Cymbalta (duloxetine) is a prescription drug used to treat several conditions, including depression and anxiety. This drug can interact with other medications, certain supplements, and alcohol. This includes bupropion (Wellbutrin) and the herb St. John’s wort.
Cymbalta is used to treat:
- major depressive disorder in adults
- generalized anxiety disorder in adults and children ages 7 years and older
- diabetic nerve pain in adults
- fibromyalgia in adults and in children ages 13 years and older
- chronic (long-term) musculoskeletal pain in adults
An interaction can occur because one substance causes another substance to have a different effect than expected. Interactions can also occur if you have certain health conditions.
Keep reading to learn about Cymbalta’s possible interactions. And for more information about Cymbalta, including details about its uses, see this article.
Certain health conditions or other factors could raise your risk of harm if you take Cymbalta. In that case, your doctor may not prescribe Cymbalta for you. This is known as a contraindication. The list below includes contraindications of Cymbalta.
If you take or have recently taken a monoamine oxidase inhibitor drug. Using Cymbalta with a type of antidepressant called a monoamine oxidase inhibitor (MAOI) raises your risk of serotonin syndrome. This is a serious side effect of Cymbalta that’s caused by too much serotonin building up in your body. Symptoms include agitation, fever, muscle twitches, and fast heart rate.
Examples of MAOIs that interact with Cymbalta include:
- selegiline (Emsam, Zelapar)
- phenelzine (Nardil)
- linezolid
- methylene blue (Provayblue)
Due to the risk of serotonin syndrome, doctors usually won’t prescribe Cymbalta with an MAOI. Your doctor will likely have you wait at least 2 weeks after you’ve stopped taking an MAOI before you begin taking Cymbalta. And they’ll usually have you wait at least 5 days after your last dose of Cymbalta before you start taking an MAOI. If you have questions, talk with your doctor.
If you’ve had an allergic reaction. If you have had an allergic reaction to Cymbalta or any of its ingredients, your doctor likely won’t prescribe Cymbalta. You can ask them about other treatments that may be better options for you.
Before you start taking Cymbalta, talk with your doctor if any of the factors above apply to you. Your doctor can determine whether Cymbalta is safe for you to take.
Cymbalta and alcohol could interact with each other and cause damage to your liver.
Since Cymbalta was approved, there have been rare reports of it causing liver damage. This includes fatal liver failure.
Drinking alcohol, especially large amounts of alcohol, can also cause liver damage, including liver failure. Due to this risk, you should not take Cymbalta if you drink excessive amounts of alcohol.
If you drink alcohol, it’s important to let your doctor know before you start taking Cymbalta. Your doctor can help determine whether Cymbalta is safe for you to take.
Before you start taking Cymbalta, tell your doctor and pharmacist about any prescription, over-the-counter, or other drugs you take. Sharing this information with them may help prevent possible interactions. (To learn whether Cymbalta interacts with supplements, herbs, and vitamins, see the “Are there other interactions with Cymbalta?” section below.)
If you have questions about drug interactions that may affect you, talk with your doctor or pharmacist.
The chart below lists drugs that may interact with Cymbalta. Keep in mind that this chart does not include all drugs that may interact with Cymbalta. For more information about some of these interactions, see the “Drug interactions explained” section below. And for details about Cymbalta’s side effects, refer to this article.
| Drug class or drug name | Drug examples | What can happen |
| nonsteroidal anti-inflammatory drugs (NSAIDs) | • aspirin • ibuprofen (Advil) • naproxen (Aleve) | can increase the risk of side effects from NSAIDs and Cymbalta |
| tramadol (Ultram) | — | • can raise the risk of side effects from Cymbalta and tramadol • can make tramadol less effective |
| trazodone | — | can raise the risk of side effects from Cymbalta and trazodone |
| aripiprazole (Abilify) | — | can increase the risk of side effects from aripiprazole |
| zolpidem (Ambien) | — | can raise the risk of side effects from zolpidem |
| certain drugs for mental health conditions | • other serotonin and norepinephrine reuptake inhibitors (SNRIs), such as venlafaxine extended-release (Effexor XR) • selective serotonin reuptake inhibitors such as sertraline (Zoloft) • lithium (Lithobid) •buspirone • tricyclic antidepressants, such as amitriptyline | can increase the risk of side effects from Cymbalta and these mental health medications |
| amphetamines | • amphetamine/dextroamphetamine (Adderall) | can increase the risk of side effects from Cymbalta and amphetamines |
| anticoagulants (blood thinners) | • warfarin (Jantoven) • rivaroxaban (Xarelto) • apixaban (Eliquis) | can increase the risk of side effects of Cymbalta and anticoagulants |
| certain drugs that affect how your body metabolizes (breaks down) Cymbalta | • ciprofloxacin (Cipro) • disulfiram • amiodarone (Pacerone) • bupropion (Wellbutrin) • mirabegron (Myrbetriq) | can increase the risk of side effects of Cymbalta and these other drugs |
Learn more about certain drug interactions that can occur with Cymbalta.
Interaction with certain drugs used for mental health conditions
Cymbalta can interact with certain drugs used to treat mental health conditions. The table below describes some examples of the mental health medications that may interact with Cymbalta.
These drugs have different uses, including treating depression, bipolar disorder, anxiety, and more. To learn more about the uses of drugs in this list or about other drugs that may interact with Cymbalta, talk with your doctor.
| What could happen | Examples of mental health medications that can interact with Cymbalta |
| can cause serotonin syndrome | • other serotonin and norepinephrine reuptake inhibitors (SNRIs), such as venlafaxine extended-release (Effexor XR) • selective serotonin reuptake inhibitors (SSRIs), such as sertraline (Zoloft) • lithium (Lithobid) •buspirone • tricyclic antidepressants, such as amitriptyline |
What you can do
If you and your doctor agree that you’ll take one of these medications with Cymbalta, your doctor will monitor you closely for symptoms of serotonin syndrome. This risk is highest when you begin taking Cymbalta or any time the dose of either medication is increased.
Interaction with nonsteroidal anti-inflammatory drugs
Cymbalta may interact with nonsteroidal anti-inflammatory drugs (NSAIDs), as described in the table below.
| What could happen | Examples of NSAIDs |
| Can increase your risk of bleeding, including hemorrhage | • aspirin • ibuprofen (Advil) • naproxen (Aleve) |
What you can do
If you take Cymbalta with an NSAID, watch for excessive or unusual bleeding. Call your doctor right away if this happens.
Interaction with amphetamines
Cymbalta may interact with amphetamine medications, such as those used to treat attention deficit hyperactivity disorder (ADHD) or narcolepsy.
| What could happen | Examples of amphetamine medications |
| Can cause serotonin syndrome | • amphetamine/ dextroamphetamine (Adderall) • dextroamphetamine (Dexedrine, Xelstrym) • methamphetamine (Desoxyn) |
What you can do
If you and your doctor agree that you’ll take an amphetamine with Cymbalta, your doctor will monitor you closely for symptoms of serotonin syndrome. This risk is highest when you begin taking Cymbalta or any time the dose of either medication is increased.
Cymbalta may have other interactions. They could occur with foods, supplements, vaccines, or even lab tests. See below for details. Note that the information below does not include all other possible interactions with Cymbalta.
Does Cymbalta interact with food?
There are currently no reports of Cymbalta interacting with food. If you have questions about eating certain foods during your treatment with Cymbalta, talk with your doctor.
Does Cymbalta interact with supplements?
Before you start taking Cymbalta, talk with your doctor and pharmacist about any supplements, herbs, and vitamins you take. Sharing this information with them may help you avoid possible interactions.
If you have questions about interactions that may affect you, talk with your doctor or pharmacist.
Cymbalta interactions with herbs
The herbal supplement St. John’s wort can interact with Cymbalta. Taking this supplement with Cymbalta may raise your risk of serotonin syndrome, which is a serious side effect. This risk is highest when you first begin taking Cymbalta or any time your doctor increases your dose.*
If you use St. John’s wort, let your doctor know before you start taking Cymbalta. They may have you stop taking St. John’s wort. If you and your doctor agree that you’ll use St. John’s wort with Cymbalta, your doctor will monitor you closely for symptoms of serotonin syndrome. Symptoms include agitation, fever, muscle twitches, and fast heart rate.
If you develop serotonin syndrome, your doctor will likely have you stop taking Cymbalta and St. John’s wort. They’ll also recommend a treatment for your symptoms. In some cases, you may need treatment in the hospital.
* For details about Cymbalta’s dosage, refer to this article.
Cymbalta interactions with vitamins
There are currently no reports of Cymbalta interacting with vitamins. But this does not mean that vitamin interactions won’t be recognized in the future.
For this reason, it’s still important to check with your doctor or pharmacist before taking any of these products while taking Cymbalta.
Does Cymbalta interact with vaccines?
No. Cymbalta hasn’t been reported to interact with any vaccines. If you have questions about getting vaccines during your Cymbalta treatment, talk with your doctor.
Does Cymbalta interact with lab tests?
No, Cymbalta is not known to interact with any lab tests. If you have questions about getting certain lab tests done during your Cymbalta treatment, talk with your doctor.
Does Cymbalta interact with cannabis or CBD?Cannabis (commonly called marijuana) and cannabis products, such as cannabidiol (CBD), have been specifically reported to interact with Cymbalta. CBD, a component of cannabis, may affect levels of Cymbalta in your body. This could raise your risk of side effects from Cymbalta or cause Cymbalta to be less effective.
Before you start treatment with Cymbalta, tell your doctor and pharmacist if you use cannabis. By sharing this information with them, you may help prevent possible interactions.
Note: Cannabis is illegal at a federal level but is legal in many states to varying degrees.
Certain medical conditions or other health factors may raise the risk of interactions with Cymbalta. Before taking Cymbalta, talk with your doctor about your health history. They’ll determine whether Cymbalta is right for you.
Health conditions or other factors that might interact with Cymbalta include:
- Heart problems, such as high blood pressure. Cymbalta may cause high blood pressure. If you already have high blood pressure or other heart problems, taking Cymbalta could make your condition worse. Talk with your doctor about whether it’s safe for you to take Cymbalta.
- Diabetes. Cymbalta may increase blood sugar levels in some people. If you have diabetes, this can make it harder to manage your blood sugar. If you have diabetes and take Cymbalta, talk with your doctor about how to manage your blood sugar levels.
- Severe kidney problems. Your kidneys are responsible for clearing Cymbalta from your body. Cymbalta levels may build up in your body if you have severe kidney problems, such as severe chronic kidney disease. This can raise your risk of side effects from the drug. Due to this risk, doctors typically won’t prescribe Cymbalta if you have severe kidney problems. They can discuss possible other treatments for your condition with you instead.
- Liver problems. In rare cases, Cymbalta can cause liver damage. Due to this risk, doctors typically won’t prescribe Cymbalta if you have certain liver problems, such as chronic (long-term) liver disease or cirrhosis. Talk with your doctor about other possible treatments for your condition that may be safer for you.
- Narrow eye angles. If you have eye angles that are more narrow than usual, Cymbalta may cause closed-angle glaucoma. If left untreated, closed-angle glaucoma can lead to blindness. Your doctor may have you get an eye exam before prescribing Cymbalta for you.
- Seizures. Cymbalta may cause seizures. The drug hasn’t been studied in people with seizure disorders such as epilepsy. If you’ve had seizures, tell your doctor before taking Cymbalta. Your doctor can determine whether the medication is safe for you.
- Bleeding problems. Cymbalta can raise your risk for bleeding. If you already have a bleeding problem, such as hemophilia, Cymbalta may not be safe for you to take. Let your doctor know if you have a bleeding problem before you start taking Cymbalta. Your doctor can determine whether the drug is safe for you to take.
- Pregnancy. Cymbalta may cause harm if taken during pregnancy. Talk with your doctor before using Cymbalta if you’re pregnant or planning to become pregnant. You can also learn more about Cymbalta and pregnancy in this article.
- Breastfeeding. Cymbalta passes into breast milk and may cause mild side effects, such as drowsiness, in a breastfed child. If you’re breastfeeding or planning to breastfeed, talk with your doctor about the risks and benefits of taking Cymbalta.
- Allergic reaction. If you’ve had an allergic reaction to Cymbalta or any of its ingredients, your doctor will likely not prescribe Cymbalta. You can ask them about other treatments that may be better choices for you.
Find answers to some frequently asked questions about Cymbalta and possible interactions.
Can Lyrica interact with Cymbalta?
No, Lyrica and Cymbalta haven’t been reported to interact.
Lyrica and Cymbalta are both approved to treat diabetic nerve pain in adults. They’re also both approved to treat fibromyalgia. Sometimes, these drugs may be prescribed together to treat these conditions.
If you have other questions about taking Lyrica and Cymbalta together, talk with your doctor.
Is it safe to take Xanax and Cymbalta together?
Yes, it should be. There haven’t been reports of interactions between alprazolam (Xanax) and Cymbalta.
Sometimes, doctors prescribe Cymbalta and Xanax together. Xanax is approved to manage anxiety disorders, including generalized anxiety disorder (GAD). Cymbalta is also prescribed to treat GAD.
Usually, you will take Cymbalta every day. You might take Xanax every day or as needed.
If you have other questions about taking Cymbalta with Xanax, talk with your doctor or pharmacist.
Can Topamax interact with Cymbalta?
No, Topamax (topiramate) isn’t known to interact with Cymbalta. There haven’t been reports of an interaction between these medications.
Cymbalta can interact with phentermine/topiramate (Qsymia). This drug contains topiramate, which is also the active ingredient in Topamax. (The active ingredient is what makes a drug work.) But topiramate isn’t known to interact with Cymbalta.
If you have other questions about using Topamax with Cymbalta, talk with your doctor or pharmacist.
You can take certain steps to help you avoid interactions with Cymbalta. Before starting treatment, talk with your doctor and pharmacist. Things to discuss with them include:
- Whether you drink alcohol or use cannabis.
- Other medications you take, as well as any vitamins, supplements, and herbs. Your doctor or pharmacist can help you fill out a
medication list. - What to do if you start taking a new drug during your Cymbalta treatment.
It’s also important to read Cymbalta’s
Taking Cymbalta exactly as prescribed can also help prevent interactions.
If you still have questions about Cymbalta and its possible interactions, talk with your doctor.
Questions you may want to ask your doctor include:
- Will my dosage of Cymbalta affect my risk for interactions?
- Do other drugs that could treat my condition have similar interactions as Cymbalta?
- Could I still take Cymbalta even if it interacts with a health condition I have?
You should also let your doctor know if you start taking a new medication or supplement while using Cymbalta.
To learn more about Cymbalta, see these articles:
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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 another 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.