What is the use of Duloxetine (Cymbalta)?

From the Guidelines

Duloxetine is primarily used to treat depression, anxiety disorders, fibromyalgia, and certain types of chronic pain, including neuropathic pain, with a typical starting dose of 30 mg once daily, increased to 60 mg daily after one week, as supported by the most recent and highest quality study 1.

Key Points

• Duloxetine belongs to a class of drugs called serotonin-norepinephrine reuptake inhibitors (SNRIs) and works by increasing the levels of serotonin and norepinephrine in the brain, which helps improve mood, reduce anxiety, and decrease pain perception.
• The medication should be taken at the same time each day, with or without food, and swallowed whole without crushing or chewing.
• Common side effects include nausea, dry mouth, constipation, decreased appetite, fatigue, increased sweating, and dizziness, which often improve over time.
• Patients should be aware that duloxetine shouldn't be stopped abruptly as this may cause withdrawal symptoms; dosage should be gradually reduced under medical supervision.
• It may take 2-4 weeks to experience the full benefits of the medication, so patience is important when starting treatment, as noted in studies such as 1 and 1.

Usage and Dosage

• For depression or anxiety, the typical starting dose is 30 mg once daily, usually increased to 60 mg daily after one week.
• For fibromyalgia or chronic pain, the dose is often 60 mg once daily.
• Duloxetine has shown efficacy in the treatment of pain associated with diabetic peripheral neuropathy (DPN) and has been associated with improved neuropathy-related quality of life, as seen in studies like 1.

Important Considerations

• Duloxetine may have adverse effects, such as nausea, and should be prescribed with caution in patients with cardiac disease, as noted in 1.
• The medication's efficacy and safety profile make it a viable option for the treatment of certain types of chronic pain and depression, as supported by the evidence from 1, which is the most recent and highest quality study.

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

What are duloxetine delayed-release capsules? Duloxetine delayed-release capsules are a prescription medicine used to treat a certain type of depression called Major Depressive Disorder (MDD) Duloxetine delayed-release capsules belong to a class of medicines known as SNRIs (or serotonin-norepinephrine reuptake inhibitors). Duloxetine delayed-release capsules are also used to treat or manage: Generalized Anxiety Disorder (GAD) Diabetic Peripheral Neuropathic Pain (DPNP) Fibromyalgia (FM) Chronic Musculoskeletal Pain

The use of Duloxetine (Cymbalta) is for the treatment of:

• Major Depressive Disorder (MDD) in adults
• Generalized Anxiety Disorder (GAD) in adults and pediatric patients 7 years of age and older
• Diabetic Peripheral Neuropathic Pain (DPNP) in adults
• Fibromyalgia (FM) in adults
• Chronic Musculoskeletal Pain in adults 2 2

From the Research

Uses of Duloxetine (Cymbalta)

• Duloxetine is a selective dual neuronal serotonin (5-Hydroxytryptamine, 5-HT) and norepinephrine reuptake inhibitor (SSNRI) used for the treatment of:
  • Major depressive disorder (MDD) 3, 4
  • Generalized anxiety disorder (GAD) 3
  • Diabetic peripheral neuropathic pain 3, 5, 6
  • Fibromyalgia 3, 5, 6, 7
  • Chronic musculoskeletal pain due to chronic osteoarthritis (OA) pain and chronic low back pain (LBP) 3

Efficacy of Duloxetine

• Duloxetine 60 mg once-daily dosing is an effective option for the management of diabetic peripheral neuropathic pain, fibromyalgia, and chronic musculoskeletal pain due to chronic OA pain and chronic LBP 3
• Duloxetine at 60 mg daily is effective in treating painful diabetic peripheral neuropathy in the short term, with a risk ratio (RR) for ≥ 50% pain reduction at 12 weeks of 1.73 (95% CI 1.44 to 2.08) 5
• Duloxetine at 60 mg daily is also effective for fibromyalgia over 12 weeks (RR for ≥ 50% reduction in pain 1.57,95% CI 1.20 to 2.06) and over 28 weeks (RR 1.58,95% CI 1.10 to 2.27) 5

Safety and Tolerability

• Adverse events including nausea, constipation, dry mouth, and insomnia, were mild and transient and occurred at relatively low rates 6, 7
• The majority of adverse events were associated with initial duloxetine dosing; further escalations in dose produced few additional adverse events 4
• Long-term treatment at a stabilized duloxetine dose was associated with a relatively low incidence of treatment-emergent adverse events and treatment discontinuation due to adverse events 4