium) levels in the blood
• Problems with urination
• Nausea
• Dry mouth
• Sleepiness
• Fatigue
• Constipation
• Loss of appetite
• Increased sweating
• Dizziness

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From the Research

Overview of Cymbalta (Duloxetine)

• Cymbalta (duloxetine) is a potent serotonin and noradrenaline (norepinephrine) reuptake inhibitor (SNRI) used in the treatment of various conditions, including generalized anxiety disorder (GAD), major depressive disorder (MDD), diabetic peripheral neuropathic pain, fibromyalgia, and chronic musculoskeletal pain due to chronic osteoarthritis pain and low back pain 3, 4, 5, 6, 7.
• It is available in a 60 mg once-daily dosing regimen, which has been shown to be effective in managing these conditions 4.

Indications for Cymbalta (Duloxetine)

• Generalized anxiety disorder (GAD) 3
• Major depressive disorder (MDD) 6, 7
• Diabetic peripheral neuropathic pain 4, 5, 7
• Fibromyalgia 4, 5, 7
• Chronic musculoskeletal pain due to chronic osteoarthritis pain and low back pain 4, 5, 7

Efficacy of Cymbalta (Duloxetine)

• Effective in the short-term treatment of patients with primary GAD of at least moderate severity 3
• Effective in preventing or delaying relapse in responders to duloxetine in a longer-term study 3
• Effective in the management of diabetic peripheral neuropathic pain, fibromyalgia, and chronic musculoskeletal pain due to chronic osteoarthritis pain and low back pain 4
• Comparable to other marketed antidepressants in terms of response and remission rates in patients with MDD 5, 6

Safety and Tolerability of Cymbalta (Duloxetine)

• Generally well tolerated, with most adverse events being of mild to moderate severity 3, 4, 5, 6, 7
• Common adverse events include nausea, dry mouth, headache, constipation, dizziness, and fatigue 3, 4, 5, 6
• May be associated with a higher discontinuation rate due to adverse events, particularly at the 60 mg/day dosage 6

Pharmacokinetics and Pharmacodynamics of Cymbalta (Duloxetine)

• Highly protein bound and widely distributed throughout tissues 3
• Rapidly and extensively metabolized in the liver by cytochrome P450 (CYP) 1A2 and 2D6 3
• Mean elimination half-life of approximately 12 hours 3
• Moderate inhibitor of CYP2D6, which may require dose reductions and careful monitoring when co-administered with other drugs that are preferentially metabolized by CYP2D6 5