Duloxetine (By mouth)

Introduction

Duloxetine (doo-LOX-e-teen)

Treats depression, anxiety, diabetic peripheral neuropathy (nerve pain caused by diabetes), fibromyalgia (muscle pain and stiffness), or chronic (long-lasting) pain related to muscles and bones. This medicine is a selective serotonin and norepinephrine reuptake inhibitor (SSNRI).

Brand Name(s)

Cymbalta

There may be other brand names for this medicine.

When This Medicine Should Not Be Used

You should not use this medicine if you have had an allergic reaction to duloxetine, or if you are using or have used an MAO inhibitor (MAOI) such as isocarboxazid, phenelzine, selegiline, tranylcypromine, Eldepryl®, Marplan®, Nardil®, or Parnate® within the past 14 days. Do not start taking an MAO inhibitor within 5 days of stopping duloxetine. You should not use this medicine if you have severe kidney disease or uncontrolled narrow-angle glaucoma.

How to Use This Medicine

Delayed Release Capsule

  • Your doctor will tell you how much of this medicine to use and how often. Your dose may need to be changed several times in order to find out what works best for you. Do not use more medicine or use it more often than your doctor tells you to.
  • You may take this medicine with or without food.
  • Swallow the delayed-release capsule whole. Do not crush, chew, or break the capsule. Do not open the capsule and sprinkle the contents on food or in liquids.
  • You will need to use this medicine for several weeks before you begin to feel better. Keep using the medicine even if you feel you are not getting better, and talk to your doctor if you have any questions.
  • This medicine should come with a Medication Guide. Read and follow these instructions carefully. Ask your doctor or pharmacist if you have any questions. Ask your pharmacist for the Medication Guide if you do not have one.

If a dose is missed:

  • If you miss a dose or forget to use your medicine, use it as soon as you can. If it is almost time for your next dose, wait until then to use the medicine and skip the missed dose. Do not use extra medicine to make up for a missed dose.

How to Store and Dispose of This Medicine

  • Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light.
  • Ask your pharmacist, doctor, or health caregiver about the best way to dispose of any outdated medicine or medicine no longer needed.
  • Keep all medicine away from children and never share your medicine with anyone.

Drugs and Foods to Avoid

Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products.

  • Make sure your doctor knows if you are also using cimetidine (Tagamet®), thioridazine (Mellaril®), tryptophan, or medicine to treat an infection (such as ciprofloxacin, enoxacin Ciloxan®, Cipro®, or Penetrex®).
  • Make sure your doctor knows if you are using St. John's wort, lithium (Eskalith®, Lithane®, Lithobid®), tramadol (Ultram®), other medicines to treat depression (such as amitriptyline, desipramine, fluoxetine, fluvoxamine, imipramine, nortriptyline, paroxetine, Celexa®, Effexor®, Lexapro?, Luvox®, Norpramin®, Paxil®, or Zoloft®), medicine to treat headaches (such as eletriptan, sumatriptan, zolmitriptan, Imitrex®, Relpax®, or Zomig®), medicine to treat an infection (such as linezolid, Levaquin®, Tequin®, or Zyvox®), or a phenothiazine medicine (such as prochlorperazine, Compazine®, Phenergan®, Thorazine®, or Trilafon®).
  • Tell your doctor if you are using a blood pressure medicine (such as atenolol, lisinopril, metoprolol, Cozaar®, Diovan®, Lotrel®, Norvasc®, or Toprol®), diuretic or "water pill" (such as hydrochlorothiazide [HCTZ], furosemide, or Lasix®), medicine for heart rhythm problems (such as flecainide, propafenone, quinidine, Rythmol®, or Tambocor®), pain or arthritis medicine, also called "NSAIDs" (such as aspirin, ibuprofen, Advil®, Aleve®, Celebrex®, or Motrin®), or a blood thinner (such as warfarin, Coumadin®).
  • Tell your doctor if you are using any medicines that make you sleepy. These include sleeping pills, cold and allergy medicine, narcotic pain relievers, and sedatives.
  • Do not drink alcohol while you are using this medicine. Drinking alcohol while using this medicine may increase your risk of liver damage. If you regularly drink 3 or more alcoholic drinks every day, tell your doctor.

Warnings While Using This Medicine

  • It is important to tell your doctor if you are pregnant or trying to become pregnant. Your doctor may want you to join a pregnancy registry for patients taking this medicine.
  • Make sure your doctor knows if you are breastfeeding, or if you have kidney disease, liver disease (including cirrhosis), bleeding problems, diabetes, narrow-angle glaucoma, problems with urination, digestion problems (slow bowels), or a history of seizures or mania. Tell your doctor if you have heart disease, high or low blood pressure, or low sodium in the blood. Also tell your doctor if you have been addicted to drugs or alcohol.
  • For some teenagers and young adults, this medicine can increase thoughts of suicide. Tell your doctor right away if you start to feel more depressed and have thoughts about hurting yourself. Report any unusual thoughts or behaviors that trouble you, especially if they are new or get worse quickly. Make sure the doctor knows if you have trouble sleeping, get upset easily, have a big increase in energy, or start to act reckless. Also tell the doctor if you have sudden or strong feelings, such as feeling nervous, angry, restless, violent, or scared. Let the doctor know if you or anyone in your family has bipolar disorder (manic-depressive) or has tried to commit suicide.
  • Stop using this medicine and check with your doctor right away if you have pain or tenderness in the upper stomach; pale stools; dark urine; loss of appetite; nausea; unusual tiredness or weakness; or yellow eyes or skin. These could be symptoms of a serious liver problem.
  • Serious skin reactions can occur during treatment with this medicine, including erythema multiforme and Stevens-Johnson Syndrome (SJS). Stop using this medicine and check with your doctor right away if you have blistering, peeling, or loosening of the skin; red skin lesions; severe acne or skin rash; sores or ulcers on the skin; or fever or chills while you are using this medicine.
  • This medicine may make you dizzy or drowsy. Avoid driving, using machines, or doing anything else that could be dangerous if you are not alert. You may also feel lightheaded 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.
  • This medicine may cause serious conditions called serotonin syndrome or neuroleptic malignant syndrome (NMS)-like reactions when it is taken with certain medicines. Check with your doctor first before taking any other medicines.
  • You will need to have your blood pressure measured 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.
  • 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, or prickling or tingling feelings.
  • This medicine may increase your risk for bleeding problems when it is taken with certain medicines. Check with your doctor first before taking any other medicines.
  • After you stop using the medicine, call your doctor if you have mood or behavior changes, confusion, headaches, nausea, vomiting, seizures, tingling pain, or ringing in your ears.
  • Hyponatremia (low sodium in the blood) may occur with this medicine. Stop using the medicine and check with your doctor right away if you have confusion, difficulty concentrating, headaches, memory problems, weakness, and unsteadiness.
  • 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.
  • Your doctor will need to check your progress at regular visits while you are using this medicine. Be sure to keep all appointments. Blood tests may be needed to check for unwanted effects.

Possible Side Effects While Using This Medicine

Call your doctor right away if you notice any of these side effects:

  • Allergic reaction: Itching or hives, swelling in your face or hands, swelling or tingling in your mouth or throat, chest tightness, trouble breathing
  • Aggression, anxiety, anger, or hostility.
  • Dark-colored urine or pale stools.
  • Decrease in how much or how often you urinate.
  • Extreme sleepiness or drowsiness.
  • Fast or uneven heartbeat, or dizziness.
  • Feeling confused, nervous, restless, or clumsy.
  • Lightheadedness or fainting.
  • Muscle spasms, twitching, or stiffness.
  • Nausea, vomiting, loss of appetite, or pain in your stomach.
  • Panic attacks, tremors, or feeling irritable.
  • Severe nausea or diarrhea.
  • Unexplained fever, sweating, or shivering.
  • Unusual behavior, or thoughts about hurting yourself.
  • Unusual bleeding or bruising.
  • Unusual tiredness or weakness.
  • Yellowing of your skin or the whites of your eyes.

If you notice these less serious side effects, talk with your doctor:

  • Blurred vision.
  • Cough, sore throat, or runny or stuffy nose.
  • Decreased appetite.
  • Dry mouth, constipation, upset stomach, or mild nausea or diarrhea.
  • Feeling tired, or having trouble sleeping.
  • Headache.
  • Increased sweating.
  • Problems with sex, or loss of interest in sex.
  • Problems with urination.
  • Skin rash.
  • Weight loss.

If you notice other side effects that you think are caused by this medicine, tell your doctor

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088

Version Info

  • Last Reviewed on 06/12/2013

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This page was last updated: September 18, 2013

         
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