From the Guidelines
Yes, Cymbalta (duloxetine) is a Serotonin-Norepinephrine Reuptake Inhibitor (SNRI). This medication works by increasing the levels of both serotonin and norepinephrine in the brain by blocking their reabsorption (reuptake) into neurons. According to the most recent and highest quality study 1, Cymbalta is commonly prescribed for major depressive disorder, generalized anxiety disorder, fibromyalgia, and certain types of chronic pain, particularly diabetic peripheral neuropathic pain and chronic musculoskeletal pain. The typical starting dose is 30 mg once daily, often increased to 60 mg daily after one week, with some conditions requiring doses up to 120 mg daily divided into two equal doses.
Some key points to consider when prescribing Cymbalta include:
- It is one of the medications from the SNRI class currently marketed in the United States, along with venlafaxine, desvenlafaxine, and levomilnacipran 1.
- Duloxetine has shown efficacy in the treatment of pain associated with diabetic peripheral neuropathy (DPN) and has been approved by the FDA for the treatment of generalized anxiety disorder in children and adolescents 7 years old 1.
- Patients should be aware that Cymbalta may cause side effects such as nausea, dry mouth, constipation, decreased appetite, fatigue, sleepiness, and increased sweating 1.
- It should not be stopped abruptly as this can lead to withdrawal symptoms, and it shouldn't be taken with MAOIs or within 14 days of stopping an MAOI due to the risk of serotonin syndrome 1.
Overall, Cymbalta (duloxetine) is a viable treatment option for various conditions, including major depressive disorder, generalized anxiety disorder, fibromyalgia, and certain types of chronic pain, and its use should be considered in the context of individual patient needs and medical history.
From the FDA Drug Label
Duloxetine delayed-release capsules belong to a class of medicines known as SNRIs (or serotonin-norepinephrine reuptake inhibitors). Duloxetine delayed-release capsules are selective serotonin and norepinephrine reuptake inhibitor (SNRI) for oral administration.
Yes, Cymbalta (duloxetine) is a Serotonin-Norepinephrine Reuptake Inhibitor (SNRI) 2, 2, 2.
From the Research
Definition and Classification of Cymbalta
- Cymbalta, also known as duloxetine, is classified as a Serotonin-Norepinephrine Reuptake Inhibitor (SNRI) 3, 4, 5, 6, 7.
- As an SNRI, duloxetine works by inhibiting the reuptake of both serotonin and norepinephrine, two neurotransmitters in the brain that play a key role in mood regulation.
Mechanism of Action
- Duloxetine is a potent and selective inhibitor of serotonin and noradrenaline transporters, with a low affinity for neuronal receptors and other neurotransmitter transporters 3, 5.
- The mechanism of action of duloxetine involves the inhibition of the reuptake of serotonin and norepinephrine, which increases the levels of these neurotransmitters in the synaptic cleft and enhances neurotransmission.
Clinical Uses
- Duloxetine is approved for the treatment of major depressive disorder (MDD), generalized anxiety disorder (GAD), neuropathic pain, fibromyalgia, and stress urinary incontinence 4, 5, 6, 7.
- The efficacy and safety of duloxetine have been established in numerous clinical trials, including studies in older adults with MDD 7.
Pharmacokinetics and Pharmacodynamics
- Duloxetine is rapidly and extensively metabolized in the liver by cytochrome P450 enzymes, with a mean elimination half-life of approximately 12 hours 3.
- The pharmacokinetics and pharmacodynamics of duloxetine are dose-proportional, with steady-state concentrations achieved within 3 days of administration 3.