duloxetine
Duloxetine (Cymbalta) is used to treat depression, anxiety, and some forms of long-term pain. This medication is an antidepressant that's called an SNRI or serotonin and norepinephrine reuptake inhibitor. The dosage is typically one capsule by mouth once daily (or twice daily for some people with depression). Side effects can include nausea, headache, and dry mouth. If you need to stop the medication for any reason, your prescriber will lower your dose slowly over time to prevent withdrawal symptoms like anxiety and trouble sleeping.
What is Duloxetine (Cymbalta)?
What is Duloxetine (Cymbalta) used for?
- Major depressive disorder in adults
- Generalized anxiety disorder in people age 7 years and older
- Diabetic neuropathy (nerve pain caused by high blood sugar) in adults
- Fibromyalgia in people age 13 years and older
- Long-term 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's thought to help improve mood and pain by raising the level of chemicals called serotonin and norepinephrine in your brain.
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
- Tremor
- Vomiting
- Low sex drive
- Yawning
- Change in weight
Note: These side effects were reported in adults. Side effects that children might have can 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 improve, black-colored stools, pink or red-colored urine, coughing up or vomiting blood, unusual bleeding from the nose or gums
- Low sodium levels: headaches, trouble concentrating, memory problems, weakness, confusion, hallucinations
- Severe skin reaction: blisters, peeling rash, sores, hives
- Seizure
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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
- Can treat several conditions, so might be good for people with multiple conditions
- Helps lower nerve pain from diabetes and other forms of long-term pain
- Can take at any time of day (as long as you're consistent)
- Available as a lower-cost generic
Cons
- Can take several weeks before you feel the full effects of the medication on your mood
- Might not be a good option for people who drink heavily or have liver or kidney problems
- Can cause higher risk of suicidal thoughts and behavior in people 24 years and younger
- Might raise your risk of bleeding
Pharmacist tips for Duloxetine (Cymbalta)
- You can take duloxetine (Cymbalta) with or without food. Food won't affect how well this medication works for you.
- Swallow the duloxetine (Cymbalta) capsules whole. Don't crush, chew, or open the capsules because this could damage the medication.
- You might feel dizzier when you first start duloxetine (Cymbalta) and any time your dose is raised. Be careful standing up from a seated or lying position to prevent falls.
- Duloxetine (Cymbalta) can sometimes make you tired and affect how clearly you can think or how fast you can react. Don't drive or operate heavy machinery until you know how the medication affects you.
- Contact your prescriber if you notice sudden mood changes or unusual thoughts. Duloxetine (Cymbalta) can sometimes make certain mental health problems worse.
- Let your prescriber know if you have trouble urinating while you're taking duloxetine (Cymbalta). This might be a side effect of the medication that your prescriber can discuss how to manage.
- Let your healthcare professional (HCP) know if you experience any vision changes while you're taking duloxetine (Cymbalta). This medication can worsen eye problems in certain people.
- If you have high blood sugar (diabetes), make sure to monitor your blood glucose levels while you're taking duloxetine (Cymbalta). This medication might raise your blood sugar levels.
- Tell your prescriber and pharmacist about all the prescription and over-the-counter medications you're taking. They can help screen for possible drug interactions with duloxetine (Cymbalta) and check that all your medications are safe to take together. For example, your risk for bleeding might be higher if you take duloxetine (Cymbalta) with blood-thinning medications like aspirin or warfarin (Coumadin).
- Talk with your prescriber if you'd like to stop your treatment with duloxetine (Cymbalta). Stopping the medication too suddenly can cause withdrawal symptoms such as dizziness, headache, nausea, diarrhea, irritability, and trouble sleeping. To lessen the risk for withdrawal symptoms, your prescriber can give guidance on how to stop the medication safely by lowering your dose slowly over time.
- Let your healthcare team know if you're breastfeeding so they can discuss with you about the benefits and risks of taking duloxetine (Cymbalta). This medication can get into breast milk. Breastfed babies might get sleepy, have poor feeding, and have poor weight gain if you take duloxetine (Cymbalta) while nursing.
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Common questions about Duloxetine (Cymbalta)
In clinical trials, some adults who took duloxetine (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 duloxetine (Cymbalta) have is minimal. Keep in mind that some people might also experience weight loss with duloxetine (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 duloxetine (Cymbalta).
No. Duloxetine (Cymbalta) works to raise serotonin levels in the brain like selective serotonin reuptake inhibitors (SSRIs). But duloxetine (Cymbalta) also raises norepinephrine levels. Because it raises both serotonin and norepinephrine levels, duloxetine (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 duloxetine (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 duloxetine (Cymbalta) had pain relief as early as the first week of treatment. But speak to your prescriber if you don't feel like duloxetine (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.
Duloxetine (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 duloxetine (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. Duloxetine (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 duloxetine (Cymbalta). Alcohol can cause side effects similar to duloxetine (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 duloxetine (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 duloxetine (Cymbalta) is appropriate for you.
You can take duloxetine (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 duloxetine (Cymbalta) can make some people feel drowsy and others have trouble sleeping. See how duloxetine (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 duloxetine (Cymbalta).
There isn't a lot of information available to know whether duloxetine (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 duloxetine (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 duloxetine (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 and behavior
- Risk factors: Age 24 years or younger | History of depression or other mental health conditions
Duloxetine (Cymbalta) can raise the risk of worsening depression. It can also raise the risk for suicidal thoughts or behavior. Watch for new or worsening depression, thoughts of harming yourself, or abnormal behavior, especially during the first few months of treatment or when your dose changes. Let a healthcare professional (HCP) know right away if you notice any unusual changes in mood or behavior while you're taking this medication.
Liver damage
- Risk factors: Drinking alcohol | History of liver problems
There have been rare reports of serious, and sometimes life-threatening, liver problems in people who took duloxetine (Cymbalta). Tell your HCP right away if you develop any stomach pain, nausea, vomiting, swelling in your legs, or yellowing of the whites of your eyes (jaundice). You'll probably need to stop duloxetine (Cymbalta) to prevent more harm to your liver.
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 | High blood pressure
It's important to regularly monitor your blood pressure because duloxetine (Cymbalta) can cause changes to your blood pressure (either up or down).
Your blood pressure might suddenly fall when you get up from a sitting or lying position. This might make you feel dizzy and can lead to falls or fainting. Drops in blood pressure when you stand and possible fainting tend to happen within the first week of treatment but can occur at any time, particularly after your dose is raised. Get up very slowly when you're changing positions, such as after lying down.
Serotonin syndrome
- Risk factors: Taking other medications that can affect the serotonin levels in your brain
Duloxetine (Cymbalta) raises the serotonin levels in your brain to help improve mood and pain. Serotonin syndrome is a rare, but potentially life-threatening condition that can happen when there's too much serotonin in the brain. Get medical help right away if you have symptoms of serotonin syndrome, like fast heart rate, sweating, muscle stiffness or spasms, high fever, and confusion.
Your risk for serotonin syndrome goes up if you use duloxetine (Cymbalta) with other medications that affect serotonin levels, such as dextromethorphan (Delsym), tramadol (Ultram), and MAOIs. Tell your prescriber about all the medications you take (including over-the-counter medications and supplements) so they can make sure duloxetine (Cymbalta) is safe for you to take. Don't start any new medications while you're taking duloxetine (Cymbalta) without letting your pharmacist or HCP know.
Higher bleeding risk
- Risk factors: Taking blood-thinning medications
Duloxetine (Cymbalta) can raise the risk of bleeding or bruising, especially if you're also taking aspirin, NSAIDs (nonsteroidal anti-inflammatory drugs), or blood thinners. The bleeding can range from nosebleeds to stomach bleeds and at times can be life-threatening. Tell an HCP right away about any bruising that doesn't go away, black-colored stools, pink or red urine, or unusual bleeding from the nose or gums.
Severe skin reaction
In some rare cases, duloxetine (Cymbalta) can cause severe skin reactions. Get medical help as soon as possible if you experience painful blisters, a peeling rash, sores, or other signs of a skin reaction.
Withdrawal symptoms
- Risk factors: Stopping duloxetine (Cymbalta) suddenly
Stopping duloxetine (Cymbalta) suddenly can cause withdrawal symptoms such as nausea, upset stomach, anxiety, irritation, confusion, trouble sleeping, dizziness, and headache. Talk to your prescriber for guidance on how to lower your dose slowly and safely if you need to stop taking it.
Mania
- Risk factors: Personal or family history of bipolar disorder
Sometimes, depression is the first symptom of bipolar disorder. Treating someone with bipolar disorder with an antidepressant alone can cause a manic episode (great excitement, euphoria, delusions, and overactivity). This is more likely to happen if you or someone in your family has had bipolar disorder. Talk to your HCP right away if you notice unusual changes in your behavior after you take duloxetine (Cymbalta). This medication isn't approved for treating bipolar depression.
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 the body. In general, sodium levels tend to go back within normal ranges when the medication is stopped. Call your HCP if you experience signs and symptoms of low sodium levels, such as headaches, trouble concentrating, memory problems, confusion, weakness, or balance problems.
Sexual problems
In clinical trials, some adults who took duloxetine (Cymbalta) had sexual problems. These problems included erectile dysfunction and low sex drive. Contact your HCP if you notice any bothersome sexual problems while you're taking duloxetine (Cymbalta).
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)
Depending on your medical condition and age, you might start the medication at a low dose before your prescriber raises the dose slowly over a few weeks to the recommended dose. Your prescriber will adjust your dose based on how well the medication is working for you and whether you have side effects.
-
Major depressive disorder
- Adults: The typical dose ranges from 40 mg (given as 20 mg twice daily) to 60 mg (once daily or as 30 mg twice daily) by mouth.
-
Generalized anxiety disorder
- Adults: The typical dose is 60 mg by mouth once daily. Older adults might start the medication at a dose of 30 mg once daily before their dose is raised to 60 mg once daily.
- Children age 7 years and older: The typical starting dose is 30 mg by mouth once daily. The recommended dose is between 30 mg to 60 mg once daily.
-
Diabetic neuropathy
- Adults: The typical dose is 60 mg by mouth once daily.
-
Fibromyalgia
- Adults and children age 13 years and older: The typical starting dose is 30 mg by mouth once daily. The dose can be raised to 60 mg once daily.
-
Long-term pain in the muscles, bones, joints, or tendons
- Adults: The typical starting dose is 30 mg by mouth once daily. The recommended dose is 60 mg once daily.
The typical maximum daily dose is 60 mg, but can go up to 120 mg when treating for depression or generalized anxiety disorder.
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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 14 days of duloxetine (Cymbalta)
- In the middle of treatment with linezolid (Zyvox) or methylene blue
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