duloxetine, Cymbalta (cont.)

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Fluoxetine (Prozac, Serafem), paroxetine (Paxil, Paxil CR, Pexeva), fluvoxamine (Luvox), and quinidine increase blood levels of duloxetine by reducing its metabolism in the liver. Such combinations may increase adverse effects of duloxetine.

Combining duloxetine with aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), warfarin (Coumadin) or other drugs that are associated with bleeding may increase the risk of bleeding, because duloxetine itself is associated with bleeding. Duloxetine has an enteric coating that prevents dissolution until it reaches a segment of the gastrointestinal that has a pH higher than 5.5. In theory, drugs that raise the pH in the gastrointestinal system (for example, omeprazole [Prilosec]) may cause duloxetine to be released early while conditions that slow gastric emptying (for example, diabetes) may cause premature breakdown of duloxetine. Nevertheless, administration of duloxetine with an antacid or famotidine (Axid) did not significantly affect the absorption of duloxetine.

Duloxetine may reduce the breakdown of desipramine (Norpramine), leading to increased blood concentrations of desipramine and potential side effects.

PREGNANCY: In animal studies, duloxetine has been shown to have adverse effects on fetal development. There are no adequate studies in pregnant women. Duloxetine should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

NURSING MOTHERS: Duloxetine is excreted into the milk of lactating women. Because the safety of duloxetine in infants is not known, breastfeeding while on duloxetine is not recommended.

Medically Reviewed by a Doctor on 11/10/2014


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