Description and Brand Names

Drug information provided by: Micromedex

US Brand Name

  1. Cymbalta
  2. Irenka

Descriptions


Duloxetine is used to treat depression and anxiety. It is also used for pain caused by nerve damage associated with diabetes (diabetic peripheral neuropathy).

Duloxetine is also used to treat fibromyalgia (muscle pain and stiffness) and chronic (long-lasting) pain that is related to muscles and bones.

Duloxetine belongs to a group of medicines known as selective serotonin and norepinephrine reuptake inhibitors (SSNRIs). These medicines are thought to work by increasing the activity of chemicals called serotonin and norepinephrine in the brain.

This medicine is available only with your doctor's prescription.

This product is available in the following dosage forms:

  • Capsule
  • Capsule, Delayed Release

Before Using

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Appropriate studies performed to date have not demonstrated pediatric-specific problems that would limit the usefulness of duloxetine in children to treat anxiety in children 7 years of age and older. However, safety and efficacy have not been established in children younger than 7 years of age.

Appropriate studies have not been performed on the relationship of age to the effects of duloxetine for other indications in the pediatric population. Safety and efficacy have not been established for other indications.

Geriatric

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of duloxetine in the elderly. However, elderly patients may be more sensitive to the effects of this medicine than younger adults, and are more likely to have hyponatremia (low sodium in the blood) which may require caution in patients receiving duloxetine.

Pregnancy

Information about this duloxetine-oral-route
Pregnancy Category Explanation
All Trimesters C Animal studies have shown an adverse effect and there are no adequate studies in pregnant women OR no animal studies have been conducted and there are no adequate studies in pregnant women.

Breastfeeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Drug Interactions

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

  • Isocarboxazid
  • Linezolid
  • Methylene Blue
  • Metoclopramide
  • Phenelzine
  • Procarbazine
  • Rasagiline
  • Selegiline
  • Thioridazine
  • Tranylcypromine

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Abciximab
  • Aceclofenac
  • Acemetacin
  • Almotriptan
  • Amtolmetin Guacil
  • Anagrelide
  • Apixaban
  • Aripiprazole
  • Asenapine
  • Aspirin
  • Bromfenac
  • Bufexamac
  • Bupropion
  • Celecoxib
  • Choline Salicylate
  • Cifenline
  • Cilostazol
  • Citalopram
  • Clonixin
  • Clopidogrel
  • Cyclobenzaprine
  • Darunavir
  • Deferasirox
  • Desvenlafaxine
  • Dexibuprofen
  • Dexketoprofen
  • Dextromethorphan
  • Diclofenac
  • Diflunisal
  • Dipyridamole
  • Dipyrone
  • Dolasetron
  • Donepezil
  • Doxorubicin
  • Doxorubicin Hydrochloride Liposome
  • Eletriptan
  • Eliglustat
  • Encainide
  • Epoprostenol
  • Eptifibatide
  • Escitalopram
  • Etodolac
  • Etofenamate
  • Etoricoxib
  • Felbinac
  • Fenoprofen
  • Fentanyl
  • Fepradinol
  • Feprazone
  • Flecainide
  • Floctafenine
  • Flufenamic Acid
  • Fluoxetine
  • Flurbiprofen
  • Fluvoxamine
  • Frovatriptan
  • Granisetron
  • Hydroxytryptophan
  • Ibuprofen
  • Ibuprofen Lysine
  • Iloprost
  • Indecainide
  • Indomethacin
  • Iobenguane I 123
  • Ketoprofen
  • Ketorolac
  • Lamifiban
  • Levomilnacipran
  • Lexipafant
  • Lithium
  • Lorcainide
  • Lorcaserin
  • Lornoxicam
  • Loxoprofen
  • Lumiracoxib
  • Meclofenamate
  • Mefenamic Acid
  • Meloxicam
  • Meperidine
  • Methadone
  • Milnacipran
  • Mirtazapine
  • Morniflumate
  • Nabumetone
  • Naproxen
  • Naratriptan
  • Nepafenac
  • Niflumic Acid
  • Nimesulide
  • Oxaprozin
  • Oxyphenbutazone
  • Palonosetron
  • Parecoxib
  • Paroxetine
  • Phenylbutazone
  • Piketoprofen
  • Piroxicam
  • Pixantrone
  • Proglumetacin
  • Propafenone
  • Propionic Acid
  • Propyphenazone
  • Proquazone
  • Recainam
  • Rizatriptan
  • Rofecoxib
  • Salicylic Acid
  • Salsalate
  • Sertraline
  • Sibrafiban
  • Sodium Salicylate
  • St John's Wort
  • Sulfinpyrazone
  • Sulindac
  • Sulodexide
  • Sumatriptan
  • Tapentadol
  • Tenoxicam
  • Tiaprofenic Acid
  • Ticlopidine
  • Tirofiban
  • Tolfenamic Acid
  • Tolmetin
  • Tramadol
  • Trazodone
  • Tryptophan
  • Valdecoxib
  • Venlafaxine
  • Vilazodone
  • Vortioxetine
  • Xemilofiban
  • Ziprasidone
  • Zolmitriptan

Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Acenocoumarol
  • Phenprocoumon
  • Warfarin

Other Interactions

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following is usually not recommended, but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use this medicine, or give you special instructions about the use of food, alcohol, or tobacco.

  • Tobacco

Other Medical Problems

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

  • Alcohol abuse, history of or
  • Kidney disease, severe or
  • Liver disease (including cirrhosis)—Should generally not be used in patients with these conditions.
  • Bipolar disorder (mood disorder with mania and depression), or risk of or
  • Bleeding problems or
  • Diabetes or
  • Digestion problems or
  • Glaucoma (angle-closure type) or
  • Heart disease or
  • Hypertension (high blood pressure) or
  • Hyponatremia (low sodium in the blood) or
  • Mania, history of or
  • Seizures, history of or
  • Urinating problems (eg, urinary retention or trouble urinating)—Use with caution. May make these conditions worse.
  • Kidney disease—Use with caution. The effects may be increased because of slower removal of the medicine from the body.

Proper Use

Take this medicine only as directed by your doctor to benefit your condition as much as possible. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered.

This medicine comes with a Medication Guide. Read and follow the instructions carefully. Ask your doctor if you have any questions.

Swallow the delayed-release capsule whole with or without food. Do not chew, crush, 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.

Dosing

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For oral dosage form (delayed-release capsules):
    • For treatment of anxiety:
      • Adults—At first, 60 milligrams (mg) once a day. Some patients may start at 30 mg once a day for 1 week before increasing the dose to 60 mg once a day. Your doctor may increase your dose as needed. However, the dose is usually not more than 120 mg per day.
      • Elderly—At first, 30 mg once a day for 2 weeks before increasing the dose to 60 mg once a day. Your doctor may increase your dose as needed. However, the dose is usually not more than 120 mg per day.
      • Children 7 years of age and older—At first, 30 mg once a day for 2 weeks before increasing the dose to 60 mg once a day. Your doctor may increase your dose as needed. However, the dose is usually not more than 120 mg per day.
      • Children younger than 7 years of age—Use and dose must be determined by your doctor.
    • For treatment of chronic muscle pain:
      • Adults—60 milligrams (mg) once a day. Some patients may start at 30 mg once a day for 1 week before increasing the dose to 60 mg once a day.
      • Children—Use and dose must be determined by your doctor.
    • For treatment of depression:
      • Adults—40 milligrams (mg) per day (given as 20 mg two times per day) to 60 mg per day (given either once a day or as 30 mg two times per day). Your doctor may increase your dose as needed. However, the dose is usually not more than 120 mg per day.
      • Children—Use and dose must be determined by your doctor.
    • For treatment of diabetic peripheral neuropathy:
      • Adults—60 milligrams (mg) once a day.
      • Children—Use and dose must be determined by your doctor.
    • For treatment of fibromyalgia:
      • Adults—60 milligrams (mg) once a day. Some patients may start at 30 mg once a day for 1 week before increasing the dose to 60 mg once a day.
      • Children—Use and dose must be determined by your doctor.

Missed Dose

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Precautions

It is important that your doctor check your progress at regular visits to allow for changes in your dose and to help prevent any unwanted effects.

Do not take duloxetine if you have taken an monoamine oxidase (MAO) inhibitor (eg, isocarboxazid [Marplan®], linezolid [Zyvox®], methylene blue injection, phenelzine [Nardil®], selegiline [Eldepryl®], or tranylcypromine [Parnate®]) in the past 2 weeks. Do not start taking an MAO inhibitor within 5 days of stopping duloxetine. If you do, you may develop confusion, agitation, restlessness, stomach or intestinal symptoms, sudden high body temperature, extremely high blood pressure, or severe convulsions.

Duloxetine may cause some teenagers and young adults to be agitated, irritable, or display other abnormal behaviors. It may also cause some people to have suicidal thoughts and tendencies or to become more depressed. Some people may have trouble sleeping, get upset easily, have a big increase in energy, or start to act reckless. If you or your caregiver notice any of these unwanted effects, tell your doctor right away. Let the doctor know if you or anyone in your family has bipolar disorder (manic-depressive) or has tried to commit suicide.

This medicine can cause serious liver problems. If you experience symptoms such as dark urine, general tiredness and weakness, light-colored stools, nausea and vomiting, upper right stomach pain, or yellow eyes and skin, contact your doctor right away.

Make sure your doctor knows about all the other medicines you are using. Duloxetine may cause serious conditions called serotonin syndrome or neuroleptic malignant syndrome (NMS)-like reactions if taken with certain medicines such as buspirone (Buspar®), fentanyl (Abstral®, Duragesic®), lithium (Eskalith®, Lithobid®), tryptophan, St. John's wort, or some pain medicines (eg, tramadol [Ultram®], sumatriptan [Imitrex®], zolmitriptan [Zomig®], or rizatriptan [Maxalt®]). Check with your doctor first before taking any other medicines.

This medicine may increase your risk for bleeding problems. Make sure your doctor knows if you are also taking other medicines that thin the blood, such as aspirin, NSAID pain medicines (eg, ibuprofen, naproxen, Advil®, Aleve®, Celebrex®, or Motrin®) or warfarin (Coumadin®).

Serious skin reactions can occur during treatment with this medicine. 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.

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 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.

Duloxetine may cause some people to become dizzy or have blurred vision. Make sure you know how you react to this medicine before you drive, use machines, or do anything else that could be dangerous if you are not alert or able to see clearly. 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.

You will need to measure your blood pressure 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.

Hyponatremia (low sodium in the blood) may occur with this medicine. Check with your doctor right away if you have confusion, difficulty concentrating, headaches, memory problems, weakness, and unsteadiness.

Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

Incidence not known

  1. Abdominal or stomach pain
  2. area rash
  3. blindness
  4. blistering, peeling, or loosening of the skin
  5. blurred vision
  6. change in consciousness
  7. chills
  8. clay-colored stools
  9. cold sweats
  10. confusion
  11. convulsions
  12. dark urine
  13. decreased urine output
  14. decreased vision
  15. difficulty swallowing
  16. dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
  17. eye pain
  18. fainting
  19. fast or irregular heartbeat
  20. general tiredness or weakness
  21. hives or welts, itching, or skin rash
  22. hives, itching, puffiness, or swelling of the eyelids or around the eyes, face, lips, or tongue
  23. increased thirst
  24. joint or muscle pain
  25. large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
  26. light-colored stools
  27. loss of consciousness
  28. red skin lesions, often with a purple center
  29. red, irritated eyes
  30. redness of the skin
  31. sores, ulcers, or white spots in the mouth or on the lips
  32. swelling of the face, ankles, or hands
  33. tearing
  34. tightness in the chest
  35. unpleasant breath odor
  36. upper right stomach pain
  37. vomiting of blood
  38. yellow eyes and skin

Get emergency help immediately if any of the following symptoms of overdose occur:

Symptoms of overdose

  1. Agitation
  2. diarrhea
  3. fever
  4. loss of bladder control
  5. muscle spasm or jerking of all extremities
  6. overactive reflexes
  7. poor coordination
  8. restlessness
  9. shivering
  10. sleepiness or unusual drowsiness
  11. sudden loss of consciousness
  12. sweating
  13. talking or acting with excitement you cannot control
  14. trembling or shaking
  15. twitching
  16. unusual tiredness or weakness
  17. vomiting

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

  1. Body aches or pain
  2. cough
  3. difficulty having a bowel movement (stool)
  4. dry mouth
  5. ear congestion
  6. frequent urination
  7. headache
  8. lack or loss of strength
  9. loss of appetite
  10. loss of voice
  11. muscle aches
  12. nausea
  13. sleepiness or unusual drowsiness
  14. sneezing
  15. sore throat
  16. stuffy or runny nose
  17. sweating increased
  18. trouble sleeping
  19. weight loss

Less common

  1. Abnormal orgasm
  2. acid or sour stomach
  3. belching
  4. burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
  5. change in taste
  6. change or problem with discharge of semen
  7. decreased interest in sexual intercourse
  8. difficulty with moving
  9. feeling of warmth or redness of the face, neck, arms, and occasionally, upper chest
  10. heartburn
  11. inability to have or keep an erection
  12. indigestion
  13. joint pain
  14. longer than usual time to ejaculation of semen
  15. loose stools
  16. loss in sexual ability, desire, drive, or performance
  17. loss of taste
  18. muscle aching or cramping
  19. muscle pains or stiffness
  20. shakiness in the legs, arms, hands, or feet
  21. stomach discomfort or upset
  22. sudden sweating
  23. swollen joints
  24. trembling or shaking of the hands or feet

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

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