Can you take Cymbalta (duloxetine) and Buspar (buspirone) together?

Taking Cymbalta (Duloxetine) and Buspar (Buspirone) Together

Yes, Cymbalta (duloxetine) and Buspar (buspirone) can be taken together, but caution is warranted due to the potential risk of serotonin syndrome. 1, 2

Safety Considerations

• Buspirone and duloxetine are both serotonergic medications that can increase serotonin levels in the brain, creating a potential risk for serotonin syndrome when used together 2
• Serotonin syndrome symptoms may include mental status changes (agitation, hallucinations), autonomic instability (tachycardia, blood pressure fluctuations), neuromuscular changes (tremor, rigidity), and gastrointestinal symptoms (nausea, vomiting) 2
• The FDA label for buspirone specifically warns about the potential for serotonin syndrome when combined with other serotonergic drugs, including SNRIs like duloxetine 2

Monitoring Recommendations

• Patients should be closely monitored for signs of serotonin syndrome, particularly during treatment initiation and dose increases 2
• Start with lower doses of both medications and titrate slowly when using this combination 1
• For duloxetine, typical starting dose is 30mg once daily, which can be increased to 60mg after 1 week if tolerated 1
• For buspirone, consider starting at 5mg twice daily and gradually increase as needed and tolerated 1

Clinical Applications

• This combination may be appropriate for patients with comorbid conditions:
  • Duloxetine is FDA-approved for depression, anxiety disorders, diabetic neuropathy, fibromyalgia, and chronic pain conditions 1
  • Buspirone is primarily used for anxiety disorders, particularly generalized anxiety disorder 1, 3
• Some evidence suggests buspirone may augment antidepressant therapy in patients with inadequate response to antidepressants alone 4

Contraindications

• This combination is contraindicated in patients taking MAOIs or within 14 days of stopping an MAOI 2
• Use with caution in elderly patients or those with hepatic or renal impairment 1
• Avoid in patients with a history of serotonin syndrome 2

Common Pitfalls to Avoid

• Failing to recognize early signs of serotonin syndrome, which can be life-threatening if not addressed promptly 2, 5
• Adding buspirone too quickly to an established SNRI regimen without appropriate monitoring 5
• Not educating patients about potential signs of serotonin syndrome that warrant immediate medical attention 2
• Overlooking potential drug interactions with other medications that might further increase serotonin levels 2, 6

Remember that while this combination can be used safely in many patients, careful monitoring and appropriate dosing are essential to minimize risks and maximize therapeutic benefits.