Duloxetine (Cymbalta): What you should know

A medication that helps relieve anxiety , depression, and nerve pain is Duloxetine, which goes under the common name Cymbalta.

Cymbalta belongs to a family of medicines called inhibitors of serotonin-norepinephrine reuptake (SNRIs).

It is also recommended by doctors for painful peripheral neuropathies, especially diabetic neuropathy, and for osteoarthritis pain. It can benefit persons with fibromyalgia as well.

We are looking at the applications and side effects of duloxetine in this article.

Uses

duloxetine drug
Cymbalta can treat depression, diabetic neuropathy, fibromyalgia, and other health issues.

Cymbalta has been approved by the Food and Drug Administration ( FDA) for treating a number of disorders, including:

  • depression
  • diabetic neuropathy
  • generalized anxiety disorder
  • fibromyalgia
  • chronic musculoskeletal pain

It is not clear how Cymbalta functions, but it appears to cause a transition in the way the central nervous system ( CNS) interacts with serotonin and norepinephrine.

Serotonin is a neurotransmitter that arises spontaneously and plays a central role in many bodily functions, including:

  • mood regulation
  • gastrointestinal function
  • pain perception

Norepinephrine, or noradrenaline, is both a neurotransmitter and a hormone. It operates specifically in an region known as the locus coeruleus of the brainstem.

In the “fight-or – flight” answer, which is how the body reacts to stress, this essential hormone plays a part.

Although this is a common response to real incidents and possible threats, individuals with anxiety or depressive conditions will also overreact or activate the “fight-or – flight” process without a direct cause.

Norepinephrine also determines how individuals perceive:

Cymbalta for depression and pain

Cymbalta stops the CNS reabsorbing serotonin. It is anticipated to have the same effects on norepinephrine.

Increased amounts of proinflammatory cytokines in the CNS may be one potential cause for depression. Cytokines are immune cells that, for example , by increasing and decreasing inflammation levels, affect other cells.

It is believed that cymbalta reduces levels of proinflammatory cytokines and increases the activity of anti-inflammatory cytokines. No scientific studies, however, have proven this theory conclusively.

In the following conditions, Cymbalta can also help a person control pain symptoms:

  • fibromyalgia
  • bone pain
  • diabetic neuropathy

Scientists assume this action is due to the active component in the drug, duloxetine hydrochloride, preventing the passage in sodium into cells.

How to take Cymbalta

A lady talking with pharmacist
The right dosage of Cymbalta depends on a person’s age and medical condition.

As a capsule or a delayed release capsule, Cymbalta is available. For a person, a doctor will determine the dose, which will depend on their medical condition and age.

People who have an anxiety disorder may begin by taking 60 milligrams ( mg) once daily with the medication. For others, 30 mg once a day may be administered by the doctor for 7 days, and then the dosage may be raised to 60 mg once a day.

For patients with such conditions, initial dosages include:

  • Major depressive disorder: From 40–60 mg per day, with some people starting at 30 mg per day.
  • Peripheral neuropathy in diabetes: 60 mg once daily.
  • Fibromyalgia: 60 mg once daily, with one week of a daily 30 mg dose.

People can take Cymbalta with or without food but should avoid crushing it or sprinkling it on food.

Adverse effects

Common side effects include:

Following taking Cymbalta, people can also feel a headache and dry mouth.

In both males and females, the drug can also induce sexual side effects.

The FDA reports that colitis and cutaneous vasculitis can be related to Cymbalta.

They also point out that there could be orthostatic hypotension, which on standing up is low blood pressure. This can lead to falls and lack of consciousness, notably during the first week of use, but likely during a recovery course at any time.

Eli Lilly, the manufacturer, warns that the medication will cause liver harm, irregular bleeding, and skin reactions.

Cymbalta can contribute to serotonin syndrome as well. This disease may, among other symptoms, be a potentially lethal disorder that can induce confusion, paranoia, and coma.

During pregnancy or while breastfeeding, women do not take Cymbalta. Studies in animal reproduction suggest that Cymbalta is likely to have detrimental impacts on embryonic growth in the womb and after birth.

Precautions

A person can speak to their doctor about how Cymbalta may interact with other drugs they are taking.
A person can speak to their doctor about how Cymbalta may interact with other drugs they are taking.

Cymbalta may interact with some other drugs.

People should not take the drug while on a course of monoanimase inhibitors (MAOIs).

MAOIs include:

  • tranylcypromine (Parnate)
  • selegiline (Eldepryl, Emsam, Zelapar)
  • furazolidone (Furoxone)
  • rasagiline (Azilect)
  • phenelzine (Nardil)
  • isocarboxazid (Marplan)
  • intravenous methylene blue
  • linezolid, an antibiotic

The FDA black box warning advises that when people start taking Cymbalta, especially children and adolescents, they can initially have suicidal thoughts. For this cause, physicians track patients closely for mood changes and other adverse symptoms during the first 4 months of therapy.

People must inform a doctor immediately if any of the following signs arise or get worse:

  • worsening symptoms of depression
  • persistent thoughts of self-harm or suicide
  • hyperactivity
  • restlessness
  • aggression
  • hostility
  • agitation
  • irritability
  • impulsivity

When taking Cymbalta, people must stop alcohol and smoking. Smoking could decrease the efficacy of the medication by a third.

When involved in activities that require a clear and alert mind, such as operating heavy machinery or driving, they should also take caution.

Before using Cymbalta, the person must inform the doctor if they have any of the following diseases or illnesses:

  • liver disease
  • kidney disease
  • epilepsy or any other seizures
  • glaucoma
  • a history of suicidal ideation
  • a bleeding or clotting disorder
  • a history of drug abuse

Before a psychiatrist prescribes Cymbalta, screening for bipolar disorder can take place, as it can cause an episode of mania.

An individual should also inform the doctor if the following medications are being used:

  • diuretics, or water pills
  • nonsteroidal anti-inflammatory drugs (NSAIDs)
  • arthritis medication
  • treatment for heart rhythm
  • treatment for migraines
  • St. John’s Wort
  • amphetamines
  • other antidepressants

People should not suddenly stop taking Cymbalta. They can first talk to the doctor, as they would need to steadily lower the dose.

Since taking a Cymbalta course, some individuals have brought cases alleging that Cymbalta is really hard to avoid using. They cite withdrawal problems such as tunnel vision and “brain zaps,” alleging that these adverse effects were played down by manufacturers.

Courts also ruled, however, that the producers gave sufficient warning about the possible withdrawal effects of the drug.

In order to determine the right medicine for them, patients should work with their doctor.

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