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> Cymbalta (duloxetine) Overview


Cymbalta Article Index | Brand and Generic Availability

Brand & Generic Names; Drug Class

US brand name: Cymbalta
Generic name: duloxetine
Drug Class: Antidepressants
Learn More about Cymbalta’s Generic & Worldwide Availability
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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 Uses

Stress urinary incontinence in women (It’s officially approved in Europe for this problem), and possibly for men as well. ADD/ADHD. Smoking cessation.

Learn More about Cymbalta’s Approved & Off-label Uses

How Long Until Cymbalta Starts Working (Onset of Action)

For Psychiatric Conditions (AKA brain cooties)

Between three days and a month, with an average of around two weeks.

For Pain

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.

Pain

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. Learn how Cymbalta Compares with Other Drugs

How to Take Cymbalta

Manufacturer’s Recommendations

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.

Crazymeds’ Suggestions

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)

Manufacturer’s Recommendations

What recommendations?

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.

Crazymeds’ Suggestions

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.

Learn More about Taking and Discontinuing Cymbalta

Cymbalta’s Pros and Cons

Pros

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).

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Cons

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 You about Cymbalta

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.

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 for

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

Cymbalta’s Side Effects (Adverse Reactions)

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 Effects

Controlled 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 Effects

Retinal detachment. Excessive disturbing and disabling yawning. I guess they considered it “excessive and disturbing” because Lexapro wasn’t involved.

Learn More about Cymbalta’s Side Effects.
TMI at times

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What You Really Need to be Careful About

Your liver could explode.

Cymbalta’s Black Box and Other Warnings, Pregnancy Category, etc.

Pharmacology

duloxetine’s Half-Life & How Long Until It Clears Your System

Plasma half-life: Half-life: 12 hours. Clearance: 3–4 days.

duloxetine’s 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 duloxetine’s pharmacokinetics page.

How duloxetine Works

the current best guess at any rate
Based upon the Communications Interference Hypothesis of depression, anxiety, and assorted other brain cooties, serotonin and norepinephrine reuptake inhibitors (SNRIs) like duloxetine effectively raise the serotonin (5-HT) and norepinephrine/noradrenaline (NE/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 NE transmission deeper into the neurons (reuptake).

Learn More than You Probably Ever Wanted to Know about How duloxetine Works
AKA mechanism/method of action, pharmacodynamics

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Ratings, Reviews, Comments, PI Sheet, and More

Cymbalta Comments

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


Extended Comments
As if I didn’t go on long enough already.

Cymbalta Ratings & Reviews, and Consumer Comments & Experiences

Rate Cymbalta

Give your overall impression of Cymbalta on a scale of 0 to 5. Detailed ratings and reviews are available on the Cymbalta Ratings & Reviews Page.

Get all critical about Cymbalta

3.5 stars Rating 3.3 out of 5 from 168 criticisms.
Vote Distribution: 20 – 12 – 13 – 20 – 59 – 44


Rate this article

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) Overview

4 stars Rates 3.9 out of 5 from 91 value judgments.
Vote Distribution: 3 – 3 – 3 – 8 – 40 – 34


Allegedly Useful Links. Mostly official sites, PI sheet-equivalents6 from countries other than the US, and reviews from other consumer review sites.


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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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References

  1. Cymbalta’s Full US Prescribing Information
  2. Faught, Edward. “Topiramate in the treatment of partial and generalized epilepsy.” Neuropsychiatric disease and treatment 3.6 (2007): 811-821.

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Cymbalta Article Index | Brand and Generic Availability

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. We 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 we write these damn things. 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. — Jerod Poore, CME, Publisher crazymeds.us


Last modified on Thursday, 27 March, 2014 at 19:23:00 by SomeMedCriticPage Author Date created April 05, 2011, at 15:24:23
“Cymbalta” by Jerod Poore is copyright © 2011 Jerod Poore Published online 2011/04/05
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Cymbalta, and all other drug names on this page and used throughout the site, are a trademark of someone else.

will probably have the name of the manufacturer and trademark owner (they’re not always the same company) at or near the very bottom. 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. It may of changed hands by the time you finished reading this article.




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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 something along the lines of 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. Plus we are big pottymouths and talk about S-E-X a lot.
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. OK, you can throw away duplicate copies, but keep at least one, as that’s your proof of purchase of having taken a med in case a doctor doubts your medical history. Plus they take up less space than a bottle, although keeping one inside of a pill bottle is even better.
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.
Very little information about visitors to this site is collected or saved. From time to time I look at search terms used and which pages they bring up in an effort to make the information I present more relevant. And the country of origin, just because I’m geeky like that. That’s about it. Depending on how you feel about Schrodinger, our privacy policy should either assuage or exacerbate your paranoia.
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. Hail Xenu!

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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? I don’t even need my big-ass rant any more. Heartbleed has made my case for me. And that’s just the one that got all the media attention. The very nature of an open source operating system makes security as much of an illusion of anonymity. Before you flip out too much: the domain Crazymeds is hosted on uses a version of SSL that is not affected by the Heartbleed bug. That’s one of the many reasons why I pay a lot of money and keep this site on Lunarpages.

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