Cymbalta Side Effects

Cymbalta Side Effects

Cymbalta (Duloxetine) is an antidepressant drug. It is a serotonin-norepinephrine reuptake inhibitor.

How Cymbalta acts

Serotonin and norepinephrine are neurotransmitters (molecules that are responsible for transmission of nerve signals in intercellular contacts). It is believed that during depression, the release of serotonin and norepinephrine is markedly reduced. Cymbalta prevents the reabsorption of neurotransmitters after the transmission of nerve impulses to the cell membrane, and thus relieves depression symptoms.

Medical uses of Cymbalta

  • Depressive disorders
  • Generalized anxiety disorders
  • Pain from diabetic neuropathy
  • Fibromyalgia
  • Chronic muscle pains (for example, osteoarthritis, persistent lower back pain)

Side effects

Most common side effects of Cymbalta

  • Sleepiness or insomnia
  • Dizziness
  • Anxiety and restlessness (especially in the early weeks of treatment)
  • Nausea
  • Orthostatic hypotension
  • Headache
  • Dry mouth
  • Constipation
  • Weakness

Cymbalta can also cause other side effects such as:

  • Loss of appetite
  • Weight loss
  • Tremor
  • Vision impairment
  • Vomiting
  • Diarrhea
  • Heartbeat
  • Rash
  • Increased blood pressure (the BP needs careful monitoring during concomitant arterial hypertension, especially in the first month of treatment)
  • Excessive sweating
  • Paresthesia (sensation of heat in the head and neck, a sensation of tingling)
  • Mydriasis (so cymbalta should be prescribed with caution to patients suffering from glaucoma)
  • Hyperglycemia (especially in patients with diabetes)
  • Urinary incontinence
  • Thirst
  • Disorders of taste perception
  • Epistaxis (nosebleed)
  • Attention disorder
  • Hyponatremia (especially pronounced for dehydrated patients and patients taking diuretics)
  • Sleep disorders
  • Shortness of breath
  • Increased bleeding
  • Photosensitivity
  • Arrhythmias
  • Convulsions
  • Moodiness and aggressiveness
  • Hallucinations

Rare side effects

  • Hyperglycemia (especially in patients with diabetes)
  • Urinary incontinence
  • Thirst
  • Disorders of taste perception
  • Epistaxis (nosebleed)
  • Attention disorder
  • Hyponatremia (especially pronounced for dehydrated patients and patients taking diuretics)
  • Sleep disorders
  • Shortness of breath
  • Increased bleeding
  • Photosensitivity
  • Arrhythmias
  • Convulsions
  • Moodiness and aggressiveness
  • Hallucinations

 Serious side effects

Any of the above side effects both the frequent and the rare ones may have negative health consequences. However, the following serious side effects have special risk:

  • Shivering and fever
  • Respiratory impairment
  • Laryngospasm
  • Swelling of the face, tongue and larynx
  • Irregular cardiac activity and heart rate
  • Rash
  • Nettle rash
  • Severe headache
  • Blurring of visual fields
  • Low or high blood pressure
  • Vomiting of blood
  • Impairment of consciousness, coma
  • Severe bleeding

Laboratory changes

There may be increased CPK, ALT, AST, alkaline phosphatase, hyponatremia, hyperkalemia.

Withdrawal syndrome

Sudden discontinuation of the drug may lead to weakness, nausea, headache, dizziness, insomnia, sensation of tingling, hyperexcitability, diarrhea, and tremor. Patients with diabetes may experience a slight increase in the level of fasting glucose. Despite the fact that in some patients, withdrawal syndrome may occur even in the case where the intake of cymbalta was accidentally omitted, this phenomenon is generally temporary and cannot be compared with the withdrawal syndrome that occur after psychological dependency. To avoid withdrawal syndrome, the dose of the drug should be reduced gradually over a period of at least two weeks.

Side effects in children

Cymbalta is not recommended for use by children and adolescents under 18 years of age, as there is insufficient clinical data on its effect in children and adolescents. However, available medical information shows that cymbalta significantly reduces suicide attempts, suicidal thoughts and gloominess in adolescents. Where it is necessary for a child to take the drug, it is important to agree with that child and his parents on the careful control of all the negative feelings, negative thoughts, aggressive behavior, and mood changes of the child and immediately report all changes to the doctor.

Side effects in women

Decreased libido, inability to achieve orgasm.

Side effects in men

Decreased sex drive, inability to achieve orgasm, ejaculation disorder, erectile dysfunction.

Side effects in pregnant women

Because there is insufficient clinical data on the trial of cymbalta in this category of patients, it is necessary to carefully weigh the indications for use of Cymbalta and assess the benefits to the mother and the potential risk to the fetus. There is a likelihood of the fetus having all of the side effects listed above and other unknown side effects. There may be a withdrawal syndrome. The same situation obtains with breastfeeding. It is known that the drug passes into breast milk, but there is not enough medical information on the effect of the drug on the child.

Side effects in the elderly

These patients most often experience hyponatremia, which is manifested in the form of such symptoms as drowsiness, confusion, and muscle twitching.

Overdose of Cymbalta

  • Loss of appetite
  • Vomiting
  • Clonic convulsions
  • Tremor
  • Impairment of consciousness
  • Cymbalta can slow down the rate of reaction, and this should be taken into account when driving a car or working with an equipment that requires careful attention.
  • After starting to take Cymbalta, its effect appears only after 2-4 weeks, so you should not expect instant improvement.
  • Taking Cymbalta for the first time with a higher frequency causes dizziness and orthostatic hypotension. Therefore, if you are just starting treatment, you should avoid sharply raising the horizontal position of the body to vertical.
  • When taking the drug at the same time with MAO inhibitors, which is contraindicated, very serious complications may arise. This is manifested in the form of hyperthermic syndrome, myoclonic convulsions, muscle rigidity, severe mental disorders. Cymbalta should be taken no earlier than 2 weeks after discontinuation of monoamine oxidase inhibitors, and the latter can be taken only 5 days after discontinuation of Cymbalta.
  • Cymbalta should be taken with caution by patients with impaired renal function, persons with a history of epilepsy, people with manic-depressive disorders and those with a history of suicide attempts.
  • Do not combine cymbalta with selective serotonin reuptake inhibitors (for example, fluvoxamine), else there may be serotonin syndrome.
  • Cymbalta is not used with fluoroquinolone antibiotics such as ciprofloxacin or enoxacin.
  • Patients suffering from sucrase-isomaltase deficiency should not take Cymbalta because the drug contains sucrose.

Warnings and recommendations

  • Cymbalta can slow down the rate of reaction, and this should be taken into account when driving a car or working with an equipment that requires careful attention.
  • After starting to take Cymbalta, its effect appears only after 2-4 weeks, so you should not expect instant improvement.
  • Taking Cymbalta for the first time with a higher frequency causes dizziness and orthostatic hypotension. Therefore, if you are just starting treatment, you should avoid sharply raising the horizontal position of the body to vertical.
  • When taking the drug at the same time with MAO inhibitors, which is contraindicated, very serious complications may arise. This is manifested in the form of hyperthermic syndrome, myoclonic convulsions, muscle rigidity, severe mental disorders. Cymbalta should be taken no earlier than 2 weeks after discontinuation of monoamine oxidase inhibitors, and the latter can be taken only 5 days after discontinuation of Cymbalta.
  • Cymbalta should be taken with caution by patients with impaired renal function, persons with a history of epilepsy, people with manic-depressive disorders and those with a history of suicide attempts.
  • Do not combine cymbalta with selective serotonin reuptake inhibitors (for example, fluvoxamine), else there may be serotonin syndrome.
  • Cymbalta is not used with fluoroquinolone antibiotics such as ciprofloxacin or enoxacin.
  • Patients suffering from sucrase-isomaltase deficiency should not take Cymbalta because the drug contains sucrose.

 Cymbalta and alcohol

It is not recommended to use cymbalta with alcohol, as these substances potentiate each other’s action on the central nervous system, as a result of which the CNS depression symptoms may increase, and motor response reduce.