Duloxetine (Cymbalta, Yentreve, Xeristar, Arclaim)

Duloxetine is a new type of antidepressant that has been on the market since 2004. It has been heavily marketed and is one of the most commercially successful medications in the world.

The Bottom Line: What You Really Need to Know


Duloxetine is primarily used to treat depression. The FDA has also approved it for the treatment of Generalized Anxiety Disorder (GAD) and Diabetic Peripheral Neuropathy (DPN).

In some countries duloxetine is approved for the treatment of stress incontinence. The owner, Eli Lilly, was seeking approval for treating stress incontinence, but has withdrawn the application. During the clinical trials, a small number of women had suicidal thoughts or attempted suicide.

Duloxetine is used to treat fibromyalgia. Clinical trials are being conducted to see if it helps fibromyalgia and chronic fatigue syndrome.

Dosage and instructions

The usual dose of duloxetine is 60 mg/day. When taken for depression, it is sometimes divided into two 30 mg doses; otherwise duloxetine is taken once a day in a single dose.

Sometimes duloxetine is started at a low dose and increased as tolerated. This is especially true in people with diabetic peripheral neuropathy, who may also have kidney disease.

Duloxetine comes in a capsule and it should be swallowed whole. Don't crush or chew it, and don't take the capsule apart and mix the medication with food or liquids.

How duloxetine works

Duloxetine is a new type of antidepressant called Selective Serotonin-Norepinephrine Reuptake Inhibitors (SSNRI). It prevents the reabsorption of both norepinephrine and serotonin at nerve endings. Researchers believe that the dual action on both neurotransmitters helps with both depression and the perception of pain.

Side effects

Most people experience some side effects when they begin taking duloxetine. The side effects usually go away after a few weeks. If they persist, you may need a lower dose of medicine or it may need to be stopped altogether.

The most common side effects are:

Other side effects that can occur include:


MAOI antidepressants: Duloxetine can have a very serious interaction with monamine oxidase inhibiting antidepressants that can include very high fevers, convulsions and death. You should not take duloxetine for at least two weeks after you stop taking MAOIs. At least five days should elapse after you stop taking duloxetine before you take an MAOI.

Serotonergic medications: Serotinergic medications can interact with duloxetine in a toxic way and produce serotonin syndrome. Early symptoms of serotonin syndrome may be limited to nervousness, agitation, tremor and sweating. It can progress to high fever, seizures, muscle rigidity, coma, cardiovascular collapse, multiple organ failure and death. Serotonergic medications that should be avoided while you are taking duloxetine include:

Other medications that interfere or interact with duloxetine are:


The manufacturer suggests withdrawing gradually from duloxetine to avoid experiencing symptoms like dizziness, nausea or headache. There are many individual reports of severe withdrawal symptoms with duloxetine that last for weeks even when the drug is tapered. Symptoms that have been reported with duloxetine withdrawal include

Be sure to discuss any symptoms you experience during withdrawal with your doctor.

Warnings, precautions and contraindications

Suicide risk: All antidepressants can increase the risk of suicide, especially when you first start taking them. People should be closely monitored during the first weeks or months of therapy with a new medication. Any unusual thoughts or behaviors or changes in mood should be reported immediately to the physician.

Other antidepressants: Duloxetine should not be taken with other antidepressants because of the potential for serious intractions.

Liver disease: Duloxetine should not be taken if you have liver problems. Your doctor may want to draw blood to check your liver function every so often. There have been reports of liver damage in people who were taking duloxetine.

Kidney disease: Duloxetine should be used with caution in people who have kidney disease.

Pregnancy and lactation: When duloxetine is taken during the 3rd trimester of pregnancy there is a six-fold increase in the chance that the baby will have problems after birth, especially Persistent Pulmonary Hypertension of the Neonate (PPHN).

Some SSRI antidepressants are thought to increase the chance of having congenital heart defects when taken during the first trimester of pregnancy. Duloxetine and other antidepressants should be used with extreme caution, if at all, during pregnancy.

You should not breast feed while taking duloxetine.

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