Medication Guide
Duloxetine (Cymbalta) Side Effects and Uses
A plain-language guide to Duloxetine, an SNRI antidepressant. Learn how it helps, what it treats, how to take it and which side effects to know about.
Quick answer. Duloxetine (Cymbalta) is an SNRI antidepressant. Common duloxetine side effects include nausea, dry mouth, constipation and sleepiness or tiredness. The rare but serious ones, and when to get help, are listed under duloxetine side effects below. Never stop or change your dose on your own.
How Duloxetine Can Help You
Duloxetine (Cymbalta) is a serotonin and norepinephrine reuptake inhibitor, or SNRI. It raises two brain chemicals. They are tied to mood, energy and the body's own pain control. So it helps when depression or anxiety comes with long-term pain.
Examples include fibromyalgia, diabetic nerve pain and ongoing back or joint pain. Many people notice changes in mood, drive and comfort together.
Mood and anxiety benefits usually build over four to eight weeks. Pain relief and mood changes do not always move at the same pace. Your prescriber may start low to limit early nausea. Then the dose is set at the level that best balances benefit and side effects for you.
Uses for Duloxetine
- Major depressive disorder
- Generalized anxiety disorder, in adults and children 7 and older
- Diabetic nerve pain (diabetic peripheral neuropathic pain)
- Fibromyalgia, in adults and teens 13 and older
- Chronic muscle and joint pain, such as low back pain and knee arthritis
- Stress urinary incontinence (off-label)
How to Take Duloxetine
Your prescriber decides your dose and any changes. Duloxetine is usually taken once a day, morning or evening, with or without food. Taking it with food can help if you feel sick to your stomach. Swallow the capsule whole. Do not crush, chew or open it, and do not sprinkle it on food.
Take it at the same time each day. Missed a dose? Take it when you remember, unless the next dose is close. Then skip it and do not double up. Do not stop duloxetine suddenly. SNRIs can cause strong stopping symptoms. These include dizziness, nausea, irritability and brain zaps. Any change should follow a taper set by your prescriber.
Duloxetine Side Effects
Common Side Effects
- Nausea, mostly in the first week or two
- Dry mouth
- Constipation
- Sleepiness or tiredness
- Lower appetite
- More sweating
- Dizziness
- Sexual side effects, such as lower desire or delayed orgasm
Serious: Get Medical Help Promptly
- New or worse suicidal thoughts, mostly in people under 25 (boxed warning)
- Liver injury, with dark urine, yellow skin or eyes, or pain in the upper right belly
- Serotonin syndrome, with agitation, fever, fast heartbeat or stiff muscles
- Higher blood pressure
- Dizziness or fainting when standing up, which can lead to falls
- Unusual bleeding or bruising
- Severe skin reaction or allergic reaction
Is Duloxetine an SSRI?
No. Duloxetine is an SNRI, a serotonin and norepinephrine reuptake inhibitor. SSRIs such as sertraline mainly affect serotonin. Duloxetine affects both serotonin and norepinephrine. That is part of why it is also used for some kinds of long-term pain.
Cymbalta is the original brand name. Generic duloxetine is widely available and works the same way. It comes as delayed-release capsules. The capsule has a coating that guards the medicine from stomach acid. That is one reason to swallow it whole.
What Is Cymbalta Used For?
The FDA has approved duloxetine for major depressive disorder and generalized anxiety disorder. It is approved for diabetic nerve pain and fibromyalgia too. It is also approved for chronic muscle and joint pain. Examples are long-term low back pain and knee arthritis. Your prescriber chooses it based on your whole picture, not one symptom.
Duloxetine is not an opioid and is not a controlled substance. It does not cause the craving some pain pills can. The body does adjust to it. So it still needs a planned taper when it is stopped. Keep track of both pain and mood between visits. This helps your prescriber judge how well it is working.
Before You Start Duloxetine
Tell your prescriber about liver disease, kidney disease, glaucoma and seizures. Also share bleeding problems, high blood pressure and any history of bipolar disorder. Duloxetine is usually avoided with chronic liver disease or heavy drinking. It is also avoided with severe kidney disease. It can cause dizziness when standing up. That can lead to falls, mostly in older adults. Some people also have trouble starting to urinate.
Like all antidepressants, duloxetine has a boxed warning. It covers suicidal thoughts and behavior in children, teens and young adults. Watch for mood changes, mostly early on. If you are thinking about harming yourself, call or text 988, or call 911. If you are pregnant or planning a pregnancy, talk it through with your prescriber.
Interactions to Know About
Duloxetine must never be combined with an MAOI antidepressant, linezolid or IV methylene blue. Other drugs that raise serotonin add to the risk of serotonin syndrome. Examples are other antidepressants, triptans, tramadol and St. John's wort.
The liver breaks down duloxetine using enzymes called CYP1A2 and CYP2D6. Fluvoxamine and some antibiotics, such as ciprofloxacin, can raise its levels a lot. They are usually avoided. Duloxetine can also raise levels of some heart and mental health medicines. Aspirin, NSAIDs and blood thinners raise bleeding risk, so share your full list. Learn about medication management by telehealth in California.
Is Duloxetine Right for You?
Only a full evaluation with a prescriber can tell you if Duloxetine fits your symptoms, history and goals. Harpal Singh, PMHNP-BC offers psychiatric evaluations and ongoing medication management by telehealth anywhere in California.
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Related Medication Guides
Other guides in the same group, written the same simple way. Being in one group does not mean you can swap one medicine for another.
- Desvenlafaxine (Pristiq), SNRI antidepressant
- Doxepin (Silenor), Tricyclic antidepressant (TCA)
- Escitalopram (Lexapro), SSRI antidepressant
- Fluoxetine (Prozac), SSRI antidepressant
- Fluvoxamine (Luvox), SSRI antidepressant
- Mirtazapine (Remeron), Atypical antidepressant (noradrenergic and specific serotonergic)
FAQ
Questions About Duloxetine
Is Cymbalta the same as duloxetine?
Yes. Duloxetine is the generic name and Cymbalta is the brand name. Generic duloxetine delayed-release capsules contain the same active medicine. Your pharmacy label may show either name.
What is duloxetine used for?
Duloxetine is FDA approved for depression, generalized anxiety disorder, diabetic nerve pain, fibromyalgia and chronic muscle and joint pain. Your prescriber explains which purpose it serves in your plan. Sometimes it covers more than one at once.
How does duloxetine help pain as well as mood?
Serotonin and norepinephrine help the brain and spinal cord turn down pain signals. By strengthening those pathways, duloxetine lowers the volume of long-term pain. This works apart from its mood effect, which is why it can help pain even in people who are not depressed.
Why do I feel nauseated when starting duloxetine?
Nausea is the most common early side effect and often fades within one to two weeks. Starting low and taking the capsule with food both help. If nausea is severe or does not ease, contact your prescriber.
How long do duloxetine side effects last?
Nausea often fades within a week or two. Other effects, such as sweating, dry mouth or sexual side effects, may continue while you take it. Bring any lasting side effect to your follow-up so your prescriber can help.
Can duloxetine make you sleepy or tired?
Yes. Drowsiness and tiredness are common side effects, mostly in the first weeks. Some people feel more awake instead. Tell your prescriber how it affects you before you change when you take it.
Can I drink alcohol on duloxetine?
Heavy drinking with duloxetine raises the risk of liver injury, so it is best avoided or kept to a minimum. If you drink often or have liver disease, tell your prescriber before you start. Another medicine may be a better fit.
Can I take ibuprofen with duloxetine?
Ibuprofen, naproxen and aspirin can raise the risk of bleeding when taken with duloxetine. Many people with pain use these medicines, so ask your prescriber or pharmacist before combining them. Report unusual bruising or bleeding right away.
Will duloxetine raise my blood pressure?
It can cause a small rise in blood pressure in some people. Your prescriber may check your blood pressure from time to time, mostly after dose changes. Most people have no major change.
How long does duloxetine stay in your system?
Duloxetine has a half-life of about 12 hours. Most of it leaves the body within a few days after the last dose. Because levels fall fairly fast, missed doses and sudden stops can bring stopping symptoms.
What happens if I stop duloxetine suddenly?
Stopping an SNRI suddenly often causes dizziness, nausea, headache, irritability and brain zaps. These can last days to weeks. They are uncomfortable but avoidable, because your prescriber can plan a slow taper.