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Cymbalta (duloxetine)



Cymbalta (duloxetine) is a SSNRI (Selective Serotonin and Norepinephrine Reuptake Inhibitor). It helps to regulate natural neurotransmitters such as norepinephrine and serotonin within the body to treat conditions such as depression, anxiety, and neuropathic pain.


How to Use


Take this medication by mouth with water, it can be taken with or without food.


Take exactly as directed, do not take it more than directed.


Do not crush, chew or break this medication.


Do not stop taking it suddenly without consulting with your doctor, this could lead to your condition worsening.


If you miss a dose, take it as soon as you can. If it is already almost time for your next dose, take only that next dose. Do not double up on any dose.



Important Information


Inform your doctor if your symptoms are not improving over time or if they get worse. It may take a few weeks before you begin to feel the benefits from this medicine, do not stop taking it without consulting with your doctor.


It is important for family, friends and patients to monitor for mood changes such as anxiousness, agitation, irritability, hostility, aggression, restless, impulsivity, hyperactivity, sleeplessness, thoughts of suicide or worsening depression.  If this happens contact your healthcare provider. This is particularly important when first starting this medicine or after a dose increase.


This medication can make your mouth dry, drinking water, chewing sugarless gum, or sucking on candy can help to decrease this side effect.


Do not operate heavy machinery, drive a car, or engage in other activity that requires fine motor skills until you are sure of how this medication affects you. This medicine may make you drowsy or dizzy in the beginning. Standing up gradually and slowly can decrease dizziness.


This medication can cause blood pressure changes, talk with your doctor to see if they recommend monitoring your blood pressure while on this medicine.



Be sure that your prescribing doctor is aware if you have any of the the following conditions before taking this medication


Bipolar disorder, kidney disease, liver disease, glaucoma, suicidal thoughts or actions, currently taken medications called MAOI’s such as Carbex, eldepryl, mar plan, nardil, or parnate within the last 14 days, history of allergic reactions, pregnancy, breastfeeding, trying to become pregnant.


Side effects that should be immediately reported to your healthcare provider


Allergic reaction(hives, itching, swelling of the face or mouth), trouble breathing, darkened urine, confusion, changes in the blood pressure, dizziness, excitability or fast talking, not in control of your actions, increased heart rate or other heart beat changes, flu like symptoms, loss of reality or hallucinations, light colored stools, loss of balance or coordination, seizures, right upper belly pain, suicidal thoughts or actions, mood changes, difficulty concentrating, changes in the passing of urine, unusually tired, yellowing of the skin or eyes, any red, blistering or peeling skin.



Other Side Effects


Blurred vision, nausea, increased sweating, headache, changes in sex drive, changes in appetite,



Adult Doses




20 mg by mouth twice daily as a starting dose.


Generalized Anxiety Disorder


60 mg by mouth once daily as a  starting dose. Some patients may benefit from starting at a dose of 30 mg per day to increase tolerability.



Diabetic Peripheral Neuropathy


60 mg by mouth once daily.


Max Dose: 120 mg by mouth daily. Doses over 60 mg by mouth daily have not shown added benefits.





1. Cymbalta ® delayed-release oral capsules, duloxetine hydrochloride delayed-release oral capsules[package insert]. Indianapolis, IN: Eli Lilly and Company; 2010.


2. Cymbalta ® oral delayed-release capsules, duloxetine oral delayed-release capsules[package insert]. Indianapolis, IN: Lilly USA, LLC (per FDA); 2014.


3. Cymbalta (duloxetine hydrochloride) [package insert]. Indianapolis, IN: Eli Lilly and Company; 2015.


4. Detke M, Lu Y, Goldstein DJ, et al. Duloxetine 60 mg once daily dosing versus placebo in the acute treatment of major depression. J Psych Res 2002;36:383-390.


5. Detke M, Lu Y, Goldstein DJ, et al. Duloxetine 60 mg once daily, for major depressive disorder: a randomized double-blind placebo-controlled trial. J Clin Psychiatry 2002;63:308-315.


6. Goldstein DJ, Mallinckrodt C, Lu Y, et al. Duloxetine in the treatment of major depressive disorder: a double-blind clinical trial. J Clin Psychiatry 2002;63:225-231.

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