What is the use of Cymbalta (duloxetine)?

From the Guidelines

Cymbalta (duloxetine) is recommended as a first-line treatment for neuropathic pain, particularly for diabetic peripheral neuropathy, due to its efficacy in reducing pain and improving quality of life, as shown in the most recent study from 2021 1.

Key Points

• Cymbalta belongs to a class of drugs called serotonin-norepinephrine reuptake inhibitors (SNRIs), which work by increasing levels of serotonin and norepinephrine in the brain to help maintain mental balance and reduce pain signals.
• The typical starting dose for depression or anxiety is 30 mg once daily, often increased to 60 mg daily after one week, while for fibromyalgia or chronic pain, dosing usually starts at 30 mg and may increase to 60 mg daily, with some patients requiring up to 120 mg daily.
• Common side effects include nausea, dry mouth, constipation, decreased appetite, fatigue, increased sweating, and dizziness, which often improve over time as the body adjusts to the medication.
• Cymbalta should be taken at the same time each day, with or without food, and should never be stopped abruptly as this can cause withdrawal symptoms.
• It typically takes 2-4 weeks to notice improvement in depression or anxiety symptoms, though pain relief may begin sooner, as noted in studies such as 1 and 1.

Considerations

• Patients should avoid alcohol while taking Cymbalta and inform their doctor of all other medications they're taking to prevent potential interactions.
• The use of any opioids for management of chronic neuropathic pain carries the risk of addiction and should be avoided, as highlighted in 1 and 1.
• Duloxetine has shown consistent efficacy in painful diabetic peripheral neuropathy, with effectiveness sustained for 1 year in an open-label trial, as reported in 1.
• The choice of medication for anxiety within the SNRI class may also be governed by other considerations such as pharmacokinetics, pharmacodynamics, tolerability, cost, insurance formularies, and unique risks leading to warnings or precautions, as discussed in 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 Additional pediatric use information is approved for Eli Lilly and Company, Inc.’s CYMBALTA (duloxetine) delayed-release capsules. However, due to Eli Lilly and Company Inc.’s marketing exclusivity rights, this drug product is not labeled with that pediatric information.

The drug Cymbalta is another name for duloxetine, which is used to treat various conditions, including:

• 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 2

From the Research

Overview of Cymbalta

• Cymbalta, also known as duloxetine, is a potent serotonin and noradrenaline reuptake inhibitor (SNRI) used in the treatment of various conditions, including generalized anxiety disorder (GAD), major depressive disorder (MDD), and neuropathic pain 3, 4, 5, 6, 7.
• It is available in oral form and is typically administered once daily, with a recommended dosage of 40-120 mg/day, depending on the indication 3, 4, 7.

Efficacy of Cymbalta

• Studies have shown that duloxetine is effective in the short-term and long-term treatment of GAD, MDD, and other conditions, with significant improvements in symptoms and quality of life 3, 4, 5, 6.
• Duloxetine has been found to be non-inferior to other antidepressants, such as paroxetine and venlafaxine, in the treatment of MDD 4.
• A systematic review of 85 studies confirmed the efficacy, safety, and tolerability of duloxetine in the treatment of various conditions, including MDD, GAD, neuropathic pain, fibromyalgia, and stress urinary incontinence 6.

Safety and Tolerability of Cymbalta

• Duloxetine is generally well-tolerated, with most adverse events being mild to moderate in severity 3, 4, 5, 6, 7.
• Common adverse events include nausea, dry mouth, headache, constipation, dizziness, and fatigue 3, 4, 7.
• Duloxetine should be used with caution in patients with certain medical conditions, such as hypertension, hepatic impairment, and renal impairment 7.
• Concomitant use of duloxetine and potent CYP1A2 inhibitors should be avoided, and duloxetine should be used with caution in patients receiving drugs that are extensively metabolized by CYP2D6 3.