Cymbalta (Duloxetine) is a selective serotonin and norepinephrine reuptake inhibitor antidepressant (SSNRI). Duloxetine affects chemicals in the brain that may be unbalanced in people with depression.

Cymbalta (Duloxetine) is used to treat major depressive disorder in adults. It is also used to treat general anxiety disorder in adults and children who are at least 7 years old.

Cymbalta (Duloxetine) is also used in adults to treat nerve pain caused by diabetes (diabetic neuropathy), or chronic muscle or joint pain (such as low back pain and osteoarthritis pain).

Cymbalta (Duloxetine) is also used to treat fibromyalgia (a chronic pain disorder) in adults and children at least 13 years old.

WARNINGS

Do not take Cymbalta (Duloxetine) within 5 days before or 14 days after you have used a MAO inhibitor, such as Isocarboxazid, Linezolid, Rasagiline, Selegiline, or Tranylcypromine, or Methylene blue injection.

Cymbalta (Duloxetine) should not be used if you have narrow angle glaucoma.

Some young people have thoughts about suicide when first taking an antidepressant. Stay alert to changes in your mood or symptoms. Report any new or worsening symptoms to your doctor, such as: mood or behaviour changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

Do not stop using Cymbalta (Duloxetine) without first talking to your doctor.

HOW TO TAKE IT

Take Cymbalta (Duloxetine) exactly as prescribed by your doctor. Follow all directions on your prescription label. Do not take this medicine in larger or smaller amounts or for longer than recommended.

You may take Cymbalta (Duloxetine) with or without food. Swallow it whole.

It may take up to 4 weeks before your symptoms improve. Keep using the medication as directed and tell your doctor if your symptoms do not improve.

Your blood pressure will need to be often checked.

Do not stop using Cymbalta (Duloxetine) suddenly, or you could have unpleasant symptoms (such as dizziness, vomiting, agitation, sweating, confusion, numbness, tingling, or electric shock feelings). Ask your doctor how to safely stop using this medicine.

MISSED DOSAGE

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

WHAT TO AVOID

Avoid driving or hazardous activity until you know how Duloxetine will affect you. Your reactions could be impaired. Dizziness or fainting can cause falls, accidents, or severe injuries.

Avoid getting up too fast from a sitting or lying position, or you may feel dizzy.

Avoid drinking alcohol. It may increase your risk of liver damage.

Ask your doctor before taking a nonsteroidal anti-inflammatory drug (NSAID) such as Aspirin, Ibuprofen (Advil, Motrin), Naproxen (Aleve), Celecoxib (Celebrex), Diclofenac, Indomethacin, Meloxicam, and others. Using an NSAID with Duloxetine may cause you to bruise or bleed easily.

SIDE EFFECTS

Get emergency medical help if you have signs of an allergic reaction to Cymbalta (Duloxetine): skin rash or hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Report any new or worsening symptoms to your doctor, such as: mood or behaviour changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

Call your doctor at once if you have:

a light-headed feeling, like you might pass out;

vision changes, eye pain or swelling, eye redness;

easy bruising, unusual bleeding;

painful or difficult urination;

a seizure;

manic episodes - racing thoughts, increased energy, decreased need for sleep, risk-taking behaviour, being agitated or talkative.

right-sided upper stomach pain, itching, dark urine, yellowing of the skin or eyes (signs of liver problems);

headache, confusion, slurred speech, severe weakness, vomiting, loss of coordination, feeling unsteady (signs of low levels of sodium in the body); or

severe skin reaction - fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain, followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling.

Seek medical attention right away if you have symptoms of serotonin syndrome, such as: agitation, hallucinations, fever, sweating, shivering, fast heart rate, muscle stiffness, twitching, loss of coordination, nausea, vomiting, or diarrhea.

Older adults may be more sensitive to the side effects of this medicine.

Common Cymbalta (Duloxetine) side effects may include:

dry mouth;

drowsiness, dizziness;

tired feeling;

nausea, constipation, loss of appetite, weight loss; or

increased sweating.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects.

INTERACTION WITH OTHER DRUGS

Many drugs can interact with Cymbalta (Duloxetine). Not all possible interactions are listed here. Tell your doctor about all your current medicines and any you start or stop using, especially:

any other antidepressant;

Cimetidine;

St. John's Wort;

Theophylline;

Tryptophan (sometimes called L-tryptophan);

an amphetamine - Adderall, Focalin, Vyvanse, Ritalin, Concerta, Strattera, and others;

an antibiotic - Ciprofloxacin, Enoxacin;

a blood thinner - Warfarin, Coumadin, Jantoven;

heart rhythm medication - Flecainide, Propafenone, Quinidine, and others;

opioid medicine - Fentanyl, Tramadol;

medicine to treat mood disorders, thought disorders, or mental illness - Buspirone, Lithium, Thioridazine, and many others; or

migraine headache medicine - Sumatriptan, Rizatriptan, Zolmitriptan, and others.

This list is not complete and many other drugs can interact with Cymbalta (Duloxetine). This includes prescription and over-the-counter medicines, vitamins, and herbal products. Give a list of all your medicines to any healthcare provider who treats you.

STORAGE

Store Cymbalta (Duloxetine) at room temperature away from moisture and heat.