side effects, dosage, reviews, how to take & discontinue, uses, pros & cons, and more
Table of Contents (hide)
- 1. Brand & Generic Names; Drug Class
- 2. What is Cymbalta (duloxetine) Used For?
- 3. When Will Cymbalta (duloxetine) Start Working?
- 4. Will Cymbalta Really Work for What You Have?
- 5. How to Take Cymbalta (duloxetine)
- 6. How to Stop Taking Cymbalta (duloxetine)
- 7. Cymbalta (duloxetine) Pros and Cons
- 8. Cymbalta (duloxetine) Side Effects
- 9. What You Really Need to be Careful About with Cymbalta (duloxetine)
- 10. Cymbalta (duloxetine) Half-Life & How Long Until Cymbalta Clears Your System
- 11. How Cymbalta (duloxetine) Works
- 12. Cymbalta (duloxetine) Ratings, Reviews, Comments, PI Sheet, and More
|US brand name: Cymbalta|
|Generic name: duloxetine|
|What is Cymbalta (duloxetine)?|
|Cymbalta (duloxetine) is in the Antidepressants class of drugs.|
Major Depressive Disorder (MDD), Generalized Anxiety Disorder (GAD), Fibromyalgia, Diabetic Peripheral Neuropathic Pain, Chronic Musculoskeletal Pain
Stress urinary incontinence in women (It’s officially approved in Europe for this problem), and possibly for men as well. ADD/ADHD. Smoking cessation.
For psychiatric conditions (AKA brain cooties): Between three days and a month, with an average of around two weeks.
As with most SNRIs, your chances are pretty damn good that Cymbalta will work for depression and anxiety spectrum disorders. They’re not the solution for everyone, but they all have a decent response rate, they are far less likely to poop-out than SSRIs, and Cymbalta is no different.
When it comes to pain, the odds are decent Cymbalta will work. It’s about as good as a TCA, but with fewer side effects, which basically makes it a coin-toss.
Eli Lilly’s recommendations, per the PI sheet
For MDD: start at 40–60mg, taken either in one or two doses. The target dosage is 60mg a day, with a maximum of 120mg a day.
For GAD: start at 60mg once a day, with a maximum of 120mg.
As usual, we disagree.
For MDD & GAD we suggest starting at 20mg a day, and increasing by 20mg a day as required. We also suggest taking Cymbalta twice a day due to its short half-life, but since you can take it only once a day at 20mg, if you need to increase your dosage you’ll know soon enough which works better for you.
Theoretically Cymbalta is a once-a-day, delayed-release product. So is Depakote ER. And you only need to take regular Keppra twice a day. From all the evidence I’ve collected I’ve learned that you
sometimes often need to take meds more frequently than what the PI sheet states. And, please, discuss that with your doctor and pharmacist.
Very slowly. If 20mg per day every week is too fast, try to get some samples from your doctor so you can step down by 10mg per day until you hit 20mg. Cymbalta comes in 20, 30 and 60mg capsules. Now do the math.
Works quickly with a fairly low side effect profile for an SNRI. Less likely to poop-out than an SSRI. Probably the best painkiller around as far as approved antidepressants are concerned (because Savella (milnacipran) is not approved in the US as an antidepressant).
It’s an SNRI, which means a discontinuation syndrome from hell if you want/need to stop taking it.
Cymbalta is more effective when taken in the morning than in the evening. This has nothing to do with meals, it all has to do with our circadian rhythms. As we suggest taking Cymbalta twice a day (see how to take, above), this may not matter.
Smoking decreases Cymbalta’s bioavailability by about one-third in smokers. Eli Lilly doesn’t recommend any changes to how much you take or how fast to increase the dosage if you smoke, but don’t be surprised if you need to take more sooner than you thought.
Not that much these days. It’s either the med approved for a much stuff as Prozac or Paxil, or the drug that makes you feel better enough to not celebrate with any alcohol because your liver could explode if you do.
In-Depth Pros & Cons
The usual for SNRIs - headache, nausea, dry mouth, sweating, urinary hesitancy (it is a med for urinary incontinence after all), sleepiness or insomnia, diarrhea or constipation (my money is on the latter), weight gain, loss of libido and a host of other sexual dysfunctions. Most everything but the constipation, urinary hesitancy and weight gain, if any, will go away in a couple of weeks. Sexual dysfunction is a coin toss, although some women will get a sexual boost instead of a sexual dampening.
Controlled narrow glaucoma (but you already have to be at risk for eye problems to start with), elevated liver serum (an annual liver panel with this med probably isn’t a bad idea), blurry vision, muscle cramps, weight loss (yes, that can be a problem).
Your liver could explode.
Half-life: 12 hours. Clearance: 3–4 days.
duloxetine Pharmacokinetics Information Overload
Half-life is the average time it takes for you to process half of the drug’s active ingredient. If a drug has a half-life of around 24 hours and you take a dose of 100mg, you’ll have roughly the equivalent a 50mg dose after one day, a 25mg dose after two days, and so on. The rule of thumb is: multiply the half-life by five and you get how long it is for the dose you took to be cleared from your bloodstream, so there’s nothing swimming around to attach itself to your brain and start doing stuff1. That’s called “plasma clearance.” Complete clearance is a complex equation based on a lot of factors which may or may not: be published in the PI sheet, include personal data like your weight, or even completely figured out by corporate and independent researchers. It usually winds up being 2–5 days after plasma clearance no matter what2, but can take weeks. Sometimes a drug will clear from your brain and other organs before it clears from your blood. If we’ve found the complete clearance, or how to calculate it if it requires things like your weight and what your piss looks like, you’ll find that on the pharmacokinetics page.
the current best guess at any rate
Cymbalta is a serotonin and norepinephrine reuptake inhibitor (SNRI). SNRIs boost the amount of serotonin and norepinephrine in various parts of your brain and allow the receptors for those neurotransmitters to marinate longer in them. Neurotransmitter wackiness is a popular theory as to the cause of depression, anxiety, and assorted other brain cooties.
More about How Cymbalta Works than You Probably Ever Wanted to Know. AKA duloxetine mechanism/method of action, or pharmacodynamics.
In a rare case of useful information in advertising, Eli Lilly’s “Depression Hurts” campaign let people know that physical pain is a common symptom of MDD. It’s too bad that they dropped the part about all meds that are serotonin and norepinephrine reuptake inhibitors (including cheap-as-dirt TCAs) could help with depression-induced pain from the TV commercials. In fairness to Lilly, they did need to free up some time to address that bit about severe liver problems.
Cymbalta is vastly more potent than Effexor (venlafaxine) and Pristiq. Transitioning between Cymbalta and either Effexor or Pristiq has to be done carefully. The estimated achievable equivalency is 20mg of duloxetine HCL = 50mg of desvenlafaxine succinate = 75mg of venlafaxine HCl. “Achievable” meaning, “based upon the dosages available.”
Cymbalta has gone from being the poster child for anti-antidepressant hysteria to being one of the top-prescribed drugs in the country. Although its use as an analgesic are as much responsible for that as its use as an antidepressant and anxiolytic (anti-anxiety drug). In fact, Lilly has positioned Cymbalta primarily as a non-narcotic pain medication instead of a psychiatric medication. Why? Because there’s no stigma3 in having and taking medications for chronic pain, and less stigma = more money. Hey Lilly, ever thought about funding some anti-stigma campaigns that actually work?4
An overall zero-to-five rating is absolutely useless information regarding medications. It is little more than a purely emotional and subjective value judgment on a med that has no bearing on how effective a drug is or, more importantly, if Cymbalta (duloxetine) is the right drug for you. So why do I have it? Mainly because it’s cathartic for anyone who is taking or has taken Cymbalta (duloxetine)5. Love it? Hate it? Here’s your chance to let everyone know. You don’t need to be a forum member or anything like that. You get all of one vote which can’t be changed, so make sure it’s what you want.
Get all judgmental about Cymbalta (duloxetine)
Rating 3.2 out of 5 from 70 criticisms
Vote Distribution: 8 – 6 – 8 – 9 – 19 – 20
Extended Comments As if I didn’t go on long enough here.
It’s always a good idea to check for drug-drug interactions yourself. Just because most people in the crazy meds business know about really important interactions (e.g. MAOIs and a lot of stuff, warfarin and everything on the planet) doesn’t mean the person who prescribed your meds told you about them, or the pharmacist has all the meds you take at their fingertips like they’re supposed to. Or they have the time to do their jobs properly when not dealing with complete idiots or playing Angry Farmers on the Faecesbooks.
If you have any questions about Cymbalta (duloxetine), please see the Crazy Meds’ Cymbalta (duloxetine) discussion board. I rarely answer questions about meds via e-mail.1 Based on Julien's calculations from A Primer of Drug Action, the half-life multiplied by five is the generally accepted estimate of how long it takes a single dose of any given drug to be eliminated from the blood stream/plasma of someone with a normal metabolism. That's also the rough estimate for steady stage if they can't get, or won't provide a number for that.
2 For crazy meds. I have no idea what the average complete clearance is for other types of medications. For all I know there are drugs that utterly vanish from your system in under five passes, and others that won't let go of your squishy bits for years after you stop taking them.
3 Outside of the military and similar cultures with a "walk it off" attitude for anything that isn't cancer.
4 I.e. Not
NAMBLA's NAMI's useless stigma busting campaigns that spend too much time and money combating sitcoms, TV commercials, and arguing about using "patient" or "consumer" in literature. Oh, and they haven't done anything since January 2011.
5 At some point I may have multiple one-to-ten ratings for individual aspects of medications, such as efficacy and side effects. That could be potentially useful.
6 These include: Canada's Product Monographs (PM), New Zealand's Medicine Data Sheets (MDS), the EU's European Public Assessment Reports (EPAR), and the Summary of Product Characteristics (SPC) used in Britain, Ireland, and many other places.
|Date created April 05, 2011, at 15:24:23||Page Author: JerodPoore||Last modified on Wednesday, 04 December, 2013 at 18:58:36 by some med critic.|
Cymbalta is a trademark of someone else. Look on the the PI sheet or ask Google who the owner is. The way pharmaceutical companies buy each other and swap products like Monopoly™ real estate, the ownership of the trademark may have changed without my noticing.
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1 While there are plenty of books to help you with hypochondria, for some reason there’s not much in the way of websites. Then again, staying off of the Internet is a large part of curing/managing the disorder.
2 Remember kids, Microsloth operating systems are like TOS Star Trek movies with in that every other one sucks way, way more. With TOS Star Trek movies you don’t want to bother watching the odd-numbered ones. With Microsloth OS you don’t want to buy and install the even-numbered ones. Anyone who remembers ME and Vista knows what I mean.
3 Have I mentioned how open source operating systems for commercial applications is one of the dumbest ideas in the history of dumb ideas?
[begin rant] I rent a dedicated server for Crazy Meds. It’s sitting on a rack somewhere in Southern California along with a bunch of other servers that other people have rented. The hardware is identical, but no two machines have exactly the same operating systems. I don’t even need to see what is on any of the others to know this. If somebody got their server at the exact same time, with the exact same features as I did, I’m confident that there would be noticeable differences in some aspects of the operating systems. So what does this mean? For one thing it means that no two computers in the same office of a single company have the same operating system, and the techs can spend hours figuring out what the fuck the problem could be based on that alone. It also means that application software like IP board that runs the forum here has to have so many fucking user-configurable bells and whistles that even when I read the manual I can’t find every setting, or every location that every flag needs to be set in order for a feature to run the way I want it to run. And in the real world it means you can get an MBA not only with an emphasis on resource planning, but with an emphasis on using SAP - a piece of software so complex there are now college programs on how to use it. You might think, “But don’t people learn how to use Photoshop or Adobe Illustrator in college?” Sure, in order to create stuff. And in a way you’re creating stuff with SAP. But do you get a Bachelor of Fine Arts degree with an emphasis on Photoshop?
Back in the Big Iron Age the operating systems were proprietary, and every computer that took up an entire room with a raised floor and HVAC system, and had less storage and processing power than an iPhone, had the same operating system as every other one, give or take a release level. But when a company bought application software like SAP, they also got the source code, which was usually documented and written in a way to make it easy to modify the hell out of it. Why? Because accounting principles may be the same the world over, and tax laws the same across each country and state, but no two companies have the same format for their reports, invoices, purchase orders and so forth. Standards existed and were universally ignored. If something went wrong it went wrong the same way for everyone, and was easy to track down. People didn’t need to take a college course to learn how to use a piece of software.
I’m not against the open source concept entirely. Back then all the programmers read the same magazines, so we all had the same homebrew utilities. We even had a forerunner of QR Code to scan the longer source code. Software vendors and computer manufacturers sponsored conventions so we could, among other things, swap recipes for such add-ons and utilities. While those things would make our lives easier, they had nothing to do with critical functions of the operating system. Unless badly implemented they would rarely cause key application software to crash and burn. Whereas today, with open source everything, who the hell knows what could be responsible some part of a system failing. [/end rant]