Duloxetine, Oral

What are other names for this medicine?

Type of medicine: selective serotonin and norepinephrine reuptake inhibitor (SSNRI); antidepressant

Generic and brand names: duloxetine, oral; Cymbalta

What is this medicine used for?

This medicine is taken by mouth to treat major depressive disorder and generalized anxiety disorder. It is also used to treat fibromyalgia and diabetic peripheral neuropathy (pain from damage of the nerves in people with diabetes).

What should my healthcare provider know before I take this medicine?

Tell your healthcare provider if you have ever had:

• an allergic reaction to any medicine
• bipolar disorder
• blood pressure problems
• delayed stomach emptying
• glaucoma
• kidney or liver disease
• problems with alcohol or drug abuse
• seizures

Tell your provider if you have taken MAO inhibitors such as phenelzine (Nardil), tranylcypromine (Parnate), selegiline (Eldepryl), or isocarboxazid (Marplan) within the past 2 weeks.

Females of childbearing age: Tell your healthcare provider if you are pregnant or plan to become pregnant. It is not known whether this medicine will harm an unborn baby. Do not breast-feed while taking this medicine without your healthcare provider's approval.

How do I take it?

Check the label on the medicine for directions about your specific dose. Take this medicine exactly as your healthcare provider prescribes. Do not take more or take it longer than prescribed. You may take this medicine with or without food. Taking it with meals may lessen the chance the drug will upset your stomach. Swallow the capsules whole. Do not crush, chew, or mix the medicine in a liquid.

You may need to take this medicine for a long time. If you need to take this medicine for more than a few days, do not stop taking it suddenly. You may have to reduce your dosage gradually to avoid withdrawal symptoms. Follow your healthcare provider's instructions.

What if I miss a dose?

If you miss a dose, take it as soon as you remember unless it is almost time for the next scheduled dose. In that case, skip the missed dose and take the next one as directed. Do not take double doses. If you are not sure of what to do if you miss a dose, or if you miss more than one dose, contact your healthcare provider.

What if I overdose?

If you or anyone else has intentionally taken too much of this medicine, call 911 or go to the emergency room right away. If you pass out, have seizures, weakness or confusion, or have trouble breathing, call 911. If you think that you or anyone else may have taken too much of this medicine, call the poison control center. Do this even if there are no signs of discomfort or poisoning. The poison control center number is 800-222-1222.

Symptoms of an acute overdose may include: nausea, vomiting, diarrhea, restlessness, confusion, hallucinations, fast heartbeat, lightheadedness, fainting.

What should I watch out for?

Antidepressant medicines may increase suicidal thoughts or actions in some children, teenagers, and young adults within the first few months of treatment. Talk with your provider about this.

Behavior changes may be caused by the medicine or by depression or another mental illness. Contact your provider right away if you or your family notice any disturbing changes in your thoughts or behavior, such as:

• more outgoing or aggressive behavior than normal
• confusion
• hallucinations
• worsening of depression
• suicidal thoughts

You need to have blood tests and blood pressure checks regularly to see how this medicine affects you. Keep all appointments for these tests.

This medicine increases the effects of alcohol and other drugs. Do not drink alcohol or take other medicines unless your healthcare provider approves.

This medicine may cause blurred vision and dizziness. Do not drive or operate machinery until you are fully alert and can see clearly.

If you need emergency care, surgery, lab tests, or dental work, tell the healthcare provider or dentist you are taking this medicine.

What are the possible side effects?

Along with its needed effects, your medicine may cause some unwanted side effects. Some side effects may be very serious. Some side effects may go away as your body adjusts to the medicine. Tell your healthcare provider if you have any side effects that continue or get worse.

Serious (report these to your healthcare provider right away): Seizures; chest pain; irregular or fast heartbeat; dizziness; lightheadedness; unusual nervousness, restlessness, or irritability; panic attacks; trouble sleeping; worsening depression or thoughts of suicide.

Other: Nausea, vomiting, gas, constipation, dry mouth, loss of appetite, weight loss, trouble urinating, change in sexual ability or desire, stomach pain, headache, drowsiness, increased sweating, blurred vision.

What products might interact with this medicine?

When you take this medicine with other medicines, it can change the way this or any of the other medicines work. Nonprescription medicines, vitamins, natural remedies, and certain foods may also interact. Using these products together might cause harmful side effects. Talk to your healthcare provider if you are taking:

• antibiotics such as ciprofloxacin (Cipro), enoxacin (Penetrex), levofloxacin (Levaquin), gatifloxacin (Tequin), lomefloxacin (Maxaquin), moxifloxacin (Avelox), norfloxacin (Noroxin), ofloxacin (Floxin), trovafloxacin (Trovan), and nalidixic acid (NegGram)
• anti-nausea medicines such as prochlorperazine (Compazine) and promethazine (Phenergan)
• antipsychotic medicines such as thioridazine, thiothixene (Navane), trifluoperazine (Stelazine), chlorpromazine (Thorazine), fluphenazine (Prolixin), perphenazine, and promazine (Sparine)
• antiseizure medicines such as phenobarbital (Luminal) and carbamazepine (Carbatrol, Epitol, Tegretol, Tegretol XR)
• birth control pills
• cimetidine (Tagamet)
• cough and cold remedies (both prescription and nonprescription products), especially antihistamines such as diphenhydramine (Benadryl) and chlorpheniramine (Chlor-Trimeton)
• herbs such as kava, St. John's wort, gotu kola, SAMe, and valerian
• ketoconazole (Nizoral)
• linezolid (Zyvox)
• MAO Inhibitor antidepressants such as phenelzine (Nardil), tranylcypromine (Parnate), selegiline (Eldepryl), and isocarboxazid (Marplan) (Do not take an MAO inhibitor and this medicine within 14 days of each other.)
• medicines used to treat heart problems such as quinidine, amiodarone (Cordarone, Pacerone), propafenone (Rythmol), and flecainide (Tambocor)
• medicines to treat migraine headaches such as almotriptan (Axert), eletriptan (Relpax), frovatriptan (Frova), naratriptan (Amerge), zolmitriptan (Zomig), sumatriptan (Imitrex), and rizatriptan (Maxalt)
• narcotic analgesics (painkillers) such as codeine, hydrocodone (Vicodin, Lortab), morphine, hydromorphone (Dilaudid), oxycodone (Percocet, Tylox, Oxy IR, OxyContin), propoxyphene (Darvocet N-100), fentanyl (Duragesic, Actiq), meperidine (Demerol), and methadone (Dolophine)
• rifampin (Rifadin)
• sleeping pills such as flurazepam (Dalmane), temazepam (Restoril), zolpidem (Ambien), zaleplon (Sonata), and eszopiclone (Lunesta)
• SSRI antidepressants such as fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox), paroxetine (Paxil), sertraline (Zoloft), and citalopram (Celexa)
• tricyclic antidepressants such as amitriptyline, nortriptyline (Aventyl, Pamelor), imipramine (Tofranil), and doxepin (Sinequan)

Do not drink alcohol while you are taking this medicine.

Keep a list of all your medicines with you. List all the prescription medicines, nonprescription medicines, supplements, natural remedies, and vitamins that you take. Be sure that you tell all healthcare providers who treat you about all the products you are taking.

How should I store this medicine?

Store this medicine at room temperature. Keep the container tightly closed. Protect it from heat, high humidity, and bright light.

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This advisory includes selected information only and may not include all side effects of this medicine or interactions with other medicines. Ask your healthcare provider or pharmacist for more information or if you have any questions.

Keep all medicines out of the reach of children.

Do not share medicines with other people.

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