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Cymbalta (Duloxetine) Side Effects, Withdrawal and FAQs

Cymbalta Warning: Withdrawal from Cymbalta and similar drugs can be risky if done too fast, or without adequate guidance and support.
Consumers, physicians and caregivers are advised to choose taper methods informed by the many serious potential consequences of coming off an SNRI drug abruptly.

The concerns about Cymbalta cover a wide range of topics, which are covered in the FAQ’s below. These discuss the drug’s mechanics upon the brain and body, interactions with other substances that one should be aware of, side effects, pregnancy-specific data, and several other important health issues.

An SNRI type of antidepressant can often produce unexpected adverse effects, despite any failure on the part of the drug manufacturer to fully and clearly disclose these to the consumer.

Anyone considering taking such a drug is well advised to research the matter thoroughly so that the most optimally informed decision can be made.

If you are currently taking Cymbalta or a similar SNRI medication and are considering tapering off the drug, please remember the strong FDA warning against coming off too quickly, or all at once.

Please use the data here freely to assist you in the information gathering phase, which is essential to successful treatment planning.

What is Cymbalta (Duloxetine) Used For?

The SNRI antidepressant Cymbalta (duloxetine) is most widely used to treat depression, anxiety disorders, and certain types of pain. Following is a timeline showing when the FDA approval for these uses came into effect:

  • In August of 2004 Cymbalta was approved for treating depression, and a month later the FDA added approval for treating Diabetes-related peripheral neuropathy.
  • In 2006, the drug gained approval to be prescribed for the treatment of GAD, or general anxiety disorder.
  • In 2008, the FDA granted approval for prescribing Cymbalta in managing symptoms relating to Fibromyalgia, a medical condition that causes widespread pain throughout the entire body, rather than pain localized to a specific area or body part.
  • In 2010, FDA expanded its approval for Cymbalta to be prescribed in the treatment of CMP, or chronic musculoskeletal pain, for example chronic back pain.

An SNRI is sometimes prescribed for conditions that lay outside the above list, which practice is generally called “off-label” prescribing. Often, where a certain condition has not yet been successfully treated or managed with a particular medication, trials are done to explore medications that may be of some help. When enough positive results have been documented, such off-label use can eventually become FDA approved.

Some off-label uses for Cymbalta (duloxetine) in the USA include:

  • Urinary incontinence in females, i.e., after pelvic surgery. (3)
  • Chemotherapy-induced neuropathy, i.e., after breast cancer treatment.

 

Cymbalta (Duloxetine) Alternative Names and Slang

Duloxetine is the generic name for the brand or trade name Cymbalta. Other trade names include Yentreve, and the drug is sold in the EU as Xeristar and Ariclaim.

Care should be taken not to confuse Cymbalta or its generic name, duloxetine with “SALA” drugs, meaning drug names that sound alike or look alike. To avoid mistaking one drug for another, drug manufacturers often use specific colors, add markings, or use other distinctive features to help minimize this risk.

For example, the Institute for Safe Medication Practices (4) lists Symbyax as a drug which is often confused with Cymbalta (duloxetine). Symbyax is an SSRI drug that compounds two drugs:

  • an SSRI called fluoxetine, and
  • an antipsychotic drug called Olanzapene

These similarities make Symbyax a drug which might be confused with Cymbalta, but are, in fact, much different from each other in how and when they would be prescribed, despite their similar sounding names.

Cymbalta (Duloxetine) Side Effects

Cymbalta primarily targets the serotonin and norepinephrine neurotransmitters, and to a lesser extent, dopamine. The drug has a blocking effect, so that these naturally occurring neurotransmitters are restrained from following their normal pathway, and remain suspended out in the synapse, instead of being reabsorbed as they normally would be. The pooling or building up of these substances can result in a wide variety of effects such as mood brightening or feelings of euphoria that speak to its popularity in the treatment of depression and pain relief.

However, after the neurotransmitters have been suspended out in the synapse they eventually degrade and become inactive. This can result in a deficit over time, as the drug does not create new stores of these naturally produced chemicals, but only purges and uses up existing resources in the body.

The result of this deficit might explain some of the more long-term negative effects of taking a drug like Cymbalta, where an initial perceived benefit can often be overshadowed by other troubling side effects that begin to appear after weeks or months. There are hundreds of reported side effects but we will focus on the most common ones here (1%-10% or higher) and a number of less common reactions that would signal a high health risk and potentially require swift medical intervention, should they occur.

  • Suicidal behavior, suicidal ideation, especially in those under the age of 25
  • Respiratory tract infection, throat/mouth inflammation or pain
  • Seizures
  • Gastrointestinal hemorrhage or other internal bleeding
  • Pain in the upper right abdomen area
  • Swelling of the abdomen region
  • Blurred vision, dilated pupils
  • Back or neck pain, muscle spasms
  • Influenza
  • Anorgasma, premature ejaculation, decreased libido, erectile dysfunction
  • Stevens-Johnson Syndrome (extremely serious reaction of the eyes, skin and mucous membranes caused by certain medications, signaled by a fever and flu-like symptoms, followed by discoloration and rash/eruptions/skin ulcers which can become septic, skin then blisters and falls off, requires medical intervention done best in a burn unit or ICU, and is fatal in approximately 5 to 10% of cases.)
  • Pruritis (severe and unrelenting itchiness)
  • Hyperhidrosis (extreme, excessive sweating)
  • Spiking blood pressure
  • Heart palpitations
  • Fatigue
  • Vertigo
  • Decreased appetite
  • Weight loss/gain
  • Worsened depression
  • Anxiety
  • Mood swings
  • Dehydration
  • Hyponatremia (abnormally low sodium level, can result in seizure, coma, spasms, mental confusion, muscle weakness, inability to speak clearly, vomiting, swelling of the body, etc.)
  • Insomnia, abnormal dreams, sleep disorders
  • Emotional blunting (reduction or total absence of normal emotional responses)
  • Mental confusion, inability to focus or think clearly
  • Panic attacks
  • Irritability, hostility, aggressive, impulsive behaviors
  • Akathisia (a relentless internal sensation of discomfort involving a compulsion to rock, pace, march, shift the feet, or otherwise stay in constant motion)
  • Mania or the lesser hypomania (an abnormally intense episode of racing thoughts, hyperactivity, euphoria, decreased need for sleep, disorganized behavior, elevated self-esteem, grandiosity, etc.)
  • Dizziness
  • Tremors
  • Vomiting
  • Darkened urine (may be a sign of liver or other organ dysfunction and should be medically assessed without delay.)
  • Abdominal pain
  • Unusual bruising or tenderness in the upper abdominal area may be a sign of internal bleeding and requires medical attention.
  • Serotonin Syndrome (a potentially life-threatening condition that occurs when too much serotonin is in the body which can result in seizure, coma, heart palpitations and other symptoms and requires immediate medical intervention.)

 

Cymbalta (Duloxetine) Withdrawal Symptoms

While no one wants to suffer any longer than necessary, it is important to strongly reiterate that the process of withdrawal can be made more difficult if attempted too rapidly. Abrupt or “cold turkey” cessation is NOT recommended, as it can actually lengthen recovery time greatly. There are many treatment methods that have been found to lessen the discomfort, and to help ease the process in a much gentler manner, and these can be found explained in further detail in the below section on “Treatment”.

There can be many adverse effects felt when coming off Cymbalta.  Some of the more common ones are listed here:

  • electric shock sensations, also called “brain zaps”
  • suicidal thoughts
  • deepened depression
  • anxiety
  • muscle spasms
  • nausea
  • nightmares, unusual or vivid dreams
  • insomnia
  • mental fog, confusion, inability to focus

Discontinuing/Quitting Cymbalta (Duloxetine)

Because of the mechanics of SNRI antidepressants, there can be a significant measure of difficulty in stopping a drug such as Cymbalta. Some of the side effects of the drug while taking it can be hard to differentiate from those that can arise and even intensify when tapering off the drug. Working with an experienced medical practitioner who can help monitor the process is recommended.

In addition to drug side effects and the adverse effects of withdrawal, a person may also be struggling with their initial symptoms that led to taking an antidepressant in the first place. This can be an overwhelming process to embark on alone, especially where such problems may have arisen.

There are holistic treatment methods that may prove beneficial in regaining natural mental health, especially during the withdrawal and also recovery phases of treatment. This is a journey that may be best taken with caregivers who can provide encouragement and effective, compassionate care along the way.

Cymbalta (Duloxetine) FAQs

Below are some of the most frequently requested points of information concerning Cymbalta (Duloxetine).

Is Cymbalta (Duloxetine) an Anti-Inflammatory Medication?

NSAID stands for Non-Steroidal-Anti-Inflammatory-Drug. NSAID’s are pain reliever drugs which reduce the inflammation that accompanies painful conditions such as arthritis, tendonitis, etc. Common NSAIDS include aspirin or ibuprofen and can be purchased over the counter. Cymbalta is available only by prescription, and is not classified as an NSAID.

An important caution is that mixing NSAID’s like aspirin with Cymbalta (duloxetine) can significantly increase the risk of internal bleeding or hemorrhaging, and therefore mixing the two should be avoided.

What drugs interact with duloxetine?

In addition to NSAID’s, other drugs that can adversely react with duloxetine include:

  • caffeine
  • SSRI drugs
  • other SNRI drugs
  • alcohol
  • antihistamines

Is Cymbalta (Duloxetine) Safe for Pregnant Women?

Since there are too few definitive pregnancy studies on the safety of Cymbalta (duloxetine), this is a difficult question to answer completely.

It is known, however, that Cymbalta (duloxetine) does leach into the breast milk. (2)

Where the mother was on Cymbalta (duloxetine) in the last weeks of pregnancy, infants in their first weeks after birth have been found to experience discontinuation symptoms, such as labored breathing, irritability and trouble sleeping. (2)

There has also been shown a 3-6% higher incidence of spontaneous abortions (miscarriages) in mothers taking Cymbalta (duloxetine) when studies compared pregnant women on Cymbalta (duloxetine) to the general population of pregnant women.  (1)

It is recommended to see your doctor to discuss any health concerns you may have before pregnancy occurs, or as early in the pregnancy as possible.

Can Cymbalta (Duloxetine) Cause Sexual Dysfunction Issues?

Yes, Cymbalta (duloxetine) has one of the highest rates of any drug-related sexual dysfunction issues. These adversely affect both males and females, for example:

  • Inability to reach orgasm
  • Erectile dysfunction
  • Premature ejaculation
  • Loss of interest in sex
  • Physical discomfort or pain during sex

Treatment for Cymbalta (Duloxetine) Abuse and Addiction?

Because of the potentially overwhelming difficulties of coming off a drug like Cymbalta (duloxetine), it can be wise to choose treatment of a mild nature, to ensure a safe and comfortable withdrawal experience.  Cymbalta addiction or dependency can be overcome. Residential treatment is often the best choice to significantly reduce any discomforts that otherwise may make withdrawal near to impossible to accomplish without step by step help.

Initial lab tests can be utilized in order to get a snapshot of existing neurochemical anomalies and deficits, as well as possible nutritional deficiencies and extant toxic body burden. Then, each of these areas can be addressed using a combination of protocols which work to safely and gently restore nutritive values, remove toxins, and stabilize a person’s neurochemistry.

The advantages of these steps are clear, especially when they are done prior to beginning the taper process:

  • Improved appetite
  • Deeper sleep
  • Increased energy and well-being
  • This is the preferred point at which to begin the gradual withdrawal steps.

Not only is it possible for the client feel better very early in the process, but the person can relax and complete the withdrawal process without unnecessarily harsh adverse effects, worry or strain. Choosing such a program can help focus on the benefits of regaining mental health naturally.

We can provide much more information concerning methods of treatment that might be able to provide a safer, gentler way to overcome dependency on and safely withdraw from prescription drugs such as Cymbalta (duloxetine). We can help where there is a desire to eliminate the adverse effects lingering after prescription drugs and regain better mental and physical health using methods which are both gentle and effective. 


This content has been reviewed, and approved by a licensed physician.

Dr. John Motl, M.D.

Dr Motl is currently certified by the American Board of Psychiatry and Neurology in Psychiatry, and Board eligible in Neurology and licensed in the state of Arizona.  He holds a Bachelor’s of Science degree with a major in biology and minors in chemistry and philosophy. He graduated Creighton University School of Medicine with a Doctor of Medicine.  Dr. Motl has studied Medical Acupuncture at the Colorado School of Traditional Chinese Medicine and at U.C.L.A.

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