duloxetine
Duloxetine (Cymbalta) helps treat depression and anxiety. It can also help with some types of chronic pain, such as nerve pain from diabetes. Duloxetine (Cymbalta) is a type of antidepressant called an SNRI, or serotonin and norepinephrine reuptake inhibitor. Most people take it by mouth once a day, but some with depression might take it twice a day. Side effects include nausea, headache, and dry mouth. When it's time to stop taking the medication, the prescriber will slowly lower your dose to help prevent withdrawal symptoms.
What is Duloxetine (Cymbalta)?
What is Duloxetine (Cymbalta) used for?
- Depression in adults
- Generalized anxiety disorder in people ages 7 years and older
- Diabetic neuropathy (nerve pain caused by high blood sugar) in adults
- Fibromyalgia in people ages 13 years and older
- Chronic pain in the muscles, bones, joints, or tendons in adults
How Duloxetine (Cymbalta) works
Duloxetine (Cymbalta) is an SNRI, or a serotonin and norepinephrine reuptake inhibitor. It works by raising the level of chemicals called serotonin and norepinephrine in your brain. This is thought to help improve mood and lessen pain.
Drug facts
Side effects of Duloxetine (Cymbalta)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Nausea (23%)
- Headache (14%)
- Dry mouth (13%)
- Drowsiness (10%)
- Feeling tired (9%)
- Trouble sleeping (9%)
- Dizziness (9%)
- Constipation (9%)
- Diarrhea (9%)
- Low appetite (7%)
- A lot of sweating (6%)
- Stomach pain (5%)
Less Common Side Effects
- Blurry vision
- Abnormal heartbeat
- Vertigo
- Chills
- Tremor
- Vomiting
- Trouble urinating
- Low sex drive
- Other sexual problems, like erectile dysfunction (ED)
- Yawning
- Change in weight
Note: Side effects were reported in adults. Side effects in children might be different.
Duloxetine (Cymbalta) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Suicidal thoughts or behaviors
- Liver damage: nausea, vomiting, loss of appetite, severe stomach pain, yellowing of the skin or whites of the eyes
- Serotonin syndrome: restlessness, fast heartbeat, diarrhea, nausea, vomiting, feeling very warm, fever, abnormal eye movements, loss of balance, muscle spasms, tremors
- Severe bleeding or bruising: bruising that doesn't get better, black stools, pink or red urine, coughing up or vomiting blood, unusual bleeding from the nose or gums
- Low sodium: headaches, trouble concentrating, memory problems, weakness, confusion, hallucinations
- Severe skin reaction: blisters, peeling rash, sores, hives
- Seizure
More on Duloxetine (Cymbalta) side effects
The following Duloxetine (Cymbalta) side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
Incidence not known
Abdominal or stomach pain
area rash
blindness
blistering, peeling, or loosening of the skin
blurred vision
change in consciousness
chills
clay-colored stools
cold sweats
confusion
convulsions
dark urine
decreased urine output
decreased vision
difficulty with swallowing
dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
fainting
fast or irregular heartbeat
general tiredness or weakness
hives or welts, itching, or skin rash
hives, itching, puffiness, or swelling of the eyelids or around the eyes, face, lips, or tongue
increased thirst
joint or muscle pain
large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
light-colored stools
loss of consciousness
red skin lesions, often with a purple center
red, irritated eyes
redness of the skin
sores, ulcers, or white spots in the mouth or on the lips
swelling of the face, ankles, or hands
tearing
tightness in the chest
unpleasant breath odor
upper right stomach pain
vomiting of blood
yellow eyes and skin
Get emergency help immediately if any of the following symptoms of overdose occur:
Symptoms of overdose
Agitation
loss of bladder control
muscle spasm or jerking of all extremities
overactive reflexes
poor coordination
restlessness
shivering
sleepiness or unusual drowsiness
sudden loss of consciousness
sweating
talking or acting with excitement you cannot control
trembling or shaking
twitching
unusual tiredness or weakness
vomiting
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
Body aches or pain
difficulty having a bowel movement (stool)
ear congestion
headache
lack or loss of strength
loss of appetite
loss of voice
muscle aches
sleepiness or unusual drowsiness
stuffy or runny nose
sweating increased
trouble sleeping
Less common
Abnormal orgasm
acid or sour stomach
belching
burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
change in taste
change or problem with discharge of semen
decreased interest in sexual intercourse
difficulty with moving
feeling of warmth or redness of the face, neck, arms, and occasionally, upper chest
inability to have or keep an erection
indigestion
longer than usual time to ejaculation of semen
loose stools
loss in sexual ability, desire, drive, or performance
loss of taste
muscle cramps, pains, or stiffness
shakiness in the legs, arms, hands, or feet
stomach discomfort or upset
sudden sweating
swollen joints
trembling or shaking of the hands or feet
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
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Pros and cons of Duloxetine (Cymbalta)
Pros
- Taken once a day for most people
- Can take at any time of day
- A first-choice option for depression
- An option for some types of chronic pain, like nerve pain from diabetes
Cons
- Can take several weeks before you feel its full effects
- Might not be a good option for people who drink heavily or have liver or kidney problems
- Can cause nausea or dry mouth
- Can interact with many medications, including other antidepressants and certain pain relievers
Pharmacist tips for Duloxetine (Cymbalta)
- You can take duloxetine (Cymbalta) with or without food at any time of day. Once you find a time that works for you, try to stick to a schedule. This helps the medication work the best it can and also can help you remember to take it.
- Swallow the duloxetine (Cymbalta) capsule whole. Don't crush, chew, or open it. Otherwise, it can affect how the medication works.
- Duloxetine (Cymbalta) can sometimes make you sleepy or tired. This can make it harder to think clearly or react fast. Don't drive or use heavy machinery until you know how the medication affects you.
- You might feel dizzy when starting duloxetine (Cymbalta) and when you switch to a higher dose. Be careful standing up after sitting or lying down to prevent falls.
- Avoid drinking alcohol while taking duloxetine (Cymbalta). Alcohol can make side effects like sleepiness and dizziness worse. It can also raise the risk of liver damage because the medication and alcohol both have this risk on their own.
- If you have diabetes, ask your care team if you need to check your blood sugar more often while taking duloxetine (Cymbalta). This medication might raise your blood sugar.
- Tell your prescriber and pharmacist about all the medications you take and plan to take. They can check for drug interactions with duloxetine (Cymbalta). For example, taking it with blood thinners like aspirin or warfarin (Coumadin) can raise the risk of bleeding. If needed, your care team can recommend dose changes or treatment changes to help keep you safe.
- Don't lower your dose or stop taking duloxetine (Cymbalta) suddenly without talking to your prescriber first. Doing this too fast can cause uncomfortable withdrawal symptoms. It can make you feel dizzy, nauseous, or irritable. And it can cause headache, upset stomach, and trouble sleeping. Your prescriber will help you slowly lower your dose over time so you can stop safely.
- Tell your healthcare team if you're breastfeeding. They can talk with you about the risks and benefits of taking duloxetine (Cymbalta). This medication can pass into breast milk, and some babies might get sleepy, feed poorly, or gain weight slowly.
Common questions about Cymbalta
In clinical trials, some adults who took Cymbalta reported weight gain. Weight gain might be more likely to happen if you take higher doses (e.g., 120 mg per day) of the medication or if you take lower doses for a long period of time (e.g., 1 year). In general, the amount of weight gain that most people who take Cymbalta have is minimal. Keep in mind that some people might also experience weight loss with Cymbalta, typically when they first start the medication. Have a discussion with your prescriber if you notice concerning changes in your weight after you start taking Cymbalta.
No. Cymbalta works to raise serotonin levels in the brain like selective serotonin reuptake inhibitors (SSRIs). But Cymbalta also raises norepinephrine levels. Because it raises both serotonin and norepinephrine levels, Cymbalta is considered an SNRI (serotonin and norepinephrine reuptake inhibitor).
For mood conditions, it can take some people 1 to 2 weeks of treatment with Cymbalta before starting to notice improvement. Antidepressants generally work slowly to improve mood and it can take up to 2 months to feel the medication's full effect. Clinical studies for fibromyalgia showed that people who took Cymbalta had pain relief as early as the first week of treatment. But speak to your prescriber if you don't feel like Cymbalta is helping with your pain; studies showed that it's unlikely that you'll get any more pain relief with continued use or with a higher dose if you've taken 60 mg daily for 2 months and haven't had any relief.
Cymbalta can make you sleepy as a side effect. Because of this, avoid driving or doing tasks that require focus until you know how the medication affects you. Don't suddenly stop taking Cymbalta if this side effect becomes bothersome. Stopping the medication too quickly can lead to sleep issues. Speak with your prescriber if the medication makes you too sleepy and it starts negatively affecting your daily life.
No. Cymbalta isn't a controlled substance because it doesn't have a risk for misuse and dependence.
Drinking alcohol isn't recommended while you're taking Cymbalta. Alcohol can cause side effects similar to Cymbalta, including nausea and drowsiness. Drinking alcohol while you're taking this medication can make these side effects more likely or more severe. In addition, both alcohol and Cymbalta can affect your liver health. The risk for liver damage is much higher if you drink alcohol while you're taking this medication, especially if you have multiple drinks at a time or drink heavily. Speak with your prescriber about your drinking habits to see whether Cymbalta is appropriate for you.
You can take Cymbalta at any time that's convenient for you. But make sure you take the medication at the same time every day. Keep in mind that Cymbalta can make some people feel drowsy and others have trouble sleeping. See how Cymbalta makes you feel to choose when you should take the medication during the day. Taking it in the morning might help prevent trouble sleeping at night, and taking it at night can be helpful if the medication makes you tired. Ask your prescriber or pharmacist for more guidance on the best time during the day you should take Cymbalta.
There isn't a lot of information available to know whether Cymbalta is safe during pregnancy. Research doesn't show a clear link between this medication and birth defects. But it does suggest that people who took Cymbalta in the last month of pregnancy might be at a higher risk of bleeding after childbirth. Speak to your healthcare team about the risks and benefits of Cymbalta if you're pregnant or thinking about becoming pregnant. Your prescriber can discuss with you about safe antidepressant options you can take while pregnant.
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Risks and warnings for Duloxetine (Cymbalta)
Duloxetine (Cymbalta) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Suicidal thoughts or behavior
- Risk factors: Age 24 years or younger | History of depression or other mental health conditions
Duloxetine (Cymbalta) might raise the risk of suicidal thoughts or behavior, especially in people under the age of 25. Watch for worsening depression or sudden changes in mood or behavior. This is very important during the first few months of treatment or after a dose change.
Talk to a healthcare professional if you or someone close to you notices any unusual mood or behavior. Call 911 right away if you have thoughts of hurting yourself.
Liver damage
- Risk factors: Drinking alcohol | History of liver problems
It's rare, but some people who took duloxetine (Cymbalta) had liver problems. They can be serious and sometimes life-threatening. Tell your care team right away if you have stomach pain, nausea, vomiting, or yellow skin or eyes (jaundice). These can be signs of liver damage. You'll probably need to stop the medication to protect your liver. Your care team will also work to find out what's causing the problem.
Changes in blood pressure and risk of falls
- Risk factors: Older adults | Balance problems | Taking more than 60 mg of duloxetine (Cymbalta) daily | Taking other medications that lower blood pressure
Duloxetine (Cymbalta) can cause changes to your blood pressure. It might sometimes raise your blood pressure. It can also cause your blood pressure to drop when you stand up. This drop can make you dizzy or faint, which can put you at risk of falling. This often happens within the first week of treatment but can happen later, especially after you switch to a higher dose.
Check your blood pressure often while taking duloxetine (Cymbalta). Get up slowly after sitting or lying down. This helps prevent sudden drops in blood pressure and dizziness. Tell your primary care provider if your blood pressure seems too high or too low, you feel dizzy, or have fainted.
Serotonin syndrome
- Risk factors: Taking other medications that raise serotonin levels in the brain
Duloxetine (Cymbalta) can sometimes cause a serious and dangerous problem called serotonin syndrome. This happens when you have too much serotonin in your brain. Duloxetine (Cymbalta) raises serotonin levels, which is how it works.
The risk is higher if you take duloxetine (Cymbalta) with other medications that also raise serotonin levels. These include other antidepressants, cough medications with dextromethorphan, and some opioid pain medications. Tell your care team about all the medications you take so they can check your risk.
Stop taking duloxetine (Cymbalta) and get medical help right away if you have signs of serotonin syndrome. These include high fever, fast heart rate, heavy sweating, stiff muscles, or confusion.
Higher risk of bleeding
- Risk factors: Taking blood thinners or other medications that make bleeding or bruising easier
Duloxetine (Cymbalta) can raise the risk of bleeding or bruising more easily. The risk is higher if you also take other medications that have a bleeding risk. These include nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin and ibuprofen (Advil). Other medications include blood thinners like warfarin (Coumadin).
Bleeding can range from nosebleeds to stomach bleeds, which can be serious and life-threatening. Tell a healthcare professional right away about any bruising that doesn't go away or bleeding that's hard to stop. Also tell them right away if you have black stools or pink or red urine. These can be signs of bleeding that could be serious.
Severe skin reaction
In some rare cases, duloxetine (Cymbalta) can cause severe skin reactions. Get medical help as soon as possible if you have painful blisters, a peeling rash, sores, or other signs of a skin reaction.
Withdrawal symptoms
- Risk factors: Stopping duloxetine (Cymbalta) too suddenly
Don't stop taking duloxetine (Cymbalta) suddenly without talking to your prescriber first. Stopping the medication too quickly can cause withdrawal symptoms. This can make you feel nauseous, anxious, irritable, or confused. It can also cause upset stomach, dizziness, headache, and trouble sleeping.
If you want to stop taking duloxetine (Cymbalta), tell your prescriber. They can help you do this safely by lowering your dose over time before you stop completely.
Low sodium levels
- Risk factors: Older adults | Medical condition called syndrome of inappropriate antidiuretic hormone (SIADH) | Taking diuretics (water pills) | Dehydrated or low fluid levels in the body
It's possible for duloxetine (Cymbalta) to cause low sodium levels. In general, sodium levels tend to go back within normal ranges when the medication is stopped. Call your prescriber if you have symptoms of low sodium. This can include headaches, trouble concentrating, memory problems, confusion, weakness, or balance problems.
Sexual problems
Duloxetine (Cymbalta) can sometimes cause sexual problems. They can include erectile dysfunction, low sex drive, or problems with orgasms. Tell your prescriber if you have any sexual problems that affect your sex life while taking this medication. Your prescriber can help find the cause and suggest ways to help.
Not for use alone for bipolar disorder because of the risk of mania
- Risk factors: Personal or family history of bipolar disorder | History of mania
Sometimes, depression is the first sign of bipolar disorder. Treating someone with bipolar disorder with an antidepressant by itself can cause a manic episode. This can look like having a lot of energy, being very talkative, having racing thoughts, and doing risky things.
Before starting duloxetine (Cymbalta) for depression, tell your prescriber if you or anyone in your family has bipolar disorder. Also tell them if you've ever had a manic episode before. Your prescriber will check your risk and make sure you get the right care. Duloxetine (Cymbalta) isn't approved to treat bipolar depression.
Angle-closure glaucoma in certain people
- Risk factors: Have narrow-angle eyes but haven't had laser eye surgery for it yet
Antidepressants like duloxetine (Cymbalta) can sometimes cause a sudden eye problem called an angle-closure attack. This is more likely in people with narrow-angle eyes who haven't had laser eye surgery.
Call your eye specialist right away if you suddenly have blurry vision, severe eye pain, or see rings around lights. These can be signs of an angle-closure attack. This needs immediate medical care.
Duloxetine (Cymbalta) dosage
Capsule| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 20mg | 30 capsules | $11.51 | $0.38 |
| 30mg | 30 capsules | $10.98 | $0.37 |
| 60mg | 30 capsules | $12.51 | $0.42 |
| 40mg | 30 capsules | $42.08 | $1.40 |
Typical dosage for Duloxetine (Cymbalta)
This medication is taken by mouth. You might start at a low dose before your prescriber raises it slowly over a few weeks to the recommended dose. Your prescriber will adjust your dose based on how well it's working for you and if you have side effects.
-
Depression
- Adults: The typical dose ranges from 40 mg per day (given as 20 mg twice daily) to 60 mg per day (given once daily or as 30 mg twice daily).
-
Generalized anxiety disorder
- Adults: The typical dose is 60 mg once daily. Older adults might start with 30 mg once daily before their dose is raised to 60 mg once daily.
- Children ages 7 years and older: The typical starting dose is 30 mg once daily. The recommended dose ranges from 30 mg to 60 mg once daily.
-
Diabetic neuropathy
- Adults: The typical dose is 60 mg once daily.
-
Fibromyalgia
- Adults and children ages 13 years and older: The typical starting dose is 30 mg once daily. The dose can be raised to 60 mg once daily.
-
Chronic pain in the muscles, bones, joints, or tendons
- Adults: The typical starting dose is 30 mg once daily. The recommended dose is 60 mg once daily.
The typical maximum daily dose is 60 mg. But it can also go up to 120 mg per day for some people with depression or generalized anxiety disorder.
More on Duloxetine (Cymbalta) dosage
Interactions between Duloxetine (Cymbalta) and other drugs
More on Duloxetine (Cymbalta) interactions
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Bromopride
- Eliglustat
- Furazolidone
- Iproniazid
- Isocarboxazid
- Linezolid
- Methylene Blue
- Metoclopramide
- Moclobemide
- Nialamide
- Phenelzine
- Procarbazine
- Rasagiline
- Safinamide
- Selegiline
- Thioridazine
- Tranylcypromine
- Viloxazine
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Abciximab
- Aceclofenac
- Acemetacin
- Alfentanil
- Almotriptan
- Amphetamine
- Amtolmetin Guacil
- Anagrelide
- Anileridine
- Apixaban
- Asenapine
- Aspirin
- Benzhydrocodone
- Benzphetamine
- Brexpiprazole
- Bromfenac
- Brompheniramine
- Bufexamac
- Buprenorphine
- Bupropion
- Buspirone
- Butorphanol
- Capmatinib
- Carbamazepine
- Celecoxib
- Chlorpheniramine
- Choline Salicylate
- Cifenline
- Cilostazol
- Cimetidine
- Ciprofloxacin
- Citalopram
- Clonixin
- Clopidogrel
- Clozapine
- Cocaine
- Codeine
- Cyclobenzaprine
- Darunavir
- Deferasirox
- Desvenlafaxine
- Dexibuprofen
- Dexketoprofen
- Dextroamphetamine
- Dextromethorphan
- Diclofenac
- Difenoxin
- Diflunisal
- Dihydrocodeine
- Diphenoxylate
- Dipyridamole
- Dipyrone
- Dolasetron
- Donepezil
- Doxorubicin
- Doxorubicin Hydrochloride Liposome
- Droxicam
- Edoxaban
- Eletriptan
- Encainide
- Enoxacin
- Epoprostenol
- Eptifibatide
- Escitalopram
- Ethylmorphine
- Etodolac
- Etofenamate
- Etoricoxib
- Felbinac
- Fenfluramine
- Fenoprofen
- Fentanyl
- Fepradinol
- Feprazone
- Flecainide
- Floctafenine
- Flufenamic Acid
- Fluoxetine
- Flurbiprofen
- Fluvoxamine
- Frovatriptan
- Givosiran
- Granisetron
- Hydrocodone
- Hydromorphone
- Hydroxytryptophan
- Ibuprofen
- Iloprost
- Indecainide
- Indomethacin
- Iobenguane I 123
- Iobenguane I 131
- Ketobemidone
- Ketoprofen
- Ketorolac
- Lamifiban
- Lasmiditan
- Levomilnacipran
- Levorphanol
- Lexipafant
- Lisdexamfetamine
- Lithium
- Lorcainide
- Lorcaserin
- Lornoxicam
- Loxoprofen
- Lumiracoxib
- Meclofenamate
- Mefenamic Acid
- Meloxicam
- Meperidine
- Metaxalone
- Methadone
- Methamphetamine
- Milnacipran
- Mirtazapine
- Morniflumate
- Morphine
- Morphine Sulfate Liposome
- Nabumetone
- Nalbuphine
- Naproxen
- Naratriptan
- Nebivolol
- Nefazodone
- Nepafenac
- Nicomorphine
- Niflumic Acid
- Nimesulide
- Nimesulide Beta Cyclodextrin
- Ondansetron
- Opium
- Opium Alkaloids
- Oxaprozin
- Oxycodone
- Oxymorphone
- Oxyphenbutazone
- Ozanimod
- Palonosetron
- Papaveretum
- Parecoxib
- Paregoric
- Paroxetine
- Pentazocine
- Phenylbutazone
- Piketoprofen
- Piritramide
- Piroxicam
- Pixantrone
- Pranoprofen
- Proglumetacin
- Propafenone
- Propyphenazone
- Proquazone
- Recainam
- Remifentanil
- Rivaroxaban
- Rizatriptan
- Rofecoxib
- Salicylic Acid
- Salsalate
- Sertraline
- Sibrafiban
- Sibutramine
- Sodium Salicylate
- St John's Wort
- Sufentanil
- Sulfinpyrazone
- Sulindac
- Sulodexide
- Sumatriptan
- Tapentadol
- Tenoxicam
- Tianeptine
- Tiaprofenic Acid
- Ticlopidine
- Tilidine
- Tirofiban
- Tolfenamic Acid
- Tolmetin
- Tramadol
- Trazodone
- Tryptophan
- Valdecoxib
- Venlafaxine
- Vilazodone
- Vortioxetine
- Xemilofiban
- Ziprasidone
- Zolmitriptan
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Acenocoumarol
- Phenprocoumon
- Warfarin
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Duloxetine (Cymbalta) contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Duloxetine (Cymbalta) will not be safe for you to take.
- Currently take or have taken a monoamine oxidase inhibitor (MAOI) within the past 14 days
- In the middle of treatment with linezolid (Zyvox) or methylene blue
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