Duloxetine

If you have depression, diabetic neuropathy pain, fibromyalgia, or generalized anxiety disorder, a healthcare provider may prescribe duloxetine. The medication works by increasing the levels of certain chemicals in the brain (serotonin and norepinephrine) and by blocking the nerve pain signals in the spinal cord or brain. Possible side effects of duloxetine include nausea, headaches, and dizziness. Prior to taking the medication, be sure to tell your healthcare provider if you have liver disease, any allergies, or bipolar disorder.

 

What Is Duloxetine?

Duloxetine hydrochloride (Cymbalta®) is a prescription medicine used to treat the following conditions:
 
(Click What Is Duloxetine Used For? for more information on what it is used for, including possible off-label uses.)
 

Side Effects of Duloxetine

As with any medicine, there are possible side effects with duloxetine.
 However, not everyone who takes duloxetine will experience side effects. In fact, most people tolerate the medication well. When side effects do occur, in most cases they are minor and either require no treatment or can easily be treated by you or your healthcare provider. Serious side effects are less common.
 
The most common side effects of duloxetine include:
 
(Click Duloxetine Side Effects to learn about specific side effects of the drug, including some of the more serious side effects that you should report to your healthcare provider. You can also read about possible side effects by going to:
 

 

What Should I Tell My Healthcare Provider?

You should talk with your healthcare provider prior to taking this medication if you have:
 
Also, let your healthcare provider know if you:
 
  • Are pregnant or thinking of becoming pregnant (see Cymbalta and Pregnancy)
  • Are breastfeeding
  • Drink alcohol regularly.
     
Make sure to tell your healthcare provider about all of the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements.
 
(Click Precautions and Warnings With Duloxetine for more information on this topic, including information on who should not take this drug.)
 

How Does It Work?

Duloxetine is part of a class of drugs called serotonin-norepinephrine reuptake inhibitors, or SNRIs for short. SNRIs, such as duloxetine, affect specific chemicals within the brain known as serotonin and norepinephrine. Serotonin and norepinephrine are two of several chemicals used to send messages from one nerve cell to another.
 
As a message travels down a nerve, it causes the end of the cell to release serotonin or norepinephrine. The serotonin or norepinephrine enters the gap between the first nerve cell and the one next to it. When enough serotonin or norepinephrine reaches the second nerve cell, it activates receptors on the cell and the message continues on its way. The first cell then quickly absorbs any serotonin or norepinephrine that remains in the gap between the cells. This is called "reuptake."
 
Normally, this process works without any problems. But when the levels of serotonin or norepinephrine become unbalanced, it can cause a variety of conditions, including depression or anxiety. Duloxetine helps to block the reuptake of serotonin and norepinephrine so more remains in the space between the brain's nerve cells. This gives the serotonin and norepinephrine a better chance of activating the receptors on the next nerve cell.
 
Although it is not entirely clear as to how duloxetine works for nerve pain, it appears that duloxetine helps block the nerve pain signals in the spinal cord or brain. This helps to relieve the pain of peripheral diabetic neuropathy.
It is not known exactly how duloxetine works for fibromyalgia pain.
 

Effects

There have been several studies looking at the effects of duloxetine on a variety of conditions.
 
Duloxetine for Depression
Four studies have shown duloxetine to be effective for depression treatment in adults. In these studies, people taking duloxetine had more improvement in their depression symptoms, compared to those not taking duloxetine.
 
Duloxetine for Neuropathy
Duloxetine has also been studied for neuropathic pain (nerve pain) in people with peripheral diabetic neuropathy. These studies included people with either type 1 or type 2 diabetes who had been experiencing diabetic neuropathy pain for at least six months. People taking duloxetine were more likely to have half as much pain as before, compared to those not taking duloxetine.
 
Duloxetine for Anxiety
Studies have also shown duloxetine to be effective for treating generalized anxiety disorder (GAD). People taking duloxetine had greater improvements in their anxiety symptoms, compared to those not taking duloxetine.
 
Duloxetine for Fibromyalgia
Studies indicate that Cymbalta can help reduce fibromyalgia pain. Duloxetine was more effective than a placebo (a "sugar pill") for relieving pain, even in people who did not have depression along with fibromyalgia (although it was most effective in people that had depression).
 

When and How to Take Duloxetine

Some general considerations for when and how to take the medication include:
 
  • Duloxetine comes in capsule form. It is taken by mouth, usually once or twice a day.
     
  • If duloxetine makes you drowsy, try taking it later in the day. If it causes insomnia, try taking it earlier.
     
  • You can take it with or without food. If duloxetine bothers your stomach, try taking it with food.
     
  • Be sure to swallow the capsules whole. Do not open or chew the capsules.
     
  • Duloxetine should be taken at the same time each day to maintain an even level of the drug in your blood.
     
  • For duloxetine to work properly, it must be taken as prescribed. It will not work if you stop taking it.
     

Dosing

The dose of duloxetine your healthcare provider recommends will vary depending on a number of factors, including:
 
  • The medical condition being treated
  • Other medical conditions you may have
  • Other medications you may currently be taking.
     
As with any medicine, do not adjust your duloxetine dose unless your healthcare provider specifically instructs you to do so.
 
(Click Duloxetine Dosing for more information about dosing for duloxetine.)
  

Drug Interactions

Duloxetine can potentially interact with a number of medicines.
 
(Click Drug Interactions With Duloxetine for more information.)
  

Alternatives to Duloxetine

Depression, even in its most severe form, is highly treatable. As with many illnesses, getting depression treatment early is more effective and reduces the chance of recurrence.
 
The most common forms of treatment for depression are medication (antidepressants) and psychotherapy ("talk therapy"). In some cases of severe depression, healthcare providers may recommend electroconvulsive therapy (ECT). Some people may also try complementary or alternative treatments for depression (see Natural Remedies for Depression).
 
For most people, duloxetine is quite effective at treating depression. It is also generally well tolerated. However, side effects can occur, or the medicine may not work as well as needed. In these cases, your healthcare provider may recommend an alternative to duloxetine. Some examples of substitute depression medications include:
 
  • Other serotonin-norepinephrine reuptake inhibitors (SNRIs)
  • Selective serotonin reuptake inhibitors (SSRIs)
  • Norepinephrine and dopamine reuptake inhibitors (NDRIs)
  • Tricyclic antidepressants
  • Monoamine oxidase inhibitors (MAOIs).
     
(Click Cymbalta Alternatives to learn more about alternatives for duloxetine. Click Dealing With Depression to learn other ways of managing depression.)
 

Overdose

People who take too much duloxetine may have overdose symptoms that could include:
 
  • Drowsiness
  • Vomiting
  • Seizures
  • Confusion
  • Hallucinations
  • A fast heartbeat
  • Feeling faint
  • Fever
  • Sweating
  • Muscle spasms
  • Difficulty walking
  • Diarrhea.
     
If you happen to overdose on duloxetine, seek medical attention immediately.
 
(Click Cymbalta Overdose for more information.)
 

Storage Methods

Duloxetine should be stored at room temperature, away from moisture or heat. Duloxetine capsules should be kept in an airtight container.
 
Keep duloxetine and all medications out of the reach of children.
 

What Should I Do If I Miss a Dose?

If you do not take your duloxetine as scheduled, take your missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and continue with your regular schedule. Do not take a double dose of duloxetine.
 

Who Makes It?

Duloxetine is manufactured by Eli Lilly and Company.
 

Strengths of Duloxetine

Duloxetine capsules are available in three strengths:
 
  • Duloxetine 20 mg capsules
  • Duloxetine 30 mg capsules
  • Duloxetine 60 mg capsules.

   

Generic Duloxetine

There is currently no generic duloxetine licensed for sale.
 
(Click Generic Cymbalta for more information.)
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Written by/reviewed by: Kristi Monson, PharmD; Arthur Schoenstadt, MD
Last reviewed by: Kristi Monson, PharmD;