Cymbalta for Fibromyalgia Treatment (cont.)

Other side effects that may occur include:

• Decreased appetite (may include anorexia)
• Decreased sex drive
• Drowsiness or sleepiness
• Increased sweating
• Jitters, nervousness, or restlessness (agitation)
• Urinary hesitation

You may feel dizzy upon standing when you first start taking Cymbalta or when your dose is increased. This is due to a drop in blood pressure, and is known as orthostatic hypotension. Your health care provider may want to check your blood pressure from time to time while you are taking Cymbalta.

Risks and Warnings

Cymbalta and other antidepressants may increase the risk for suicidal thoughts and behaviors in people under age 24. After you are prescribed Cymbalta, your doctor will monitor you closely for unusual behavior changes, new or worsening signs of depression, or suicidal thoughts.

Cymbalta may cause a drop in salt (sodium) levels in the blood, a potentially life-threatening condition called hyponatremia. Older adults, particularly those who take diuretics ("water pills") are more likely to develop this complication. Hyponatremia can cause headaches, confusion, weakness, and in severe cases can lead to fainting, seizures, coma, and death.

Some patients taking Cymbalta have developed liver problems. In rare cases, this has lead to liver failure and death. Contact your health care provider immediately if you develop any of the following symptoms while taking Cymbalta:

• Dark colored urine
• Itching
• Pain in the right, upper belly area
• Unexplained flu-like symptoms
• Yellow skin or eyes (jaundice)

Drug Interactions

In rare cases, a life-threatening condition called serotonin syndrome has occurred in patients who have taken Cymbalta. Serotonin syndrome most often results when someone takes two or more medications that increase the body's serotonin levels at the same time. You need serotonin for your brain and nerve cells to function, but too much of it can be dangerous. Serotonin syndrome can lead to rapid changes in blood pressure, muscle rigidity, seizures, and even death.

This is why it is so important that your health care providers know what medications you are taking. Always tell them about all the medicines you take, including over-the-counter drugs and herbs and supplements.

Drugs that may interact with Cymbalta and cause serotonin syndrome include:

• Cough medicines that contain dextromethorphan
• Monoamine oxidase inhibitors (MAOIs)
• Nausea and heartburn medications such as metoclopramide (Reglan) and ondansetron (Zofran)
• Pain medications, including meperidine (Demerol, a painkiller) and tramadol (Ultram)
• St. John's wort
• Triptans, used to treat migraine headaches

Other drugs may also interact with Cymbalta, including:

• Blood thinners, including warfarin, aspirin, and nonsteroidal anti-inflammatory drugs (NSAIDs). Taking Cymbalta with such medications may increase your chances for bleeding events.

Before You Take Cymbalta

Tell your doctor about any other medical conditions you may have. The drug should be prescribed with caution in those who have:

• A history of seizures or mania
• Conditions that slow gastric emptying (sometimes occurs in those with diabetes)
• Diabetes (Cymbalta may effect blood sugar levels)
• High blood pressure or heart disease
• Liver disease
• Kidney disease

Who Should Not Take Cymbalta?

You should not take Cymbalta if you:

• Are taking a medication called thioridazine
• Are taking a medicine called MAOI or have used one in the last 14 days
• Have uncontrolled narrow-angle glaucoma

In animal studies Cymbalta has demonstrated adverse effects on a developing fetus. No adequate or well-controlled studies of the drug have been performed in pregnant or breastfeeding women. Women who are breastfeeding, pregnant, or planning to become pregnant should talk to their doctor about whether or not Cymbalta is right for them. You should only take Cymbalta if the benefits outweigh the risks.

WebMD Medical Reference

SOURCES:
WebMD: "Cymbalta Oral."
Rakel R.E. Textbook of Family Medicine, 7th ed, 2007; Saunders Elsevier.
Cymbalta web site: "Cymbalta and Fibromyalgia."
Savella web site.
Rakel P, Bope E.T. Conn's Current Therapy 2007, Saunders Elsevier.
Reviewed by Louise Chang, MD, on March 17, 2009
© 2009 WebMD, LLC. All rights reserved.

Last Editorial Review: 8/7/2009