Cymbalta is the brand name for Duloxetine – a drug that is used to treat generalized anxiety disorder and major depressive disorder. It is also used for treating different types of chronic pain, such as musculoskeletal pains and the pain associated with fibromyalgia and diabetes (diabetic neuropathy).

Falling under the category of Selective Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs), Cymbalta is an FDA-approved medicine that is believed to affect the levels of two neurotransmitters – serotonin and norepinephrine.

How Cymbalta Works

While scientists aren’t sure about how Cymbalta works, it is believed that it helps with depression, anxiety, and relieves pain by enhancing the effects of noradrenaline and serotonin in the central nervous system.

Noradrenaline also called norepinephrine, is both a hormone and a neurotransmitter and is known to play a role in cognition, thinking, emotions, mood, blood pressure, perception of pain, and flight or fight response.

Commonly known as the ‘Happy Hormone’, serotonin is a neurotransmitter that is mainly responsible for mood regulation. However, it also plays a role in the perception of pain and gastrointestinal functions.

Cymbalta is believed to provide relief from depression and pain in two ways:

  1. It blocks the reuptake of noradrenaline and serotonin. Reuptake is a natural process in which neurons take back or reabsorb the neurotransmitters after they have completed their task i.e. transmission of a message.
  2. An increase in the levels of pro-inflammatory cytokines in the central nervous system is considered one of the factors that can trigger depression. It is believed that Cymbalta can help with depression by reducing the activity of pro-inflammatory cytokines as well as by increasing the activity of anti-inflammatory cytokines. However, there are no scientific research studies to back this claim.

How Long Does It Take To Get Relief?

The absorption of the drug starts after about 2 hours of consumption, but it can take around 6 hours to provide results. However, you may need to take Cymbalta for several weeks before the clinical effects become visible.

Possible Side Effects of Cymbalta

While Cymbalta is an effective medicine, it should be used carefully because it can cause a number of side effects.

Here are the some of the common side effects that a patient can experience while using the medicine:

  • Drowsiness or dizziness
  • Nausea
  • Insomnia
  • Constipation
  • Dry mouth
  • Skin reactions
  • Urinary retention
  • Fatigue
  • Loss of appetite and weight loss
  • Increased sweating
  • Increase in blood pressure
  • Low blood pressure or hypotension may occur, particularly during the first week of usage. A person may feel light-headed or faint as a result.

Cymbalta may also cause serious negative effects in some people. Immediately consult your doctor if you experience any of the following:

  • Pain, swelling, or redness in eye(s) or any change in the vision
  • Seizure
  • Any problem in liver, such as pain, jaundice, or dark-colored urine
  • Severe skin reaction. Its symptoms include swelling of the tongue or face, burning feeling in eyes and on skin, sore throat, fever, skin rashes, and blistering and peeling of skin
  • A manic episode characterized by hyperactivity, extreme aggression, severe restlessness, agitation, irritability, and impulsivity

Suicidal Thoughts

While suicidal thoughts are generally associated with major depressive disorders, the use of Cymbalta can make them more prevalent in children and teenagers.[1]

Therefore, doctors usually avoid prescribing Cymbalta to children. But, if it has been prescribed to your child, make sure to regularly monitor his/her condition and immediately consult the doctor if you notice any suicidal inclination, an increase in depressive symptoms, or any unusual behavior.

Serotonin Syndrome

In a few cases, Cymbalta may lead to serotonin syndrome. Serotonin syndrome is a potentially fatal condition caused by excessively high levels of serotonin. The higher levels of the chemical excessively increase the activities of nerve cells and can cause extreme agitation, increased heart beat, heavy sweating, high fever, shivering, muscle stiffness, diarrhea, nausea, loss of coordination, and hallucinations.

Who Should Not Take Cymbalta?

Cymbalta should be avoided by:

  • Women who are pregnant. While the adverse effects of Cymbalta on the fetus and infants are not known, some animal studies suggest that it may adversely affect the development. This is why taking Cymbalta is not recommended for pregnant ladies and nursing mothers.
  • People who are taking Monoamine Oxidase Inhibitors (MAOIs). MAOIs are also a class of anti-depressant drugs and taking Cymbalta along with them can cause serious side effects that could be fatal. Some common drugs that fall into the category of MAOIs are Nardil, Azilect, Marplan, Furoxone, Zelapar, Emsam, Eldepryl, Parnate, and Linezolid (an anti-biotic). Cymbalta should also be avoided for at least 5 days before and 14 days after the use of MAOIs.

Cymbalta should also be avoided if you are suffering from certain health conditions, both physical and mental. Make sure to tell your doctor if you have:

  • A history of drug abuse
  • A history of suicidal thoughts
  • Bipolar disorder
  • Kidney disease
  • Liver disease
  • Glaucoma
  • Heart Disease
  • Diabetes
  • Any condition that causes seizures, like epilepsy
  • A bleeding or clotting disorder

You should also inform your doctor if you are using any of the following medicines as they may interact with Cymbalta and cause problems:

  • Diuretics – commonly known as water pills
  • Any medicine for arthritis
  • John’s Wort
  • Amphetamines
  • A medication for migraine
  • Any medication for treating infections
  • A sedative or any medicine that cause sleepiness

The following drugs can reduce the metabolism of Cymbalta in liver. As a result, the levels of Cymbalta in the blood increase, which can then worsen the side effects:

  • Anti-arrhythmic drugs, such as Quinidine
  • Any other antidepressant or anti-anxiety drug, such a Fluoxetine (Sarafem, Prozac), Fluvoxamine (Luvox), and Paroxetine (Paxeva, Paxil, and Paxil CR).

Cymbalta, when used with the following medicines, can increase the risk of bleeding:

  • Warfarin (Coumadin)
  • Aspirin
  • NSAIDs ( Non-steroidal anti-inflammatory drugs)

When taken with desipramine (Norpramin) Cymbalta can increase the concentration of the drug in blood by reducing its breakdown.

Precautions While Taking Cymbalta

While taking Cymbalta, you should be careful to not:

  • Smoke – it can reduce the action of the drug by one-third.
  • Drink alcohol – it increases the risk of liver damage.
  • Perform any activity that requires an alert and a clear mind, like driving or using machinery.

Availability

Cymbalta is available in form of delayed-release capsules in 20 mg, 30 mg, and 60 mg variations.

Dosage

The right dosage of Cymbalta can vary from person to person. The patient’s age, medical history, and overall health are some of the factors that need to be taken into account to determine the right dosage.

Generally, a 60mg dosage, once a day, is prescribed for treating anxiety. However, depending on the patient’s condition, a doctor may begin with 30 mg and then gradually increase it to 60 mg, after one to two weeks.

Maximum Dosage

In most cases, the maximum per day dosage of Cymbalta is not more than 120 mg.

How Should The Medicine Be Taken?

Cymbalta should be taken orally with water. You can take it with or without food. However, the capsule should never be sprinkled on food or crushed.

What to Do If You Miss a Dose?

If you miss a dose of Cymbalta for any reason, try to take it as soon as possible. But, if it is almost time for the next dose, skip the missed dose and take your regular dosage on its time.

Never take a double dose to make up for the missed one.

What Should You Do In Case Of Overdose?

If you or someone you know has mistakenly overdosed on Cymbalta, immediately call 911 or poison control center at 1-800-222-1222.

Overdose of Cymbalta can cause severe drowsiness or fainting, so avoid driving in the condition and call for help as soon as possible.

Storage

Cymbalta should be stored between 59 to 85 degrees Fahrenheit (15 to 30 degrees centigrade), at room temperature. Make sure to keep it away from direct light, heat, and moisture.

Important Information

If you are using Cymbalta, make sure to stick to the dosage prescribed by the doctor. Also, never stop using the medicine unless directed by your doctor. This is highly important because sudden discontinuation of Cymbalta can cause serious side effects.

Talk to your doctor if you want to stop using the medication for any reason as its dosage needs to be gradually decreased.

Where to Get Cymbalta From

Always buy medicines from a registered pharmacy to ensure that they are original and not expired. A lot of people make the mistake of buying medicines from online pharmacies without confirming their registration, just because they are available at slightly cheaper rates than other places.

Someone selling medicines at lower rates should in fact be a warning sign and you should stay away from such places.

Cannot afford to buy Cymbalta or any other prescription medicine? Find a prescription assistance program in your area!

Prescription Assistance

Sponsored by the manufacturers of prescription drugs or state, Prescription Assistance Programs have been designed to make sure that everyone has access to medicines, regardless of their financial conditions.

Through Prescription Assistance Programs, medicines are provided at a low-cost or for free to people who cannot afford to buy them, specifically the ones that are uninsured, underinsured, or ineligible for other government-run medical aid programs.

In view of the fact that over 46 million Americans are living without health insurance (the figure is much higher for people who are underinsured), prescription assistance programs offer great help to people suffering from chronic health conditions, but could not afford treatment due to lack of finances.

While the beginning of such programs can be traced back to 1975, they became widespread after 2000.[2]

Applying for prescription assistance is also very simple and free. Beware of scams – there are some companies that ask you for money in order to make you a part of a prescription assistance program.

To be eligible for most of these programs, you should fulfill the following conditions:

  • Be a US citizen or permanent residence
  • Demonstrated financial need due to limited income and/or assets
  • Limited or no prescription drug coverage from government or any private source

Patient assistance and pharmaceutical assistance are some other names for these types of programs.

Prescription assistance is available for Cymbalta, Visit Rx Assist’s website or click here to see the eligibility criteria to qualify for it and the contact details of the provider.

[1] https://www.hopkinsmedicine.org/neurology_neurosurgery/centers_clinics/peripheral_nerve/patient_info/DULOXETINE_2007.pdf

[2] http://www.ncsl.org/research/health/state-pharmaceutical-assistance-programs.aspx