- Fibromyalgia Overview Slideshow
- Take the Fibromyalgia Quiz
- Fibromyalgia: 12 Tips for Coping Slideshow
- What is Cymbalta (duloxetine) and what is it used for?
- What are the side effects of Cymbalta (duloxetine)?
- What is the dosage for Cymbalta (duloxetine)?
- What drugs interact with Cymbalta (duloxetine)?
- Is Cymbalta (duloxetine) safe to take if I'm pregnant or breastfeeding?
- What else should I know about Cymbalta (duloxetine)?
What is Cymbalta (duloxetine) and what is it used for?
Cymbalta (duloxetine) is a selective serotonin and norepinephrine reuptake inhibitor (SNRI) antidepressant used for treating depression, anxiety disorder, and pain. Other drugs in this class include milnacipran (Savella), venlafaxine (Effexor), and desvenlafaxine (Pristiq).
Cymbalta (duloxetine) affects neurotransmitters, the chemicals that nerves within the brain make and release in order to communicate with one another. Neurotransmitters either travel across the space between nerves and attach to receptors on the surface of nearby nerves or they attach to receptors on the surface of the nerves that produced them, to be taken up by the nerve and released again (a process referred to as re-uptake).
Many experts believe that an imbalance among neurotransmitters is the cause of depression as well as other psychiatric disorders. Serotonin and norepinephrine are two neurotransmitters released by nerves in the brain. Cymbalta (duloxetine) works by preventing the reuptake of serotonin and epinephrine by nerves after they have been released.
Since uptake is an important mechanism for removing released neurotransmitters and terminating their actions on adjacent nerves, the reduced uptake caused by Cymbalta (duloxetine) increases the effect of serotonin and norepinephrine in the brain. The mechanism responsible for its effectiveness treating pain is not known but also is thought to involve its effects on serotonin and norepinephrine in the brain. Cymbalta (duloxetine) was approved by the FDA in August 2004.
Cymbalta (duloxetine) is approved for treating the following conditions:
What are the side effects of Cymbalta (duloxetine)?
The most common side effects of Cymbalta (duloxetine) are nausea, dry mouth, constipation, diarrhea, fatigue, difficulty sleeping, and dizziness. Increased blood pressure can occur and should be monitored. Seizures have been reported. Sexual dysfunction (decreased sex drive and delayed orgasm and ejaculation) has been associated with Cymbalta (duloxetine).
Some patients may experience withdrawal reactions upon stopping Cymbalta (duloxetine). Symptoms of withdrawal include:
The Cymbalta (duloxetine) dosage should be gradually reduced when therapy is discontinued to prevent symptoms of withdrawal.
Antidepressants increased the risk of suicidal thinking and behavior (suicidality) in short-term studies in children and adolescents with depression and other psychiatric disorders. Anyone considering the use of Cymbalta (duloxetine) or any other antidepressant in a child or adolescent must balance this risk with the clinical need. Patients who are started on therapy should be closely observed for clinical worsening, suicidality, or unusual changes in behavior.
What is the dosage for Cymbalta (duloxetine)?
The recommended dose of Cymbalta (duloxetine) for treating depression is 20 or 30 mg twice daily or 60 mg once daily. Patients may be started with 30 mg once daily for one week before the dose is advanced to 60 mg daily.
The recommended dose of Cymbalta (duloxetine) for anxiety disorder, pain associated with diabetic neuropathy, fibromyalgia, or chronic musculoskeletal pain is 60 mg daily. Starting at 30 mg daily for one week before increasing to 60 mg daily may help patients adjust to the drug. There is no evidence that doses greater than 60 mg/day provide additional benefits. However, the maximum dose for depression or anxiety disorder is 120 mg/day.
What drugs interact with Cymbalta (duloxetine)?
- Cymbalta (duloxetine) should not be used in combination with a monoamine oxidase inhibitor (MAOI) such as phenelzine (Nardil), tranylcypromine (Parnate), isocarboxazid (Marplan), and selegiline (Eldepryl), or within 14 days of discontinuing the MAOI. At least 5 days should be allowed after stopping Cymbalta (duloxetine) before starting an MAOI. Combinations of SNRIs and MAOIs may lead to serious, sometimes fatal, reactions including very high body temperature, muscle rigidity, rapid fluctuations of heart rate and blood pressure, extreme agitation progressing to delirium, and coma. Similar reactions may occur if Cymbalta (duloxetine) is combined with antipsychotics, tricyclic antidepressants or other drugs that affect serotonin in the brain. Examples include tryptophan, sumatriptan (Imitrex), lithium, linezolid (Zyvox), tramadol (Ultram), and St. John’s Wort.
- 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 Cymbalta (duloxetine).
- Combining duloxetine with aspirin, nonsteroidal antiinflammatory 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.
- Cymbalta (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, Prilosec) may cause duloxetine to be released early while conditions that slow gastric empyting (for example, diabetes) may cause premature breakdown of duloxetine. Nevertheless, aAdministration of duloxetine with an antacid or famotidine (Axid) did not significantly affect the absorption of duloxetine.
- Cymbalta (duloxetine) may reduce the breakdown of desipramine (Norpramine), leading to increased blood concentrations of desipramine and potential side effects.
Is Cymbalta (duloxetine) safe to take if I'm pregnant or breastfeeding?
Cymbalta (duloxetine) is excreted into the milk of lactating women. Because the safety of Cymbalta (duloxetine) in infants is not known, breastfeeding while on Cymbalta (duloxetine) is not recommended.
What else should I know about Cymbalta (duloxetine)?
Do I need a prescription for Cymbalta (duloxetine)?
Yes, a prescription is needed.
What brand names are available for duloxetine?
What preparations of Cymbalta (duloxetine) are available?
Delayed-release capsules: 20, 30 and 60 mg
How should I keep Cymbalta (duloxetine) stored?
Capsules should be stored at room temperature, between 15 C to 30 C (59 F to 86 F).
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Cymbalta (duloxetine) is in the drug class SSRI. Cymbalta is prescribed for the treatment of depression, generalized anxiety disorder, and neuropathic pain associated with diabetic peripheral neuropathy. The most common side effects of Cymbalta are nausea, dry mouth, constipation, diarrhea, insomnia, and dizziness.
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Related Disease Conditions
Peripheral neuropathy is a problem with the functioning of the nerves outside of the spinal cord. Symptoms may include numbness, weakness, burning pain (especially at night), and loss of reflexes. Possible causes may include carpel tunnel syndrome, shingles, vitamin or nutritional deficiencies, and illnesses like diabetes, syphilis, AIDS, and kidney failure. Peripheral neuropathy is diagnosed with exams and tests. Treatment for the condition depends on the cause. Usually, the prognosis for peripheral neuropathy is good if the cause can be successfully treated or prevented.
Fibromyalgia is a chronic pain condition characterized by symptoms such as fatigue, sleep disturbances, and tender points. Stress reduction, exercise, and medication are the standard treatments for fibromyalgia.
Anxiety is a feeling of apprehension and fear characterized by symptoms such as trouble concentrating, headaches, sleep problems, and irritability. Anxiety disorders are serious medical illnesses that affect approximately 19 million American adults. Treatment for anxiety may incorporate medications and psychotherapy.
Pain management and treatment can be simple or complex, according to its cause. There are two basic types of pain, nociceptive pain and neuropathic pain. Some causes of neuropathic pain include: complex regional pain syndrome, interstitial cystitis, and irritable bowel syndrome. There are a variety of methods to treat chronic pain, which are dependant on the type of pain experienced.
Depression is an illness that involves the body, mood, and thoughts and affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. The principal types of depression are major depression, dysthymia, and bipolar disease (also called manic-depressive disease).
Obsessive Compulsive Disorder (OCD)
Obsessive-compulsive disorder (OCD) is an anxiety disorder that causes a person to suffer repeated obsessions and compulsions. Symptoms include irresistible impulses despite a person's realization that the thoughts are irrational, excessive hand washing, skin picking, lock checking, or repeatedly rearranging items. People with OCD are more likely to develop trichotillomania, muscle or vocal tics, or an eating disorder. Treatment for OCD includes psychotherapy, behavioral therapy, and medication.
Bipolar disorder (or manic depression) is a mental illness characterized by depression, mania, and severe mood swings. Treatment may incorporate mood-stabilizer medications, antidepressants, and psychotherapy.
Postherpetic neuralgia (PHN) is a painful complication of shingles. Symptoms include severe pain, itchy skin, and possible weakness or paralysis of the area. There is no treatment for postherpetic neuralgia that is effective for all patients.
Post-traumatic Stress Disorder
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What Is Diabetic Neuropathy?
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Depression in Children
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What Is Schizotypal Personality Disorder?
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Chronic pain is pain (an unpleasant sense of discomfort) that persists or progresses over a long period of time. In contrast to acute pain that arises suddenly in response to a specific injury and is usually treatable, chronic pain persists over time and is often resistant to medical treatments.
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Duck syndrome is a situation initially coined at Stanford University whereby a college student may seem to be calm on the surface when actually he or she is frantically struggling to stay above water to meet the demands of student life.
Dysthymia is a less severe form of chronic depression. Symptoms and signs include insomnia, suicidal thoughts, guilt, empty feeling, loss of energy, helplessness, sluggishness, and persistent aches and pains. Treatment may involve psychotherapy, electroconvulsive therapy, and antidepressants.
Head and Neck Cancer
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People with bulimia nervosa, an eating disorder that involves episodes of bingeing and purging, experience symptoms and signs such as deteriorating teeth, sore throat, constipation, thinning hair, and dehydration. Treatment of bulimia may involve cognitive behavior therapy, family therapy, nutritional counseling, and medication.
Postpartum depression is a form of depression that occurs within a year after delivery. It is thought that rapid hormone changes after childbirth may lead to depression. Symptoms of postpartum depression include crying a lot, headaches, chest pains, eating too little or too much, sleeping too little or too much, withdrawal from friends and family, and feeling irritable, sad, hopeless, worthless, guilty, and overwhelmed. Treatment typically involves talk therapy and medication.
Depression in the Elderly
Depression in the elderly is very common. That doesn't mean, though, it's normal. Treatment may involve antidepressants, psychotherapy, or electroconvulsive therapy.
Pain Management: Neuropathic Pain
Neuropathic pain is chronic pain resulting from injury to the nervous system. The injury can be to the central nervous system (brain and spinal cord) or the peripheral nervous system (nerves outside the brain and spinal cord).
Treatment & Diagnosis
- Tingling in Hands and Feet
- Mood Swings
- Poor Hygiene
- Loss of Temperature Sensation
- Unusual Behavior
- Social Isolation
- Inability to Regulate Emotions
- Antisocial Personality Disorder
- Peripheral Neuropathy
- Obsessive-Compulsive Disorder (OCD)
- Bipolar Disorder
- Panic Attack
- Generalized Anxiety Disorder
- Postherpetic Neuralgia
- Bulimia Nervosa
- Diabetic Neuropathy
- Complex Regional Pain Syndrome (CRPS)
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