Duloxetine

Duloxetine is a prescription serotonin-norepinephrine reuptake inhibitor (SNRI) medication. It’s commonly used to treat major depressive disorder, generalized anxiety disorder, fibromyalgia, diabetic peripheral neuropathic pain, and chronic musculoskeletal pain.

Duloxetine increases available levels of the chemicals serotonin and norepinephrine in the brain, helping to improve mood and reduce anxiety and pain. It’s typically taken orally in capsule form and is available in various dosages. 

Some common side effects may include nausea, dry mouth, constipation, drowsiness, decreased appetite, and increased sweating, although many people tolerate duloxetine well. Serious side effects can include liver damage, serotonin syndrome, or blood pressure changes, and folks with certain medical conditions, such as uncontrolled narrow-angle glaucoma or severe liver disease, may not be able to take duloxetine. 

People taking duloxetine should be closely monitored by a healthcare provider, especially when starting the medication or adjusting the dose.

Duloxetine is the active ingredient in the brand-name medication Cymbalta^®. According to the United States Food and Drug Administration (FDA), “generic medicines use the same active ingredients as brand-name medicines and work the same way, so they have the same risks and benefits as the brand-name medicines.”

Cymbalta (duloxetine hydrochloride) is indicated for the treatment of the following conditions:

• Major depressive disorder (MDD) in adults

• Generalized anxiety disorder (GAD) in adults and pediatric patients 7 years of age and older

• Diabetic peripheral neuropathic pain (DPNP) in adults

• Fibromyalgia (FM) in adults and pediatric patients 13 years of age and older

• Chronic musculoskeletal pain in adults

Serotonin and norepinephrine reuptake inhibitor (SNRI)

Most common adverse reactions (≥5% and at least twice the incidence of placebo-treated patients):

Adults:

• Nausea

• Dry mouth

• Sleepiness

• Constipation

• Decreased appetite

• Excessive sweating

Pediatric patients:

• Decreased weight

• Decreased appetite

• Nausea

• Vomiting

• Fatigue

• Diarrhea

The cost of duloxetine varies depending on factors such as your insurance plan, which pharmacy you use, the dosage, and quantity. Without insurance, duloxetine costs about $137 for a month’s supply of 60-milligram (mg) capsules, but coupons may bring down the price as low as $4. Insurance plans may cover all or some of the cost of this medication.

On the Hers platform, duloxetine starts at $49 per month and that price includes the benefits of using the Hers telehealth platform, including free shipping and unlimited messaging with a provider.

• Concomitant use of an MAOI antidepressant with Cymbalta is contraindicated

• Use of Cymbalta within 14 days of stopping an MAOI antidepressant is contraindicated

• In linezolid- or intravenous methylene blue-treated patients, initiation of Cymbalta is contraindicated

• Drug interactions: potent inhibitors of CYP1A2, potent inhibitors of CYP2D6

• Liver toxicity

• Postural low blood pressure, falls, and fainting

• Serotonin syndrome

• Increased risk of bleeding

• Severe skin reactions

• Activation of mania or hypomania

• Angle-closure glaucoma

• Seizures

• Blood pressure increases

• Inhibitors of CYP1A2 or thioridazine: Avoid co-administration with Cymbalta

• Low blood sodium: Can occur in association with SIADH

• Glucose control in diabetes

• Conditions that slow gastric emptying

• Sexual dysfunction

• Pregnancy: Third trimester use may increase risk for symptoms of poor adaptation (respiratory distress, temperature instability, feeding difficulty, hypotonia, tremor, irritability) in the neonate

WARNING: SUICIDAL THOUGHTS AND BEHAVIORS

Increased risk of suicidal thinking and behavior in children, adolescents, and young adults taking antidepressants.

Monitor for worsening and emergence of suicidal thoughts and behaviors.

*This information is from the label for brand name Cymbalta^®. See the Full Prescribing Information for more complete information. Duloxetine, the active ingredient in Cymbalta, may also be the active ingredient in other medications, and this information may not be accurate for all medications that include the active ingredient duloxetine.