Cymbalta

Generic Name: duloxetine (do LOX e teen)

What is the most important information I should know about Cymbalta?

Do not take Cymbalta together with thioridazine (Mellaril), or a monoamine oxidase inhibitor (MAOI) such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate). You must wait at least 14 days after stopping an MAOI before you can take Cymbalta. After you stop taking Cymbalta, you must wait at least 5 days before you start taking an MAOI.

You may have an increased risk of suicidal thoughts or behavior at the start of treatment with an antidepressant medication, especially if you are under 18 years old. Talk with your doctor about this risk. While you are taking Cymbalta you will need to be monitored for worsening symptoms of depression and/or suicidal thoughts during the first weeks of treatment, or whenever your dose is changed. In addition to you watching for changes in your own symptoms, your family or other caregivers should be alert to changes in your mood or symptoms. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment.

Contact your doctor promptly if you have any of the following side effects, especially if they are new symptoms or if they get worse: mood changes, anxiety, panic attacks, trouble sleeping, irritability, agitation, aggressiveness, severe restlessness, mania (mental and/or physical hyperactivity), thoughts of suicide or hurting yourself.

Avoid using other medicines that make you sleepy (such as cold medicine, pain medication, muscle relaxers, medicine for seizures, other medication for depression or anxiety). They can add to sleepiness caused by Cymbalta.

Cymbalta can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

What is Cymbalta?

Cymbalta is an antidepressant in a group of drugs called selective serotonin and norepinephrine reuptake inhibitors (SSNRIs). Cymbalta affects chemicals in the brain that may become unbalanced and cause depression.

Cymbalta is used to treat major depressive disorder and general anxiety disorder. It is also used to treat pain caused by nerve damage in people with diabetes (diabetic neuropathy).

Cymbalta may also be used for purposes other than those listed in this medication guide.

What should I discuss with my healthcare provider before taking Cymbalta?

Do not use Cymbalta together with thioridazine (Mellaril), or an MAO inhibitor such as isocarboxazid (Marplan), tranylcypromine (Parnate), phenelzine (Nardil), rasagiline (Azilect), or selegiline (Eldepryl, Emsam). Serious and sometimes fatal reactions can occur when these medicines are taken with Cymbalta. You must wait at least 14 days after stopping an MAO inhibitor before you can take Cymbalta. After you stop taking Cymbalta, you must wait at least 14 days before you start taking an MAOI. You must wait 5 days after stopping Cymbalta before you can take an MAOI. Do not use this medication if you are allergic to Cymbalta, or if you have untreated or uncontrolled glaucoma.

Before taking Cymbalta, tell your doctor if you are allergic to any drugs, or if you have:

• liver or kidney disease;

• seizures or epilepsy;

• bipolar disorder (manic depression); or

• a history of drug abuse or suicidal thoughts.

If you have any of these conditions, you may not be able to use Cymbalta, or you may need a dosage adjustment or special tests during treatment.

You may have an increased risk of suicidal thoughts or behavior at the start of treatment with an antidepressant medication, especially if you are under 18 years old. Talk with your doctor about this risk. While you are taking Cymbalta you will need to be monitored for worsening symptoms of depression and/or suicidal thoughts during the first weeks of treatment, or whenever your dose is changed.

In addition to you watching for changes in your own symptoms, your family or other caregivers should be alert to changes in your mood or symptoms. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment.

FDA pregnancy category C. Cymbalta may be harmful to an unborn baby, and may cause problems in a newborn baby if the mother takes the medication late in pregnancy (during the third trimester). Tell your doctor if you are pregnant or plan to become pregnant during treatment. Cymbalta can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby. Older adults may be more sensitive to the side effects of this medication. Do not give this medication to anyone under 18 years old without the advice of a doctor.

How should I take Cymbalta?

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Your doctor may occasionally change your dose to make sure you get the best results from the medication.

Try to take the medicine at the same time each day. Follow the directions on your prescription label.

Do not crush, chew, break, or open a delayed-release capsule. Swallow the pill whole. It is specially made to release medicine slowly in the body. Breaking or opening the pill would cause too much of the drug to be released at one time. It may take 4 weeks or longer for your symptoms improve. For best results, keep using the medication as directed. Do not stop using Cymbalta without first talking to your doctor. You may have unpleasant side effects if you stop taking this medication suddenly. Store Cymbalta at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember. However, if it is almost time for the next regularly scheduled dose, skip the missed dose and take the next one as directed. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have taken too much of this medication. Symptoms of a Cymbalta overdose may include nausea, vomiting, diarrhea, agitation, confusion, hallucinations, fast heart rate, feeling light-headed, or fainting.

What should I avoid while taking Cymbalta?

Avoid drinking alcohol while taking Cymbalta. Alcohol may increase the risk of damage to your liver.

Avoid using other medicines that make you sleepy (such as cold medicine, pain medication, muscle relaxers, medicine for seizures, other medication for depression or anxiety). They can add to sleepiness caused by Cymbalta.

Cymbalta can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

What are the possible side effects of Cymbalta?

Get emergency medical help if you have any of these signs of an allergic reaction: skin rash or hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Contact your doctor promptly if you have any of the following side effects, especially if they are new symptoms or if they get worse: mood changes, anxiety, panic attacks, trouble sleeping, irritability, agitation, aggressiveness, severe restlessness, mania (mental and/or physical hyperactivity), thoughts of suicide or hurting yourself.

Call your doctor at once if you have any of these serious side effects:

• nausea, stomach pain, low fever, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes);

• restlessness, overactive reflexes, hallucinations, loss of coordination, fainting, coma; or

• nausea, vomiting, diarrhea, fever, and fast heartbeat.

Other less serious side effects are more likely to occur, such as:

• constipation;

• drowsiness, dizziness, headache;

• sleep problems (insomnia);

• weight changes;

• feeling anxious or nervous, increased sweating;

• sore throat; or

• decreased sex drive, impotence, or difficulty having an orgasm.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

What other drugs will affect Cymbalta?

Talk to your doctor before taking any medicine for pain, arthritis, fever, or swelling. This includes aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), diclofenac (Voltaren), indomethacin, piroxicam (Feldene), nabumetone (Relafen), etodolac (Lodine), and others. Taking any of these drugs with Cymbalta may cause you to bruise or bleed easily.

Before taking Cymbalta, tell your doctor if you are using any of the following medicines:

• cimetidine (Tagamet);

• linezolid (Zyvox);

• lithium (Lithobid, Eskalith);

• St. John's wort;

• tramadol (Ultram);

• tryptophan (sometimes called L-tryptophan);

• a blood thinner such as warfarin (Coumadin);

• almotriptan (Axert), frovatriptan (Frova), sumatriptan (Imitrex), naratriptan (Amerge), rizatriptan (Maxalt), or zolmitriptan (Zomig); or

• any other antidepressants such as amitriptyline (Elavil), amoxapine (Ascendin), clomipramine (Anafranil), desipramine (Norpramin), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox), imipramine (Janimine, Tofranil), nortriptyline (Pamelor), paroxetine (Paxil), protriptyline (Vivactil), sertraline (Zoloft), trimipramine (Surmontil), or venlafaxine (Effexor).

If you are using any of these drugs, you may not be able to use Cymbalta, or you may need dosage adjustments or special tests during treatment.

There may be other drugs not listed that can affect Cymbalta. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Where can I get more information?

• Your pharmacist has additional information about Cymbalta written for health professionals that you may read.

What does my medication look like?

Duloxetine is available with a prescription generically and under the brand name Cymbalta. Other brand or generic formulations may also be available. Ask your pharmacist any questions you have about this medication, especially if it is new to you.

• Cymbalta 20 mg - green capsules

• Cymbalta 30 mg - white/blue capsules

• Cymbalta 60 mg - green/blue capsules

• Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
• Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.
• Click here for more information on Cymbalta from the manufacturer.