Cymbalta and Duloxetine: The Same Medication
Yes, Cymbalta is the brand name for duloxetine. Duloxetine is the generic name of the medication, while Cymbalta is one of its brand names 1.
Medication Classification and Properties
Duloxetine (Cymbalta) is classified as a serotonin and norepinephrine reuptake inhibitor (SNRI) that works by inhibiting the reuptake of both serotonin and norepinephrine in the central nervous system 2. It has the following characteristics:
- It has a more balanced binding profile of approximately 10:1 for serotonin and norepinephrine transporter binding 2
- It has a half-life of approximately 12 hours 3
- It is metabolized primarily by CYP1A2 and CYP2D6 enzymes in the liver 3
- It is highly protein-bound and widely distributed throughout tissues 3
FDA-Approved Indications
Duloxetine (Cymbalta) is FDA-approved for multiple conditions 1:
- Major Depressive Disorder (MDD) in adults
- Generalized Anxiety Disorder (GAD) in adults and pediatric patients 7-17 years
- Diabetic Peripheral Neuropathic Pain (DPNP)
- Fibromyalgia in adults
- Chronic Musculoskeletal Pain including:
- Chronic low back pain
- Chronic pain due to osteoarthritis
Dosing Considerations
Duloxetine is typically administered as:
- 60 mg once daily for depression 4, 1
- 60-120 mg daily for anxiety disorders 3
- 60 mg daily for diabetic neuropathic pain 1
- 60 mg daily for fibromyalgia and chronic musculoskeletal pain 1
For osteoarthritis, duloxetine is considered a second-line or combination treatment option after initial treatments such as topical agents, acetaminophen, and NSAIDs have been tried 4.
Common Adverse Effects
The most frequently reported adverse effects include 4, 1, 2:
- Nausea (most common reason for discontinuation)
- Dry mouth
- Headache
- Constipation
- Dizziness
- Fatigue
- Sexual dysfunction
- Sweating
- Tremor
- Weight gain
Rare adverse effects may include acid reflux, which has been reported in approximately 1.38% of patients 5.
Drug Interactions
Important drug interactions to be aware of 6, 3:
- Absolute contraindication: Concomitant use with MAOIs due to risk of serotonin syndrome
- Use with caution: Medications metabolized by CYP2D6, particularly those with a narrow therapeutic index, as duloxetine is a moderate inhibitor of this enzyme
- Avoid: Concomitant use with potent CYP1A2 inhibitors
Clinical Efficacy
Duloxetine has demonstrated efficacy in:
- Major depression, with improvements seen after 1-2 weeks of treatment at the 60 mg daily dose 7
- Generalized anxiety disorder, with significant improvements in anxiety symptoms compared to placebo 3
- Chronic pain conditions, including diabetic neuropathic pain, fibromyalgia, and chronic musculoskeletal pain 4, 1
For chronic low back pain, duloxetine 60-120 mg daily has shown significantly greater pain reduction compared to placebo in multiple trials 1.
Important Considerations
- When discontinuing duloxetine, a gradual tapering is recommended to minimize discontinuation symptoms, which may include dizziness, headache, nausea, irritability, and sensory disturbances 6
- Blood pressure monitoring is recommended, especially in patients with cardiac disease, as duloxetine may cause increases in blood pressure 6
- Duloxetine should be used with caution in older adults due to higher rates of adverse effects, including falls 1
In summary, Cymbalta is indeed the brand name for duloxetine, which is an SNRI with multiple therapeutic applications in psychiatric and pain conditions.