Cymbalta (Duloxetine) - Oral

Warning:

Antidepressants may increase the risk of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults. If you’re considering using Cymbalta or any other antidepressant, it’s important to balance this possible risk with your current medical needs. When on antidepressant therapy, your healthcare provider will work with you to help look for any symptoms over time that may mean that your condition is worsening (e.g., suicidality, unusual behavior). It’s important that the individual on the medication, family members, and/or caregivers thoughtfully and carefully observe any changes and keep communication open with each other and the prescriber.

What Is Cymbalta?

Cymbalta (duloxetine) is a prescription medication that treats several mood and pain conditions, including anxiety and depression. It can also relieve diabetic peripheral neuropathic pain, fibromyalgia (muscle pain and stiffness), and long-lasting (chronic) muscle and bone pain. 

Duloxetine is a serotonin and norepinephrine reuptake inhibitor (SNRI). These neurotransmitters affect many aspects of the body’s functions, including mood, pain, heart rate, and more. Cymbalta increases the effects of serotonin and norepinephrine by keeping them in their active nerve locations. 

Like other antidepressants, Cymbalta carries a boxed warning about the increased risk of suicidal thinking and behavior in young people taking these medications. A boxed warning is the strictest warning that can be given by the Food and Drug Administration (FDA).

This medication comes as a capsule in different strengths, taken orally (by mouth).

Drug Facts

Generic Name: Duloxetine

Brand Name: Cymbalta, Drizalma Sprinkle, Irenka

Drug Availability: Prescription

Therapeutic Classification: Antidepressant

Available Generically: Yes

Controlled Substance: N/A

Administration Route: Oral

Active Ingredient: Duloxetine

Dosage Form: Delayed-release capsule

What Is Cymbalta Used For?

The FDA approved Cymbalta to treat adults, but it can also treat certain conditions in both children and adults.

Cymbalta is approved for treating the following conditions for adults:


Cymbalta is approved for treating the following conditions for children and adults:

Cymbalta helps prevent symptoms related to these conditions. It should not be used as a cure or as an emergency treatment.

How to Take Cymbalta

Cymbalta is prescribed to be taken once a day, usually at the same time every day. You can take it with or without food.

To work properly, you must swallow the capsules whole. You shouldn’t crush, chew, or open the capsule. 

Be sure to tell your healthcare provider right away if you have worsening depression, unusual behavior changes, or other mood changes. You will want to watch for these signs, particularly when starting a new antidepressant or when your dose is changed.

Storage

You should keep this medication in its original container and out of the reach of children or pets. Keep it at room temperature (77 Fahrenheit [F]). You can briefly expose it to temperatures of 59 F and 86 F.

Off-Label Uses

Healthcare providers sometimes prescribe this medication off-label to treat different conditions, both in clinical treatment and research.

Off label uses include: 

  • Osteoarthritis pain 
  • Post-operative pain after orthopedic (bone) surgery
  • Stress urinary incontinence after pelvic surgery 
  • Chemotherapy-induced peripheral neuropathy in adults

How Long Does Cymbalta Take to Work?

Cymbalta can begin to have some effects within a few days. It may take three weeks or longer to begin to experience a therapeutic effect on your symptoms.

What Are the Side Effects of Cymbalta?

Cymbalta can have mild or severe side effects. You may not be bothered by side effects, or they can be very problematic. Tell your healthcare provider about any side effects you experience, especially if they worsen or don’t go away.

This is not a complete list of side effects, and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your pharmacist or a healthcare provider. You may report side effects to the FDA at fda.gov/medwatch or 1-800-FDA-1088.

Common Side Effects

The common side effects of Cymbalta can be different for children and adults.

Common side effects for adults: 

Common side effects for children:

  • Weight loss or inadequate weight gain 
  • Decreased appetite
  • Nausea, vomiting
  • Tiredness 
  • Diarrhea

Let your healthcare provider know about any of these side effects. Sometimes you can manage certain side effects—such as dry mouth, diarrhea, or constipation—with lifestyle adjustments or medication. If your side effects interfere with your quality of life, your healthcare provider may change your Cymbalta prescription.

Severe Side Effects

Cymbalta can cause harmful adverse effects for some people. These would necessitate a significant change in your prescription.

Severe side effects can include:

  • Suicidal thoughts or actions, especially in children, adolescents, and young adults 
  • Liver damage, which can cause a generalized feeling of being sick and yellow discoloration of the skin and eyes 
  • Low blood pressure with symptoms such as dizziness, falling, or passing out 
  • Serotonin Syndrome, which causes agitation, blood pressure changes, and muscle stiffness 
  • Bleeding risk
  • Severe skin reactions, which can cause a rash, peeling of the skin, and infection risk
  • Mania or hypomania with symptoms such as insomnia, hyperactivity, and reckless behavior
  • Angle-closure glaucoma may cause vision changes
  • Seizures manifesting with changes in consciousness and involuntary movements
  • High blood pressure that might cause chest pain, headaches, or might not cause any symptoms
  • Low blood sodium levels, which can cause dizziness or changes in consciousness
  • Difficulty urinating

The serious side effects of Cymbalta can worsen rapidly and cause long-term health complications or may be life-threatening. Get medical attention right away if you develop severe side effects of Cymbalta—treatment can help prevent the harmful consequences from occurring.

Do not suddenly stop taking Cymbalta—follow your healthcare provider's instructions for discontinuing.

Stopping too rapidly can cause withdrawal symptoms that may include:

  • Dizziness
  • Headaches
  • Nausea, vomiting
  • Diarrhea
  • Tingling sensations
  • Irritability, anxiety
  • Trouble sleeping, tiredness
  • Sweating

Even if you are following a tapering schedule, tell your healthcare provider if you develop any symptoms of discontinuation.

Antidepressant use can cause suicidal thoughts or actions in children, adolescents, and young adults. People who have or have a family history of bipolar illness or suicidal behavior are at an increased risk. If you or someone you are caring for is taking Cymbalta, make sure to pay attention to any sudden changes in mood, behaviors, thoughts, or feelings.

Call a healthcare provider immediately if any of these symptoms occur:

  • Thoughts about suicide or dying
  • Attempts to commit suicide
  • New or worse depression
  • New or worse anxiety
  • Agitation or restlessness
  • Trouble sleeping
  • New or worse irritability
  • Aggressive, angry, or violent actions
  • Dangerous and impulsive actions
  • An extreme increase in activity and talking
  • Other unusual mood or behavior changes

Long-Term Side Effects

The effects of Cymbalta are expected to wear off within a few days. However, severe side effects may cause long-term health damage.

Report Side Effects

Cymbalta may cause other side effects. Call your healthcare provider if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your healthcare provider may send a report to the FDA's MedWatch Adverse Event Reporting Program or by phone (800-332-1088).

Dosage: How Much Cymbalta Should I Take?

Drug Content Provided and Reviewed by IBM Micromedex®

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For oral dosage form (delayed-release capsules):
    • For treatment of anxiety:
      • Adults—At first, 60 milligrams (mg) once a day. Some patients may start at 30 mg once a day for 1 week before increasing the dose to 60 mg once a day. Your doctor may increase your dose as needed. However, the dose is usually not more than 120 mg per day.
      • Older adults—At first, 30 mg once a day for 2 weeks before increasing the dose to 60 mg once a day. Your doctor may increase your dose as needed. However, the dose is usually not more than 120 mg per day.
      • Children 7 years of age and older—At first, 30 mg once a day for 2 weeks before increasing the dose to 60 mg once a day. Your doctor may increase your dose as needed. However, the dose is usually not more than 120 mg per day.
      • Children younger than 7 years of age—Use and dose must be determined by your doctor.
    • For treatment of chronic muscle pain:
      • Adults—60 milligrams (mg) once a day. Some patients may start at 30 mg once a day for 1 week before increasing the dose to 60 mg once a day.
      • Children—Use and dose must be determined by your doctor.
    • For treatment of depression:
      • Adults—40 milligrams (mg) per day (given as 20 mg two times per day) to 60 mg per day (given either once a day or as 30 mg two times per day). Your doctor may increase your dose as needed. However, the dose is usually not more than 120 mg per day.
      • Children—Use and dose must be determined by your doctor.
    • For treatment of diabetic peripheral neuropathy:
      • Adults—60 milligrams (mg) once a day.
      • Children—Use and dose must be determined by your doctor.
    • For treatment of fibromyalgia:
      • Adults—60 milligrams (mg) once a day. Some patients may start at 30 mg once a day for 1 week before increasing the dose to 60 mg once a day.
      • Children 13 years of age and older—At first, 30 mg once a day. Your doctor may increase your dose as needed. However, the dose is usually not more than 60 mg per day.
      • Children younger than 13 years of age—Use and dose must be determined by your doctor.

Modifications

Cymbalta may be less effective if you are a smoker due to reduced bioavailability.

If you need to stop taking Cymbalta, your dose may be gradually lowered (tapered) by your healthcare provider to prevent withdrawal symptoms.

Missed Dose

If you miss your scheduled dose, take it as soon as you can. If it is almost time to take your next dose, take your next scheduled dose without doubling up and then resume your regular dosing schedule.

Overdose: What Happens If I Take Too Much Cymbalta?

Taking too much Cymbalta can be very dangerous, and it may result in death. 

Effects of Cymbalta overdose can include:

  • Extreme tiredness
  • Fainting 
  • Vomiting 
  • Diminished level of consciousness 
  • Rapid heart rate 
  • Low or high blood pressure 
  • Seizures 
  • Serotonin syndrome 
  • Coma

If you have taken too much Cymbalta, get prompt medical attention. You may need to be observed for signs of an overdose. Your treatment would depend on the overdose effects that you develop and could include interventions to support your breathing and blood pressure management. 

In some situations, your healthcare provider may attempt to reduce the level of the drug in your body with gastric lavage or activated charcoal.

Precautions

Drug Content Provided and Reviewed by IBM Micromedex®

It is important that your doctor check your progress at regular visits to allow for changes in your dose and to help prevent any unwanted effects.

Do not take duloxetine with a monoamine oxidase (MAO) inhibitor (eg, isocarboxazid [Marplan®], phenelzine [Nardil®], selegiline [Eldepryl®], or tranylcypromine [Parnate®]) in the past 2 weeks. Do not start taking an MAO inhibitor within 5 days of stopping duloxetine. If you do, you may develop confusion, agitation, restlessness, stomach or intestinal symptoms, sudden high body temperature, extremely high blood pressure, or severe convulsions. Ask your doctor if you are not sure if you take an MAOI, including linezolid (Zyvox®) or methylene blue injection.

Duloxetine may cause some teenagers and young adults to be agitated, irritable, or display other abnormal behaviors. It may also cause some people to have suicidal thoughts and tendencies or to become more depressed. Some people may have trouble sleeping, get upset easily, have a big increase in energy, or start to act reckless. If you or your caregiver notice any of these unwanted effects, tell your doctor right away. Let the doctor know if you or anyone in your family has bipolar disorder (manic-depressive) or has tried to commit suicide.

Check with your doctor right away if you have pain or tenderness in the upper stomach, pale stools, dark urine, loss of appetite, nausea, vomiting, or yellow eyes or skin. These could be symptoms of a serious liver problem.

Make sure your doctor knows about all the other medicines you are using. Duloxetine may cause serious conditions called serotonin syndrome or neuroleptic malignant syndrome (NMS)-like reactions if taken with certain medicines such as buspirone (Buspar®), fentanyl (Abstral®, Duragesic®), lithium (Eskalith®, Lithobid®), tryptophan, St. John's wort, amphetamines, or some pain medicines (eg, tramadol [Ultram®], sumatriptan [Imitrex®], zolmitriptan [Zomig®], or rizatriptan [Maxalt®]). Check with your doctor first before taking any other medicines.

This medicine may increase your risk for bleeding problems. Make sure your doctor knows if you are also taking other medicines that thin the blood, such as aspirin, NSAID pain medicines (eg, ibuprofen, naproxen, Advil®, Aleve®, Celebrex®, or Motrin®) or warfarin (Coumadin®).

Serious skin reactions (eg, erythema multiforme, Stevens-Johnson syndrome) can occur during treatment with this medicine. Check with your doctor right away if you have blistering, peeling, or loosening of the skin, chills, cough, diarrhea, itching, joint or muscle pain, red irritated eyes, red skin lesions, often with a purple center, sore throat, sores, ulcers, or white spots in the mouth or on the lips, or unusual tiredness or weakness while you are using this medicine.

Do not suddenly stop taking this medicine without checking first with your doctor. If you have been instructed to stop taking duloxetine, ask your doctor how to slowly decrease the dose. This will decrease your chance of having withdrawal symptoms such as dizziness, nausea, headaches, vomiting, increased sweating, irritability, nightmares, trouble with sleeping, or prickling or tingling feelings.

This medicine may affect blood sugar levels. If you are diabetic and notice a change in the results of your blood or urine sugar tests, check with your doctor.

This medicine may cause blurred vision, dizziness, drowsiness, trouble with thinking, or trouble with controlling body movements, which may lead to falls, fractures, or other injuries. Make sure you know how you react to this medicine before you drive, use machines, or do anything else that could be dangerous if you are not alert or able to see clearly. You may also feel lightheaded or you may fall or faint when getting up suddenly from a lying or sitting position, so get up slowly. If these symptoms are bothering you or keeping you from doing your daily activities, tell your doctor right away..

You will need to measure your blood pressure before starting this medicine and while you are using it. If you notice any change to your recommended blood pressure, call your doctor right away. If you have questions about this, talk to your doctor.

Hyponatremia (low sodium in the blood) may occur with this medicine. Check with your doctor right away if you have confusion, decreased urine output, difficulty concentrating, fast or irregular heartbeat, headaches, memory problems, nausea or vomiting, swelling of the face, ankles, or hands, trouble breathing, or unusual tiredness or weakness.

This medicine may cause sexual problems. Check with your doctor right away if you have decreased interest in sexual intercourse, inability to have or keep an erection, or loss in sexual ability, desire, drive, or performance.

Avoid smoking while you are using this medicine. If you have any questions about this, check with your doctor.

What Are Reasons I Shouldn’t Take Cymbalta?

This medication may not be safe for people who have severe liver or kidney disease or who are in the last trimester of pregnancy. Your healthcare provider may discuss the pros and cons of this medication or avoid prescribing it for you if you have any of these conditions.

What Other Medications Interact With Cymbalta?

Cymbalta has many drug interactions, some of which can cause serious adverse events. Do not use alcohol when you are taking Cymbalta—the combination can cause severe liver damage.

Medications that can interact with Cymbalta include: 

  • Triptans, such as Reyvow (lasmiditan), Zolmitriptan (Zomg), and others
  • Medications that interact with serotonin, such as monoamine oxidase inhibitors (MAOIs), serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants, tryptophan, or St. John’s Wort
  • Eskalith, Lithobid (lithium)
  • Buspar, Vanspar (buspirone)
  • Tramadol
  • Fentanyl
  • Amphetamines
  • Cimetidine
  • Certain antibiotics, such as ciprofloxacin or enoxacin
  • Blood thinners and non-steroidal anti-inflammatory drugs (NSAIDs)
  • Zyvox (linezolid)
  • Intravenous methylene blue
  • Medications that are potent inhibitors of CYP1A2 
  • Medications that are potent inhibitors of CYP2D6
  • Some medications used for treatment of irregular heart rate
  • Theo-24, Elixophylline, Theochron, among others (theophylline)
  • Mellaril (thioridazine)

Also, Cymbalta should not be used within 14 days of an MAOI inhibitor. Because Cymbalta has so many drug interactions, you must tell your healthcare provider and pharmacist about any other prescription or over-the-counter (OTC) medications, supplements, or herbs that you use or plan to use.

What Medications Are Similar?

There are many other medications used to treat depression, anxiety, pain, and fibromyalgia. Other SNRIs are approved for similar indications as Cymbalta.

Other SNRIs include: 

  • Pristiq (desvenlafaxine)
  • Fetzima (levomilnacipran)
  • Effexor XR (venlafaxine)

Frequently Asked Questions

  • What is Cymbalta used for?

    Cymbalta is used for treating many different conditions, including major depressive disorder, diabetic peripheral neuropathic pain, and chronic musculoskeletal pain in adults, as well as fibromyalgia symptoms and generalized anxiety disorder in children and adults. It is also used off-label to treat certain types of bladder problems and some types of post-surgical pain.

  • How does Cymbalta work?

    Cymbalta inhibits the termination of the action of serotonin and norepinephrine, which are neurotransmitters that have an effect on mood, pain, and many body functions.

  • What drugs should not be taken with Cymbalta?

    Cymbalta has many drug interactions, including interactions with blood thinners, antidepressants, and certain antibiotics. You should not take Cymbalta within 14 days of taking a monoamine oxidase inhibitor.

  • How long does it take for Cymbalta to work?

    Cymbalta can begin to have some effects within a few days. It may take three weeks or longer to begin to experience a therapeutic effect on your symptoms.

  • What are the side effects of Cymbalta?

    The most common side effects of Cymbalta include decreased energy, decreased appetite, and nausea. It can also cause serious side effects, such as suicidal thoughts or actions, liver damage, bleeding, and more.

  • How do I stop taking Cymbalta?

    If you need to stop this medication, your healthcare provider will give you a schedule to gradually reduce your dose. This will help avoid the symptoms of sudden discontinuation.

How Can I Stay Healthy While Taking Cymbalta?

When using Cymbalta, you need to keep several considerations in mind. Make sure to take the medication exactly as directed.

Communicate with your healthcare provider about:

  • New changes in your health that develop while taking Cymbalta
  • Any prescription, OTC medications, supplements, or herbs you are planning to take
  • Any serious side effects you are experiencing, especially if you notice changes in your mood, thoughts, and behavior

While taking Cymbalta, make sure to continue with the other parts of your treatment plan, such as attending therapy or counseling.

Medical Disclaimer

Verywell Health's drug information is meant for educational purposes only and not intended as a replacement for medical advice, diagnosis, or treatment from a healthcare provider. Consult your healthcare provider before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.

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