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Cymbalta: What is it? Uses, Side Effects, and Dosage

If you are one of millions of Americans suffering from common conditions like major depressive disorder, generalized anxiety disorder, fibromyalgia, chronic low back pain, and diabetic neuropathy, it might be hard to believe that one medication can treat all of these conditions at once. However, Cymbalta has many applications that can be beneficial for patients struggling to manage the symptoms of their conditions.

What is Cymbalta?

Cymbalta, known under its generic name of duloxetine, is a medication that belongs to a class of drugs called selective serotonin and norepinephrine reuptake inhibitor antidepressants (SSNRIs), which are commonly used to treat depression and anxiety. Cymbalta was approved by the Food and Drug Administration (FDA) to treat depression in August 2004, and it immediately became a popular medication. Approximately 16.5 million prescriptions were written for Cymbalta in 2017, making it the 46th most popularly prescribed drug in the United States. It should be stored at room temperature to keep its integrity. 

What is Cymbalta Used to Treat?

Cymbalta was first approved to treat clinical depression, also known as major depressive disorder, in 2004, but in the years since, it has been approved for the treatment of numerous other conditions, including general anxiety disorder (GAD) in adults and children who are at least seven years old, fibromyalgia, chronic muscle or joint pain, and diabetic neuropathy. A brief explanation of each of these conditions and their associated symptoms is provided below.

Clinical Depression/Major Depressive Disorder

Clinical depression, also known as major depressive disorder, is characterized by persistent and intense feelings of sadness that last for extended periods of time (a minimum of two weeks or more). In addition to impacting your mood and behavior, major depressive disorder can also have physical characteristics as well, including changes to appetite and sleep. People who experience major depressive disorder may lose interest in doing activities that they once enjoyed or have trouble performing everyday activities, and they may have suicidal thoughts and tendencies. Approximately seven percent of American adults has an episode of clinical depression each year, making it one of the most common mental health issues. The following Symptoms are very common with major depressive disorder:

  • Feeling sad, empty, or tearful
  • Mood Swings
  • Feelings of worthlessness, guilt, hopelessness, or helplessness
  • Lost of interest in activities you used to enjoy
  • Difficult concentrating and low energy
  • Sleeping and eating more or less than usual
  • Nervous energy
  • Feelings of moving or thinking in slow motion
  • Suicidal thoughts or behaviors

General Anxiety Disorder

Anxiety is the body’s natural response to stress and is defined by fear or apprehension about what is to come. Everyone experiences anxiety at one point or another in their lives, but anxiety becomes a problem and is described as an anxiety disorder when the feelings are extreme, last longer than six months, and interfere with your life. Symptoms of generalized anxiety culminate in a panic attack and can include an increased heart rate, rapid breathing, restlessness, trouble concentrating, and difficulty falling asleep. A more acute form of anxiety, called an anxiety attack, has symptoms that include feeling faint or dizzy, shortness of breath, dry mouth, sweating, chills or hot flashes, apprehension and worry, restlessness, distress, fear, numbness or tingling.

Fibromyalgia

Fibromyalgia is a chronic condition characterized by unexplainable widespread musculoskeletal pain. In addition to pain that occurs all over the body, fibromyalgia symptoms also include fatigue, sleep issues, memory issues, mood issues, tension headaches, temporomandibular joint (TMJ) disorders, irritable bowel syndrome (IBS), anxiety, and depression. While researchers are not entirely sure what causes fibromyalgia, they believe that the condition results from your brain processing pain signals improperly and amplifying painful sensations.  Onset of fibromyalgia sometimes occurs after a physical trauma or significant psychological stress, or symptoms may slowly build over time.

Diabetic neuropathy

Diabetic neuropathy is a type of nerve damage that may occur in diabetic patients with uncontrolled high blood sugar. Long term high blood sugar can injure the nerves in the body, and symptoms of diabetic neuropathy are particularly present in the legs and feet. However, symptoms can range from pain and numbness in the legs and feet to digestive issues, urinary tract problems, or blood vessels and heart problems. 

How Does Cymbalta Work?

Cymbalta belongs to a family of drugs called selective serotonin and norepinephrine reuptake inhibitors (SSNRIs), which work by increasing the levels of the neurotransmitters serotonin and norepinephrine in the brain. SSNRIs help regulate the amount of serotonin and norepinephrine in the brain, which helps brain cells transmit messages to each other, resulting in an improved and more stable mood, and which also helps to block pain signals traveling through the brain. People who experience major depressive disorder or generalized anxiety disorder and take Cymbalta may experience an improved mood, regain interest in old hobbies that they once enjoyed, and feel the physical symptoms of their conditions ease. The mood stabilizing effects of Cymbalta also help people with the other conditions treated by Cymbalta such as fibromyalgia, which may have depression and anxiety as symptoms.

What is the Cost of Cymbalta?

Like most medications, the brand name form of Cymbalta is substantially more expensive than the generic form of the drug, duloxetine. The generic form of the medication is typically covered by most Medicare and insurance plans, but it may be possible to receive a cheaper price on the drug by using a pharmacy discount card or coupon or paying the cash price. The following table compares the costs of a 30 day supply of Cymbalta and duloxetine.


Costs of a 30-Day Supply of Cymbalta and Duloxetine

 

 

Cymbalta

Duloxetine

20 mg oral capsules

$243.72

$46.18

30 mg oral capsules

$277.60

$18.22

60 mg oral capsules

$277.60

$22.94


Because there are numerous manufacturers for duloxetine, the prices of the drug are extremely affordable even for those who are uninsured or underinsured. While some people are concerned about taking the generic forms of medication, the FDA subjects generic drugs to the same stringent testing as the brand name form of the drug. The generic medication uses the same active ingredient as the brand name form of the medication in the same amount, but may use different inactive ingredients that affect the color, size, shape, or taste of the medication. However, you will receive the same treatment when using a generic medication of the same form and strength as you would with a brand name medication.

What Are the Benefits of Using Cymbalta?

Because Cymbalta is capable of treating many different types of seemingly unrelated conditions, the benefits of the medication are far-reaching. Benefits associated with the use of Cymbalta include:

  • Cymbalta can relieve many types of chronic pain especially in the nervous system, including nerve pain caused by diabetic neuropathy, pain caused by fibromyalgia, pain caused by chronic back problems, and pain caused by osteoarthritis.
  • Cymbalta has been proven to be effective at treating a number of different disorders, including major depressive disorder, generalized anxiety disorder, fibromyalgia, diabetic neuropathy, and other types of chronic pain, so individuals suffering from several of these conditions may find relief with one medication.
  • Cymbalta does not cause the substantial changes to blood pressure that can be attributed to other drugs in its class.
  • Cymbalta is able to treat children as young as seven with generalized anxiety disorder.
  • Cymbalta is available as a generic medication, making it more accessible and affordable for patients. 

How Do I Know What Dose of Cymbalta to Take?

Your health care provider will determine the appropriate dose of Cymbalta for you based on your age, the form of the medication you take,  and the purpose of treatment, but your medication dose may have to be adjusted several times before you get it just right. Your health care provider is a great place to get the drug information that you need. The standard treatment for adults suffering from major depressive disorder starts at 40 mg per day, taken as one 20 mg release capsules twice per day. Over time, your doctor may choose to adjust your dose to 60 mg, given either as one 30 mg capsule twice per day or one 60 mg capsule taken once daily. Your daily dose for major depressive disorder should not exceed 120 mg per day.  

Adults with generalized anxiety disorder will generally start out taking one 60 mg capsule per day. Your daily dose for generalized anxiety disorder should not exceed 120 mg per day.  Elderly patients should start out taking 30 mg and assess the effects about considering an increase to 60 mg once per daily at their doctor’s direction. Children will start Cymbalta at a dose of 30 mg per day before increasing to 60 mg per day, with a maximum of 120 mg per day. 

Patients taking Cymbalta for treatment of diabetic peripheral neuropathy or fibromyalgia will take 60 mg once per day. There is no evidence to support that taking a dose higher than 60 mg per day yields any additional benefit to the patient.
If you had a missed dose, do not take extra medicine to make up for it. If you are approaching the time for your time for the next dose, take it as usual. 

Patients who take Cymbalta should not abruptly stop or change their dose without consulting with their doctor, as this can cause withdrawal symptoms if a patient has been using the medication for six weeks or more. Unfortunately withdrawal from Cymbalta, known was Cymbalta Withdrawal Syndrome due to its high likelihood of occurrence, may occur even when gradually discontinuing the medication as directed. However,  withdrawing from Cymbalta under a doctor’s medical attention to lessen your symptoms and will allow your doctor to manage your symptoms appropriately. Symptoms of Cymbalta withdrawal include:
Irritability
Insomnia
Nausea
Dizziness
Drowsiness or fatigue
Increased sweating
Vomiting
Vivid nightmares
Muscle spasms or tremors
Headache
Paresthesias
Seizures
Electrical shock sensations
Depressive symptoms
Feelings of anxiety
Malaise

Are There Any Side Effects of Cymbalta I Should be Aware Of?

Possible Side effects associated with Cymbalta generally fall into two categories: common and less common. Common side effects associated with Cymbalta include:

  • Dry mouth
  • Nausea
  • Muscle weakness
  • Vomiting
  • Constipation
  • Abdominal Pain or Stomach Pain
  • Tremor
  • Loss of appetite
  • Tiredness or sleepiness
  • Low blood pressure
  • Weight loss
  • Excessive sweating
  • Skin rash
  • Lightheadedness
  • Bruising Easily

Less common adverse effects that may occur in long-term users of Cymbalta include:

  • Sexual dysfunction
  • Colitis
  • Liver disease or damage in individuals who mix the medication with alcohol
  • Frequent Urination
  • <h3>Are There Any Risks Associated With Cymbalta?</h3>

There are several risks associated with Cymbalta, but the most significant risk is the increased risk of suicidal thinking, ideation, and behavior in children, adolescents, and young adults suffering from major depressive disorder. Patients with a diagnosis of major depressive disorder should be closely monitored while taking Cymbalta.

Cymbalta has a higher likelihood than some other SSNRIs to cause physical dependence; in fact, withdrawal issues with the drug are so common that healthcare professionals have coined the term “Cymbalta Withdrawal Syndrome” to describe the condition. While addiction to Cymbalta is unlikely, it is possible, and misuse of the drug does occur. Individuals may take increasingly high doses of the medication to avoid withdrawal symptoms or to experience the pleasurable effects of the drug. Signs of Cymbalta abuse include:

  • Slurred speech
  • Lying about symptoms to get additional prescriptions
  • Bloodshot eyes
  • Noticeable weight loss
  • Financial problems
  • Sudden changes in hygiene and physical appearance
  • Decreased appetite
  • Changes in sleep patterns

Who Should Not Take Cymbalta?

People who currently or have recently taken a type of medication known as monoamine oxidase inhibitors (MAOIs) should not take Cymbalta, nor should individuals taking Mellaril (thioridazine), as there are drug interactions. Individuals with uncontrolled narrow-angle glaucoma should not take Cymbalta. People who experience an allergic reaction to Cymbalta or its active ingredient, duloxetine, should not take the medication.  People who are taking other medications that are ssris or serotonin-norepinephrine reuptake inhibitors  (snris), including Prozac, Lithium, tramadol, linezolid, Ultram, Imitrex, Fluoxetine, Lexapro, Dilaudid, Phelelzine, and St. John’s Wort, should not take Cymbalta due to the potential to develop Serotonin syndrome. Ask your doctor for medical advice to see if it is right for you. 

Other people should use caution when taking Cymbalta. Be sure to give your doctor a complete medical history, especially including any personal or family history examples of:

  • Alcoholism or heavy drinking
  • Kidney or liver problems
  • Personal or family history of suicide attempts
  • Liver problems
  • Personal or family history of bipolar disorder
  • Low or HIgh Blood Pressure
  • Glaucoma (angle-closure type)
  • Taking Nonsteroidal anti-inflammatory drugs (NSAIDS)

Cymbalta may cause an increased risk of serious side effects for older adults, who are particularly at risk for bleeding and loss of coordination; loss of coordination increases the risk of falling. Older adults are also considered to be at increased risk of developing low blood sodium. 

Is Cymbalta Safe For Pregnant and Nursing Women?

Cymbalta is not considered safe for pregnant women and should only be taken during pregnancy if the potential benefits outweigh the potential for risks to the fetus. When taken during the final 30 days of pregnancy, Cymbalta use can cause an increased risk of bleeding at birth. Babies born to mothers who have taken Cymbalta in the final trimester of pregnancy may develop withdrawal symptoms, including feeding/breathing difficulties, seizures, muscle stiffness or constant crying. Your doctor can tell you if discontinuation is the best idea. 

Because Cymbalta can be passed into breast milk, use by nursing mothers is not advised.
 

Published April 25th, 2020 by Bridget Reed
Fact Checked by Chris Riley

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