Generic Name: duloxetine, Oral capsule

Cymbalta

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  • Cymbalta
SECTION 1 of 4

Highlights for duloxetine

Oral capsule
1

Duloxetine is an oral medication used to treat anxiety, depression, diabetes nerve pain, fibromyalgia, and chronic muscle and joint pain.

2

Stopping duloxetine too quickly or changing from another antidepressant too quickly may result in serious symptoms. Don’t stop duloxetine without talking to your healthcare provider.

3 4

Common side effects include nausea, dry mouth, sleepiness, fatigue, and constipation.

IMPORTANT INFORMATION

FDA Warning

This drug has a Black Box Warning. This is the most serious warning from the Food and Drug Administration (FDA). A black box warning alerts doctors and patients to potentially dangerous effects.

Thoughts of suicide. Duloxetine may increase the risk of suicidal thoughts and behaviors in people aged 24 years and younger. This drug can make depression worse in the early stages of treatment. Tell your doctor right away if your depression gets worse or if you have thoughts about suicide.

May cause drowsiness

Duloxetine can cause sleepiness or affect your ability to make decisions, think clearly, or react quickly. You shouldn’t drive, operate heavy machinery, or do other dangerous activities until you know how the drug affects you.

May cause serotonin syndrome

Duloxetine affects a chemical in your brain called serotonin. Taking duloxetine with other medications that affect serotonin may result in increased risk of a serious side effect called serotonin syndrome. Symptoms may include:

  • agitation
  • confusion
  • increased blood pressure or heart rate
  • sweating
  • loss of coordination

Dizziness and falling warning

Duloxetine can cause a sudden drop in blood pressure if you stand up too fast. This can cause dizziness and increase your risk of falling.

Drug Features

Duloxetine is a prescription medication. It’s available as an oral delayed-release capsule. It’s also available in a generic version. Generic drugs usually cost less. In some cases they may not be available in every strength or form as the brand. Talk to your healthcare provider to see if the generic will work for you.

Why It's Used

Duloxetine is used to treat:

  • generalized anxiety disorder
  • major depressive disorder
  • nerve pain caused by diabetes
  • fibromyalgia pain
  • chronic muscle and joint pain

How It Works

Duloxetine works by balancing chemicals in your brain that cause depression and anxiety. By balancing these chemicals, duloxetine also helps inhibit pain signals from your nerves to your brain.

Duloxetine belongs to a class of drugs called serotonin and norepinephrine reuptake inhibitors.

SECTION 2 of 4

duloxetine Side Effects

Oral capsule

Most Common Side Effects

The most common side effects of duloxetine include:

  • in adults:

    • nausea
    • dry mouth
    • sleepiness
    • fatigue
    • constipation
    • loss of appetite
    • increased sweating
    • dizziness
  • in children:

    • nausea
    • decreased weight
    • dizziness
    • diarrhea
    • stomach pain

Serious Side Effects

If you experience any of these serious side effects, call your doctor right away. If your symptoms are potentially life threatening, or if you think you’re experiencing a medical emergency, call 9-1-1.

  • liver damage. Symptoms may include:

    • itching
    • right upper abdominal pain
    • dark urine
    • yellowing of your skin or whites of your eyes
  • changes in blood pressure. Symptoms may include:

    • dizziness or fainting when standing. This may occur more often when you first start duloxetine or when you increase the dose.
  • serotonin syndrome. Symptoms may include:

    • agitation
    • hallucinations
    • coma
    • coordination problems or muscle twitching
    • racing heart
    • high or low blood pressure
    • sweating or fever
    • nausea, vomiting, or diarrhea
    • muscle rigidity
    • dizziness
    • flushing
    • tremor
    • seizures
  • abnormal bleeding. Duloxetine may increase your risk of bleeding or bruising, especially if you take warfarin or nonsteroidal anti-inflammatory drugs. 

  • severe skin reactions. Symptoms may include:

    • skin blisters
    • peeling rash
    • sores in your mouth
    • hives 
  • manic episodes in people with depression or bipolar disorder. Symptoms may include:

    • greatly increased energy
    • severe trouble sleeping
    • racing thoughts
    • reckless behavior
    • unusually grand ideas
    • excessive happiness or irritability
    • talking more or faster than usual
  • vision problems. Symptoms may include:

    • eye pain
    • changes in vision
    • swelling or redness in or around your eye
  • seizures or convulsions
  • low salt (sodium) levels in your blood. Symptoms may include:

    • headache
    • weakness or feeling unsteady
    • confusion, problems concentrating, or thinking or memory problems
  • problems with urination. Symptoms may include:

    • decrease in your urine flow
    • trouble passing urine
Pharmacist's Advice
Healthline Pharmacist Editorial Team

Duloxetine can cause sleepiness or may affect your ability to make decisions, think clearly, or react quickly. You shouldn’t drive, operate heavy machinery, or do other dangerous activities until you know how it affects you.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare provider who knows your medical history.
SECTION 3 of 4

duloxetine May Interact with Other Medications

Oral capsule

Duloxetine can interact with other medications, herbs, or vitamins you might be taking. That’s why your doctor should manage all of your medications carefully. If you’re curious about how this drug might interact with something else you’re taking, talk to your doctor or pharmacist.

Note: You can reduce your chances of drug interactions by having all of your prescriptions filled at the same pharmacy. That way, a pharmacist can check for possible drug interactions.

Alcohol Interaction

Drinking heavily while taking this drug increases your risk of severe liver injury. Talk to your doctor about how much alcohol you drink before starting duloxetine.

Medications That Might Interact with This Drug

Drugs that affect serotonin

Duloxetine affects a chemical in your brain called serotonin. Taking duloxetine with other medications that affect serotonin may result in increased risk of a serious side effect called serotonin syndrome. 

Examples are: 

  • linezolid
  • venlafaxine
  • St John’s wort
  • sumatriptan
  • fluvoxamine
  • metoclopramide

Schizophrenia drug
  • thioridazine

Taking both duloxetine and thioridazine can increase the amount of thioridazine in your body. This may increase your risk of an abnormal heart rate, or arrhythmia.

Nonsteroidal anti-inflammatory drugs

Taking both duloxetine and NSAIDs may increase your risk of abnormal bleeding.

Examples are:

  • ibuprofen
  • indomethacin
  • naproxen

Mental health drug
  • aripiprazole

Taking both duloxetine and aripiprazole may increase the amount of aripiprazole in your body. This can lead to unwanted side effects.

Iron toxicity drug
  • deferasirox

Taking both duloxetine and deferasirox may increase the amount of duloxetine in your body. This can lead to side effects.

Anticoagulants, blood thinners

These include:

  • apixaban
  • warfarin
  • clopidogrel
  • rivaroxaban
  • ticagrelor 

Taking both duloxetine and apixaban may increase your risk of abnormal bleeding.

Gaucher disease drug
  • eliglustat

Taking both duloxetine and eliglustat can increase the amount of eliglustat in your body. This may cause side effects on your heart.

Depression, and drug to stop smoking
  • bupropion

Taking both duloxetine and bupropion may increase your risk of seizures.

Cancer drug
  • doxorubicin

Taking both duloxetine and doxorubicin may increase the amount of doxorubicin in your body. This can lead to side effects.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking.

People with liver disease

Avoid taking duloxetine if you have a chronic liver disease or cirrhosis of the liver. You may have trouble clearing the drug from your body. This can lead to further liver damage.

People with kidney disease

Avoid taking duloxetine if you have severe kidney disease or if you receive dialysis. Your kidneys may have trouble removing the drug from your body. This could lead to a build up of the drug and increase your risk of side effects.

People with diabetes

Duloxetine may affect your blood sugar levels. If you have diabetes your doctor may want you to monitor your levels more closely and may need to change the dose of your diabetes medication.

People with bladder problems

Duloxetine may affect your ability to urinate. Consult your doctor if you have any problems with urine flow.

Pregnant women

Duloxetine is a category C pregnancy drug. That means two things: 

  1. Research in animals has shown adverse effects to the fetus when the mother takes the drug.
  2. There haven’t been enough studies done in humans to be certain how the drug might affect the fetus.

Speak with your doctor if you’re pregnant or plan to become pregnant. Duloxetine should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

Women who are nursing

Duloxetine may pass into breast milk. If you take duloxetine while you breastfeed, your baby may have side effects of the drug. Tell your doctor if you wish to breastfeed. You may need to decide whether to breastfeed or take duloxetine.

For Seniors

If you’re 65 years or older and you take duloxetine, you may be at a greater risk for falls due to blood pressure changes.

You may also be at greater risk for low sodium (salt) in your blood. Symptoms may include:

  • headache
  • weakness or feeling unsteady
  • confusion, problems concentrating, or thinking or memory problems

For Children

Duloxetine hasn’t been proved to be safe or effective in treating major depressive disorder in people younger than 18 years.

It hasn’t been proved to be safe or effective in treating generalized anxiety disorder in people younger than 7 years.

Allergies

Duloxetine can cause a severe allergic reaction. Symptoms may include:

  • trouble breathing
  • swelling of your throat or tongue
  • hives
SECTION 4 of 4

How to Take duloxetine (Dosage)

Oral capsule

All possible dosages and forms may not be included here. Your dose, form, and how often you take it will depend on:

  • your age
  • the condition being treated
  • how severe your condition is
  • other medical conditions you have
  • how you react to the first dose

What Are You Taking This Medication For?

Major depressive disorder
Form: Oral delayed-release capsule
Strengths: 20 mg, 40 mg, 60 mg
Adult Dosage (ages 18 years and older)
  • The starting dose may be 30–60 mg per day.
  • The usual dose is 40–60 mg per day.
  • The maximum dose is 120 mg per day.
Child Dosage (ages 0-17 years)

Dosage for people younger than 18 years hasn’t been established.

Generalized anxiety disorder
Form: Oral delayed-release capsule
Strengths: 20 mg, 40 mg, 60 mg
Adult Dosage (ages 18-64 years)
  • The starting dose may be 30–60 mg per day.
  • The usual dose is 60 mg per day.
  • The maximum dose is 120 mg per day.
Child Dosage (ages 7-17 years)
  • The starting dose is 30 mg per day.
  • The target dose is 30–60 mg per day.
  • The maximum dose is 120 mg per day.
Child Dosage (ages 0-6 years)

Dosage for people younger than 7 years hasn’t been established.

Senior Dosage (ages 65 years and older)
  • The starting dose may be 30 mg per day for 2 weeks.
  • The usual dose is 60 mg per day.

Nerve pain caused by diabetes
Form: Oral delayed-release capsule
Strengths: 20 mg, 40 mg, 60 mg
Adult Dosage (ages 18-64 years)
  • The starting dose is 60 mg per day.
  • The maximum dosage is 60 mg per day.
Child Dosage (ages 0-17 years)

Dosage for people younger than 18 years hasn’t been established.

Senior Dosage (ages 65 years and older)
  • The starting dose is 30 mg per day.
  • The target dose is 60 mg per day.
  • The maximum dose is 120 mg per day.

Fibromyalgia
Form: Oral delayed-release capsule
Strengths: 20 mg, 40 mg, 60 mg
Adult Dosage (ages 18 years and older)
  • The starting dose is 30 mg per day.
  • The target dose is 60 mg per day.
  • The maximum dosage is 60 mg per day.
Child Dosage (ages 0-17 years)

Dosage for people younger than 18 years hasn’t been established.

Chronic muscle and joint pain
Form: Oral delayed-release capsule
Strengths: 20 mg, 40 mg, 60 mg
Adult Dosage (ages 18 years and older)
  • The starting dose is 30 mg per day.
  • The target dose is 60 mg per day.
  • The maximum dosage is 60 mg per day.
Child Dosage (ages 0-17 years)

Dosage for people younger than 18 years hasn’t been established.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always to speak with your doctor or pharmacist about dosages that are right for you.
Pharmacist's Advice
Healthline Pharmacist Editorial Team

Duloxetine comes with risks if you don’t take it as prescribed by your doctor.

If You Don’t Take It at All

Your symptoms won’t get better and could get worse.

If You Stop Taking It Suddenly

Stopping duloxetine too quickly may result in serious side effects, including:

  • anxiety
  • irritability
  • feeling tired or problems sleeping
  • headache
  • sweating
  • dizziness
  • electric shock-like sensations
  • vomiting or nausea
  • diarrhea

What to Do If You Miss a Dose

If you miss a dose, take it as soon as you remember. However, if it’s just a few hours until your next dose, skip the missed dose and take your next dose on schedule.

Never try to catch up by taking two doses at once. This could result in toxic side effects.

How Can I Tell if the Drug is Working?

Your response to treatment will vary depending on the condition you’re treating.

This is a long-term medication.

Important Considerations for Taking Duloxetine

Store duloxetine at room temperature: 68–77°F (20-25°C)

Note: Keep your medications away from areas where they could get wet, such as bathrooms. Store them away from moisture and damp locations.

Travel

When traveling with your medication:

  • Always carry it with you or in your carry-on bag.
  • Don’t worry about airport X-ray machines. They can’t hurt your medication.
  • You may need to show your pharmacy’s preprinted label to identify the medication. Keep the original prescription-labeled box with you when traveling.

Clinical Monitoring

Your doctor may monitor you for worsening or new suicidal thoughts and behaviors.

Insurance

Many insurance companies will require a prior authorization before they approve the prescription and pay for duloxetine.

What does the pill look like?

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Are There Any Alternatives?

There are other drugs available to treat your condition. Some may be more suitable for you than others. Talk to your doctor about possible alternatives.


Show Sources

Content developed in collaboration with University of Illinois-Chicago, Drug Information Group

Medically reviewed by Creighton University, Center for Drug Information and Evidence-Based Practice on May 12, 2015

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Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

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