Cymbalta

Generic Name: duloxetine (du LOX e teen)

What is Cymbalta?

Cymbalta is an antidepressant in a group of drugs called selective serotonin and norepinephrine reuptake inhibitors (SSNRIs). Cymbalta affects chemicals in the brain that may become unbalanced and cause depression.

Cymbalta is used to treat major depressive disorder and general anxiety disorder. It is also used to treat a chronic pain disorder called fibromyalgia, and to treat pain caused by nerve damage in people with diabetes (diabetic neuropathy).

Cymbalta may also be used for other purposes not listed in this medication guide.

Important information about Cymbalta

Do not take Cymbalta together with thioridazine (Mellaril), or a monoamine oxidase inhibitor (MAOI) such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate). You must wait at least 14 days after stopping an MAOI before you can take Cymbalta. After you stop taking Cymbalta, you must wait at least 5 days before you start taking an MAOI.

You may have thoughts about suicide when you first start taking an antidepressant, especially if you are younger than 24 years old. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment.

Call your doctor at once if you have any new or worsening symptoms such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself. Avoid drinking alcohol while taking Cymbalta. Alcohol may increase the risk of damage to your liver.

Cold or allergy medicine, narcotic pain medicine, sleeping pills, muscle relaxers, and medicine for seizures or anxiety can add to sleepiness caused by Cymbalta. Tell your doctor if you regularly use any of these other medicines.

Cymbalta can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

Before taking Cymbalta

Do not use Cymbalta together with thioridazine (Mellaril), or an MAO inhibitor such as isocarboxazid (Marplan), tranylcypromine (Parnate), phenelzine (Nardil), rasagiline (Azilect), or selegiline (Eldepryl, Emsam). Serious and sometimes fatal reactions can occur when these medicines are taken with Cymbalta. You must wait at least 14 days after stopping an MAO inhibitor before you can take Cymbalta. After you stop taking Cymbalta, you must wait at least 5 days before you start taking an MAOI. Do not use this medication if you are allergic to duloxetine, or if you have untreated or uncontrolled glaucoma.

Before taking Cymbalta, tell your doctor if you are allergic to any drugs, or if you have:

seizures or epilepsy;

a bleeding or blood clotting disorder;

glaucoma;

bipolar disorder (manic depression); or

a history of drug abuse or suicidal thoughts.

If you have any of these conditions, you may need a dose adjustment or special tests to safely take Cymbalta.

You may have thoughts about suicide when you first start taking an antidepressant, especially if you are younger than 24 years old. Tell your doctor if you have worsening symptoms of depression or suicidal thoughts during the first several weeks of treatment, or whenever your dose is changed.

Your family or other caregivers should also be alert to changes in your mood or symptoms. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment.

FDA pregnancy category C. Cymbalta may be harmful to an unborn baby, and may cause problems in a newborn baby if the mother takes the medication late in pregnancy (during the third trimester). Tell your doctor if you are pregnant or plan to become pregnant during treatment. Duloxetine can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

Older adults may be more sensitive to the side effects of this medication.

Do not give Cymbalta to anyone younger than 18 years old without the advice of a doctor.

How should I take Cymbalta?

Take Cymbalta exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Your doctor may occasionally change your dose to make sure you get the best results from the medication.

Try to take the medicine at the same time each day. Follow the directions on your prescription label.

Do not crush, chew, break, or open a delayed-release capsule. Swallow the pill whole. It is specially made to release medicine slowly in the body. Breaking or opening the pill would cause too much of the drug to be released at one time. It may take 4 weeks or longer for your symptoms to improve. For best results, keep using the medication as directed. Do not stop using Cymbalta without first talking to your doctor. You may have unpleasant side effects if you stop taking this medication suddenly. Store Cymbalta at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember. However, if it is almost time for the next regularly scheduled dose, skip the missed dose and take the next one as directed. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have taken too much of this medication. Overdose symptoms may include nausea, vomiting, diarrhea, agitation, confusion, hallucinations, fast heart rate, feeling light-headed, or fainting.

What should I avoid while taking Cymbalta?

Avoid drinking alcohol while taking Cymbalta. Alcohol may increase the risk of damage to your liver. Cymbalta can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

Tell your doctor if you regularly use other medicines that make you sleepy (such as cold or allergy medicine, narcotic pain medicine, sleeping pills, muscle relaxers, and medicine for seizures or anxiety). They can add to sleepiness caused by Cymbalta.

Cymbalta side effects

Get emergency medical help if you have any of these signs of an allergic reaction to Cymbalta: skin rash or hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have any new or worsening symptoms such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

Call your doctor at once if you have any of these serious side effects while using Cymbalta:

nausea, stomach pain, low fever, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes);

painful or difficult urination;

easy bruising or bleeding, nosebleeds;

black, bloody, or tarry stools;

very stiff (rigid) muscles, high fever, vomiting, diarrhea, sweating, fast or uneven heartbeats, tremors, overactive reflexes;

headache, trouble concentrating, memory problems, confusion, hallucinations; or

weakness, feeling unsteady, loss of coordination, fainting, seizure, shallow breathing or breathing that stops.

Less serious Cymbalta side effects may include:

dry mouth, blurred vision;

drowsiness, dizziness, spinning sensation;

mild nausea, constipation, gas;

sleep problems (insomnia);

joint or muscle pain;

weight changes; or

decreased sex drive, impotence, or difficulty having an orgasm.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect Cymbalta?

Talk to your doctor before taking any medicine for pain, arthritis, fever, or swelling. This includes aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), diclofenac (Voltaren), indomethacin, piroxicam (Feldene), nabumetone (Relafen), etodolac (Lodine), and others. Taking any of these drugs with Cymbalta may cause you to bruise or bleed easily.

Before taking Cymbalta, tell your doctor if you are using any of the following medicines:

a blood thinner such as warfarin (Coumadin);

cimetidine (Tagamet);

a diuretic (water pill);

fluvoxamine (Luvox);

linezolid (Zyvox);

lithium (Lithobid, Eskalith);

St. John’s wort;

tramadol (Ultram);

tryptophan (sometimes called L-tryptophan);

an antibiotic such as ciprofloxacin (Cipro) or enoxacin (Penetrex);

almotriptan (Axert), frovatriptan (Frova), sumatriptan (Imitrex), naratriptan (Amerge), rizatriptan (Maxalt), or zolmitriptan (Zomig); or

any other antidepressant such as desipramine (Norpramin), fluoxetine (Prozac, Sarafem), paroxetine (Paxil), and others.

This list is not complete and there may be other drugs that can interact with Cymbalta. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.