Pharmacist tips for Duloxetine (Cymbalta)
You can take duloxetine (Cymbalta) with or without food. Food won't affect how well this medication works for you.
Swallow the duloxetine (Cymbalta) capsules whole. Don't crush, chew, or open the capsules because this could damage the medication.
You might feel dizzier when you first start duloxetine (Cymbalta) and any time your dose is raised. Be careful standing up from a seated or lying position to prevent falls.
Duloxetine (Cymbalta) can sometimes make you tired and affect how clearly you can think or how fast you can react. Don't drive or operate heavy machinery until you know how the medication affects you.
Contact your prescriber if you notice sudden mood changes or unusual thoughts. Duloxetine (Cymbalta) can sometimes make certain mental health problems worse.
Let your prescriber know if you have trouble urinating while you're taking duloxetine (Cymbalta). This might be a side effect of the medication that your prescriber can discuss how to manage.
Let your healthcare professional (HCP) know if you experience any vision changes while you're taking duloxetine (Cymbalta). This medication can worsen eye problems in certain people.
If you have high blood sugar (diabetes), make sure to monitor your blood glucose levels while you're taking duloxetine (Cymbalta). This medication might raise your blood sugar levels.
Tell your prescriber and pharmacist about all the prescription and over-the-counter medications you're taking. They can help screen for possible drug interactions with duloxetine (Cymbalta) and check that all your medications are safe to take together. For example, your risk for bleeding might be higher if you take duloxetine (Cymbalta) with blood-thinning medications like aspirin or warfarin (Coumadin).
Talk with your prescriber if you'd like to stop your treatment with duloxetine (Cymbalta). Stopping the medication too suddenly can cause withdrawal symptoms such as dizziness, headache, nausea, diarrhea, irritability, and trouble sleeping. To lessen the risk for withdrawal symptoms, your prescriber can give guidance on how to stop the medication safely by lowering your dose slowly over time.
Let your healthcare team know if you're breastfeeding so they can discuss with you about the benefits and risks of taking duloxetine (Cymbalta). This medication can get into breast milk. Breastfed babies might get sleepy, have poor feeding, and have poor weight gain if you take duloxetine (Cymbalta) while nursing.
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What are the risks and warnings for Duloxetine (Cymbalta)?
Duloxetine (Cymbalta) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Suicidal thoughts and behavior
Risk factors: Age 24 years or younger | History of depression or other mental health conditions
Duloxetine (Cymbalta) can raise the risk of worsening depression. It can also raise the risk for suicidal thoughts or behavior. Watch for new or worsening depression, thoughts of harming yourself, or abnormal behavior, especially during the first few months of treatment or when your dose changes. Let a healthcare professional (HCP) know right away if you notice any unusual changes in mood or behavior while you're taking this medication.
Liver damage
Risk factors: Drinking alcohol | History of liver problems
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There have been rare reports of serious, and sometimes life-threatening, liver problems in people who took duloxetine (Cymbalta). Tell your HCP right away if you develop any stomach pain, nausea, vomiting, swelling in your legs, or yellowing of the whites of your eyes (jaundice). You'll probably need to stop duloxetine (Cymbalta) to prevent more harm to your liver.
Changes in blood pressure and risk of falls
Risk factors: Older adults | Balance problems | Taking more than 60 mg of duloxetine (Cymbalta) daily | Taking other medications that lower blood pressure | High blood pressure
It's important to regularly monitor your blood pressure because duloxetine (Cymbalta) can cause changes to your blood pressure (either up or down).
Your blood pressure might suddenly fall when you get up from a sitting or lying position. This might make you feel dizzy and can lead to falls or fainting. Drops in blood pressure when you stand and possible fainting tend to happen within the first week of treatment but can occur at any time, particularly after your dose is raised. Get up very slowly when you're changing positions, such as after lying down.
Serotonin syndrome
Risk factors: Taking other medications that can affect the serotonin levels in your brain
Duloxetine (Cymbalta) raises the serotonin levels in your brain to help improve mood and pain. Serotonin syndrome is a rare, but potentially life-threatening condition that can happen when there's too much serotonin in the brain. Get medical help right away if you have symptoms of serotonin syndrome, like fast heart rate, sweating, muscle stiffness or spasms, high fever, and confusion.
Your risk for serotonin syndrome goes up if you use duloxetine (Cymbalta) with other medications that affect serotonin levels, such as dextromethorphan (Delsym), tramadol (Ultram), and MAOIs. Tell your prescriber about all the medications you take (including over-the-counter medications and supplements) so they can make sure duloxetine (Cymbalta) is safe for you to take. Don't start any new medications while you're taking duloxetine (Cymbalta) without letting your pharmacist or HCP know.
Higher bleeding risk
Risk factors: Taking blood-thinning medications
Duloxetine (Cymbalta) can raise the risk of bleeding or bruising, especially if you're also taking aspirin, NSAIDs (nonsteroidal anti-inflammatory drugs), or blood thinners. The bleeding can range from nosebleeds to stomach bleeds and at times can be life-threatening. Tell an HCP right away about any bruising that doesn't go away, black-colored stools, pink or red urine, or unusual bleeding from the nose or gums.
Severe skin reaction
In some rare cases, duloxetine (Cymbalta) can cause severe skin reactions. Get medical help as soon as possible if you experience painful blisters, a peeling rash, sores, or other signs of a skin reaction.
Withdrawal symptoms
Risk factors: Stopping duloxetine (Cymbalta) suddenly
Stopping duloxetine (Cymbalta) suddenly can cause withdrawal symptoms such as nausea, upset stomach, anxiety, irritation, confusion, trouble sleeping, dizziness, and headache. Talk to your prescriber for guidance on how to lower your dose slowly and safely if you need to stop taking it.
Mania
Risk factors: Personal or family history of bipolar disorder
Sometimes, depression is the first symptom of bipolar disorder. Treating someone with bipolar disorder with an antidepressant alone can cause a manic episode (great excitement, euphoria, delusions, and overactivity). This is more likely to happen if you or someone in your family has had bipolar disorder. Talk to your HCP right away if you notice unusual changes in your behavior after you take duloxetine (Cymbalta). This medication isn't approved for treating bipolar depression.
Low sodium levels
Risk factors: Older adults | Medical condition called syndrome of inappropriate antidiuretic hormone (SIADH) | Taking diuretics (water pills) | Dehydrated or low fluid levels in the body
It's possible for duloxetine (Cymbalta) to cause low sodium levels in the body. In general, sodium levels tend to go back within normal ranges when the medication is stopped. Call your HCP if you experience signs and symptoms of low sodium levels, such as headaches, trouble concentrating, memory problems, confusion, weakness, or balance problems.
Sexual problems
In clinical trials, some adults who took duloxetine (Cymbalta) had sexual problems. These problems included erectile dysfunction and low sex drive. Contact your HCP if you notice any bothersome sexual problems while you're taking duloxetine (Cymbalta).
Duloxetine (Cymbalta) dosage forms
The average cost for 30 capsules of 60mg of Duloxetine (Cymbalta) is $278.55 with a free GoodRx coupon. This is 19.75% off the average retail price of $347.12.
Capsule
Dosage | Quantity | Price as low as | Price per unit |
---|---|---|---|
20mg | 30 capsules | $254.83 | $8.49 |
30mg | 30 capsules | $283.60 | $9.45 |
60mg | 30 capsules | $278.55 | $9.28 |
Typical dosing for Duloxetine (Cymbalta)
Depending on your medical condition and age, you might start the medication at a low dose before your prescriber raises the dose slowly over a few weeks to the recommended dose. Your prescriber will adjust your dose based on how well the medication is working for you and whether you have side effects.
Major depressive disorder
Adults: The typical dose ranges from 40 mg (given as 20 mg twice daily) to 60 mg (once daily or as 30 mg twice daily) by mouth.
Generalized anxiety disorder
Adults: The typical dose is 60 mg by mouth once daily. Older adults might start the medication at a dose of 30 mg once daily before their dose is raised to 60 mg once daily.
Children age 7 years and older: The typical starting dose is 30 mg by mouth once daily. The recommended dose is between 30 mg to 60 mg once daily.
Diabetic neuropathy
Adults: The typical dose is 60 mg by mouth once daily.
Fibromyalgia
Adults and children age 13 years and older: The typical starting dose is 30 mg by mouth once daily. The dose can be raised to 60 mg once daily.
Long-term pain in the muscles, bones, joints, or tendons
Adults: The typical starting dose is 30 mg by mouth once daily. The recommended dose is 60 mg once daily.
The typical maximum daily dose is 60 mg, but can go up to 120 mg when treating for depression or generalized anxiety disorder.
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Duloxetine (Cymbalta) contraindications
Contraindications are specific health conditions or situations in which a person shouldnot take a medication due to safety concerns. If you have any of the following conditionsor if any of the following apply to you, let your healthcare provider know because Duloxetine (Cymbalta) will not be safe for you to take.
Currently take or have taken a monoamine oxidase inhibitor (MAOI) within 14 days of duloxetine (Cymbalta)
In the middle of treatment with linezolid (Zyvox) or methylene blue