side effects, dosage, reviews, how to take & discontinue, uses, pros & cons, and more
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Brand & Generic Names; Drug Class
|US brand name: Cymbalta|
|Generic name: duloxetine|
|Drug Class: Antidepressants|
|More on Generic & Worldwide Availability|
Cymbalta’s Approved & Off-Label Uses (Indications)
US FDA Approved Treatment(s)Major Depressive Disorder (MDD), Generalized Anxiety Disorder (GAD), Fibromyalgia, Diabetic Peripheral Neuropathic Pain (DPNP) , Chronic Musculoskeletal Pain (CMSP)
Popular Off-Label UsesStress urinary incontinence in women (It’s officially approved in Europe for this problem), and possibly for men as well. ADD/ADHD. Smoking cessation.
Cymbalta’s Usual Onset of Action (when it starts working)
For Psychiatric Conditions (AKA brain cooties)
Between three days and a month, with an average of around two weeks.
For DPNP & CMSP - like TCAs and any other med with a positive effect on norepinephrine, you could start feeling some relief anywhere from a couple of days to two-three weeks.
For fibromyalgia - how long does it take for anything to start working on fibro?
Likelihood of Working
Depression & Anxiety Spectrum Disorders
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.
For DPNP & CMSP The odds are decent. It’s about as good as a TCA, with fewer side effects, which basically makes it a first-choice coin-toss.
For fibromyalgia - who the fuck knows. Even opioids may as well be placebos for a lot of people, and those folks are the Crazymeds’ demographic. And meds tend to poop-out (tachyphylaxis) a lot. I’ll get back to you if I can find some numbers I can trust.More on Chances of Working for You and Comparisons with Other Drugs
How to Take Cymbalta
Per the PI sheet Eli Lilly’s Recommendations:
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.
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.
While theoretically 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 some meds more frequently than what the PI sheet states. And, please, discuss that with your doctor and pharmacist. The only real side effect to taking two 30 mg capsules instead of one 60 mg is how much it costs. Your doctor will probably be OK with it. You insurance company might have a different idea.
How to Stop Taking Cymbalta (discontinue / withdrawal)
2.4 Discontinuing Cymbalta
Symptoms associated with discontinuation of Cymbalta and other SSRIs and SNRIs have been reported. A gradual reduction in the dose rather than abrupt cessation is recommended whenever possible [see Warnings and Precautions (5.7)]. --the PI sheet And that’s it.
Very slowly. Reduce your dosage by 10–20 mg a day each week. 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 60 mg capsules. Now do the math. Once you’re at 20mg you have to stop taking it after one or two weeks at that dosage. If the discontinuation symptoms don’t go away, ask your doctor for a Prozac prescription.
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Pros and Cons
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.
Interesting Stuff your Doctor Probably didn’t Tell YouCymbalta 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.
Smoking decreases Cymbalta’s bioavailability by about one-third. 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.
Best Known forNot 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.
Cymbalta’s Side Effects
Typical Side Effects
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.
Uncommon Side EffectsControlled narrow glaucoma (but you already have to be at risk for eye problems to start with), elevated liver serum (your doctor should have you get an annual liver panel), blurry vision, muscle cramps, and weight loss (yes, that can be a problem).
Freaky Rare Side EffectsRetinal detachment. Excessive disturbing and disabling yawning. I guess they considered it “excessive and disturbing” because Lexapro wasn’t involved.
Side Effect Details.
TMI at times
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What You Really Need to be Careful About
Your liver could explode.
Half-Life & Clearance
Half-life: 12 hours. Clearance: 3–4 days.
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.
How duloxetine Works
the current best guess at any rateBased upon the chemical imbalance theory of depression, anxiety, and assorted other brain cooties, serotonin and norepinephrine reuptake inhibitors (SNRIs) like duloxetine effectively raise the serotonin (5-HT) and norepinephrine (NA) levels in your brain by letting your synapses soak in those tasty brain juices (neurotransmitters) for longer than usual by slowing (inhibiting) the mechanism of 5-HT and NA transmission deeper into the neurons (reuptake).
More than You Probably Ever Wanted to Know about How a Drug Works
AKA mechanism/method of action, pharmacodynamics
Ratings, Reviews, Comments, PI Sheet, and More
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, so transitioning to or from 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 it 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
As if I didn’t go on long enough already.
Get all critical about Cymbalta
Rating 3.1 out of 5 from 84 criticisms.
Vote Distribution: 12 – 8 – 8 – 9 – 24 – 23
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If you’re still feeling judgmental as well as just mental5, please boost or destroy my self-confidence by honestly (and anonymously) rating this article on a scale of 0 to 5. The more value-judgments the better, even if you can criticize my work only once.
Get all judgmental about the Cymbalta (duloxetine) Synopsis
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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.
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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 Thank you! I'll be here all weak. Be sure to tip your content provider. And don't try the veal, it's cruelicious!
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.
If you have any questions not answered here, please see the Crazymeds Cymbalta discussion board. I welcome criticisms of the articles, notifications of bad links, site problems, consumer experiences with medications, etc. I’m not always able to write back. Hence I never answer questions about meds via e-mail that are answered by this or other articles. Especially if they have been repeatedly asked on the forum. That’s why I write these damn things. I’m frustrated enough as it is. Questions about which meds are best for your condition should also be asked on the forum; because this is a free site, so the price of admission is making things easier for somebody else searching for the same answer. We don’t deal with children on the forum or in private because after doing this for ten years I don’t have the emotional stamina to deal with kids who have brain cooties. How to contact Crazymeds.
|Last modified on Monday, 10 March, 2014 at 11:28:14 by SomeMedCritic||Page Author: JerodPoore||Date created April 05, 2011, at 15:24:23|
Cymbalta, and all other drug names on this page and use throughout the site, are 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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Almost all of the material on this site is by Jerod Poore and is copyright © 2004, 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, and 2014 Jerod Poore. Except, of course, the PI sheets - those are the property of the drug companies who developed the drugs the sheets are about - and any documents that are written by other people which may be posted to this site will remain the property of the original authors. You cannot reproduce this page or any other material on this site outside of the boundaries of fair use copying without the express permission of the copyright holder. That’s usually me, so just ask first. That means if want to print out a few pages to take to your doctor, therapist, counselor, support group, non-understanding family members or something like that - then that’s OK to just do. Go for it! Please. As long as you include this copyright notice and the following disclaimer, I’m usually cool with it.
All rights reserved. No warranty is expressed or implied in this information. Consult one or more doctors and/or pharmacists before taking, or changing how you take any neurological and/or psychiatric medication. Your mileage may vary. What happened to us won’t necessarily happen to you. If you still have questions about a medication or condition that were not answered on any of the pages you read, please ask them on Crazy Talk: the Crazymeds Forum.
The information on Crazymeds pertains to and is intended for adults. While some information about children and adolescents is occasionally presented (e.g. US FDA approvals), pediatric-specific data such as dosages, side effects, off-label applications, etc. are rarely included in the articles on drugs or discussed on the forum. If you are looking for information regarding meds for children you’ll have to go somewhere else.
Know your sources!
Nobody on this site is a doctor, a therapist, or a pharmacist. We don’t portray them either here or on TV. Only doctors can diagnose and treat an illness. While it’s not as bad as it used to be, some doctors still get pissed off by patients who know too much about medications, so tread lightly when and where appropriate. Diagnosing yourself from a website is like defending yourself in court, you suddenly have a fool for a doctor. Don’t be a cyberchondriac, thinking you have every disease you see a website about, or that you’ll get every side effect from every medication1. Self-prescribing is as dangerous as buying meds from fraudulent online pharmacies that promise you medications without prescriptions.
All information on this site has been obtained through our personal experience and the experiences family, friends, what people have reported on various reputable sites all over teh intergoogles, the medications’ product information / summary of product characteristic (PI/SPC) sheets, and from sources that are referenced throughout the site. As such the information presented here is not intended as a substitute for real medical advice from your real doctor, just a compliment to it. You should never, ever, replace what a real doctor tells you with something from a website on the Internet. The farthest you should ever take it is getting a second opinion from another real doctor. Educate yourself - always read the PI/SPC sheet or patient information leaflet (PIL) that comes with your medications and never ever throw them away.
Crazymeds is not responsible for the content of sites we provide links to. We like them, or they’re paid advertisements, or they’re something else we think you should read to help you make an informed decision about a particular med. Sometimes they’re more than one of those things. But what’s on those sites is their business, not ours.
All brand names of the drugs listed in this site are the trademarks of the companies named on the PI/SPC sheet associated with the medication, sometimes on the pages about the drugs, even though those companies may have been acquired by other companies who may or may not be listed in this site by the time you read this. Or the rights to the drug were sold to another company. And any or all of the companies involved may have changed their names.
Crazymeds is optimized for the browser you’re not using on the platform you wish you had. Between you and me, it all looks a lot cleaner using Safari or Chrome, although more than half of the visitors to this site use either Safari or Internet Explorer, so I’m doing my best to make things look nice for IE as well. I’m using Firefox and running Windows 72. On a computer that sits on top of my desk. With a 23 inch monitor. Hey, at least you can make the text larger or smaller by clicking on the + or - buttons in the upper right hand corner. If you have Java enabled. Like 99% of the websites on the planet, Crazymeds is hosted on domain running an open source operating system with a variety of open source applications, including the software used to display what you’ve been reading. As such Crazymeds is not responsible for whatever weird shit your browser does or does not do when you read this site3.
No neurologists, psychiatrists, therapists or pharmacists were harmed in the production of this website. Use only as directed. Void where prohibited. Contains nuts. Certain restrictions may apply. All data are subject to availability. Not available on all mobile devices, in the 12 Galaxies Guiltied to a Zegnatronic Rocket Society, or in all dimensions of reality.
‘Everything is true, nothing is permitted.’ - Jerod Poore
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 Crazymeds. 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]