Cymbalta Capsule: Uses, Dosage, Side Effects, Precautions and Alternates

Quick overview

Cymbalta Capsule contains duloxetine, a serotonin-norepinephrine reuptake inhibitor (SNRI). The brand-name version has been discontinued by its manufacturer for commercial reasons, not safety reasons, but generic duloxetine remains widely available. It is used to treat depression, generalized anxiety disorder, and certain types of pain, including diabetic nerve pain, fibromyalgia, and chronic musculoskeletal pain.

What is Cymbalta Capsule

Cymbalta is a brand-name delayed-release capsule containing the medicine duloxetine. Note that the brand-name version has been discontinued by its manufacturer for commercial reasons (not safety reasons), but the generic duloxetine remains widely available and works the same way.

Cymbalta Capsule uses

• Major depressive disorder (MDD), commonly called depression, in adults
• Generalized anxiety disorder (GAD) in adults, and in children ages 7 years and older
• Pain caused by diabetic peripheral neuropathy (nerve damage) in adults
• Fibromyalgia in adults, and in children ages 13 years and older
• Chronic musculoskeletal pain, including chronic low back pain and pain from osteoarthritis, in adults

Benefits of Cymbalta Capsule

• Can relieve symptoms of depression such as low mood, loss of interest, and sleep or concentration problems
• Can reduce excessive worry and other symptoms of generalized anxiety disorder
• Can reduce nerve pain caused by diabetes
• Can reduce pain and improve function in people with fibromyalgia
• Can reduce chronic musculoskeletal pain such as low back pain or osteoarthritis pain

How Cymbalta Capsule works

It isn't fully understood how this medicine treats depression, anxiety, or pain, but it is thought to work by changing the levels of two brain chemicals, serotonin and norepinephrine, that affect mood and can also reduce pain signals in the brain.

Cymbalta Capsule dosage

This medicine can be taken at any time of day, but try to take it at the same time every day. It can be taken with or without food; taking it with food may help reduce nausea. Swallow the capsule whole; do not chew, crush, split, or open it, and do not sprinkle the contents on food or mix with liquids, since this can affect how the coating protects the drug and change how well it works.

If you miss a dose, take it as soon as you remember, but if it is almost time for your next dose, skip the missed dose; do not take two doses at once. This medicine is usually meant to be taken long term; continue taking it as directed even after you start to feel better, unless your doctor tells you otherwise. Do not stop taking this medicine suddenly; your doctor will usually lower your dose gradually over time to reduce the chance of withdrawal symptoms. In children being treated for generalized anxiety disorder or fibromyalgia, doctors typically start with a lower dose before considering an increase.

Available forms and strengths

• Delayed-release oral capsule (20 mg, 30 mg, and 60 mg strengths)

Side effects of Cymbalta Capsule

Common

• Nausea
• Constipation
• Decreased appetite
• Dizziness
• Dry mouth
• Excessive sweating
• Fatigue
• Sleepiness
• Headache
• Insomnia (trouble sleeping)
• Sexual side effects, including erectile dysfunction and decreased sex drive
• Diarrhea

Serious

• Liver damage (dark urine, itchy skin, pain in upper right abdomen, yellowing of skin or eyes)
• Orthostatic hypotension - a drop in blood pressure when standing that can cause dizziness or fainting and lead to falls
• Serotonin syndrome (agitation, fever, muscle twitches, nausea, vomiting, diarrhea, fast heart rate, sweating, tremors)
• Severe skin reactions such as Stevens-Johnson syndrome (hives, mouth sores, peeling rash, blisters)
• Eye problems such as glaucoma (vision changes, eye pain, swelling around the eye)
• Hyponatremia, or low sodium levels (confusion, trouble concentrating, memory problems, weakness)
• Trouble urinating or inability to pass urine
• High blood pressure
• Unusual bleeding or bruising
• Seizures
• Withdrawal symptoms if the drug is stopped suddenly
• Severe allergic reaction (swelling of face, lips, tongue, or throat; trouble breathing; hives)
• Suicidal thoughts and behaviors, especially in people under 25

Warnings and precautions

• This medicine has a boxed warning, the most serious type of warning from the FDA, because it can increase the risk of suicidal thoughts and behaviors in children and young adults up to age 24, especially during the first few months of treatment or after a dose change. Patients and their families should watch closely for any new or worsening changes in mood, behavior, or thoughts.
• This medicine should not be taken together with, or within 14 days of stopping, a monoamine oxidase inhibitor (MAOI), due to the risk of a serious and potentially fatal reaction.
• This medicine should not be used by people with uncontrolled narrow-angle glaucoma, since it can increase pressure in the eye.
• Combining this medicine with other drugs that increase serotonin, such as certain other antidepressants, tramadol, triptans, or St. John's Wort, can increase the risk of a serious condition called serotonin syndrome.
• This medicine can increase the risk of bleeding, especially when combined with NSAIDs like ibuprofen, aspirin, or blood thinners like warfarin.
• Stopping this medicine suddenly can cause withdrawal symptoms; your doctor will typically reduce your dose gradually.
• This medicine may raise blood pressure, so blood pressure should be checked before starting treatment and periodically during treatment.
• This medicine may cause complications if taken during pregnancy, including an increased risk of severe bleeding after delivery if taken near the end of pregnancy, and possible withdrawal-like symptoms in the newborn. Talk with your doctor before taking this medicine if you are pregnant or planning to become pregnant.
• This medicine passes into breast milk. There have been a few reports of drowsiness, feeding problems, and difficulty gaining weight in breastfed infants whose mothers took this medicine. Discuss the risks and benefits with your doctor before breastfeeding while taking this medicine.
• This medicine should not be used in people with severe kidney impairment or end-stage kidney disease, since the kidneys help clear the drug from the body and impairment can lead to a buildup of the drug and more side effects.
• This medicine should not be used in people with liver disease that causes impaired liver function, because the liver helps clear the drug from the body and impairment could cause the drug to build up and increase side effects, including liver damage.
• Drinking excessive alcohol while taking this medicine may increase the risk of serious liver damage, so people who drink heavily should talk to their doctor before starting this medicine.
• This medicine can cause sleepiness and dizziness, so you should avoid driving or operating hazardous machinery until you know how it affects you.

Storage

• Store capsules at room temperature, in a tightly sealed container, away from light
• For short periods of time, this medicine may be stored at slightly cooler or warmer room temperatures
• Avoid storing this medicine in places where it could get damp or wet, such as bathrooms
• Keep out of the sight and reach of children
• If you have leftover or expired medicine, ask your pharmacist how to dispose of it safely rather than throwing it in the trash or flushing it

When to see a doctor

• Get emergency help right away if you or someone else has thoughts of suicide or self-harm, or shows sudden changes in mood, behavior, or thoughts, especially early in treatment or after a dose change.
• Seek emergency care if you have symptoms of a severe allergic reaction, such as swelling of the face, lips, tongue, or throat, trouble breathing, or widespread hives or blistering.
• Get emergency help if you have symptoms of serotonin syndrome, such as agitation, hallucinations, fast heartbeat, high fever, muscle twitching or stiffness, loss of coordination, nausea, vomiting, or diarrhea.
• Stop taking this medicine and call your doctor right away if you notice signs of liver damage, such as yellowing skin or eyes, dark urine, pale stools, nausea, loss of appetite, or pain in the upper right abdomen.
• Get medical attention right away if you have signs of a severe skin reaction, such as painful red or purple skin that looks burned, blistering, or peeling of the skin, mouth, nose, or genitals.
• Seek medical attention right away if you have eye pain, vision changes, or swelling or redness around the eye, which could be signs of a serious eye problem like glaucoma.
• Contact your doctor if you have trouble urinating or cannot empty your bladder.
• Call your doctor if you notice signs of low sodium levels, such as headache, confusion, memory problems, weakness, or unsteadiness that could lead to falls.

Alternatives

• Effexor XR
• Zoloft
• Prozac