CymbaltaPagesIndex

Table of Contents (hide)

  1. 1. Names, Availability, Brand vs. Generic Issues, Forms
    1. 1.1 US brand name: Cymbalta
    2. 1.2 Available as Cymbalta in these countries1
    3. 1.3 Other trade name(s) for Cymbalta used in these countries1
    4. 1.4 Generic Name and Availability
    5. 1.5 duloxetine is available in these countries2
    6. 1.6 Branded generic names3
    7. 1.7 Specific generics with complaints, or preferred generics manufacturers
    8. 1.8 Generics with independently-tested bioequivalence
    9. 1.9 Forms and Classes
  2. 2. Approved and Off-Label Uses
    1. 2.1 US FDA approved use(s)
    2. 2.2 Cymbalta is approved elsewhere for
    3. 2.3 Common off-label uses
    4. 2.4 Less common/experimental off-label uses
    5. 2.5 Failed off-label uses
    6. 2.6 Potentially dangerous off-label uses
    7. 2.7 When / why you should take Cymbalta
    8. 2.8 When / why you should not take Cymbalta
  3. 3. Chances of Working & Comparisons with Other Meds
    1. 3.1 How long until Cymbalta starts working:
    2. 3.2 Likelihood Cymbalta will work for its approved indications:
    3. 3.3 For off-label applications:
    4. 3.4 Cymbalta versus other Antidepressants for approved treatments:
    5. 3.5 For off-label uses:
  4. 4. Dosage, Titration, and Discontinuation
    1. 4.1 Dosage and doses:
    2. 4.2 Best time / way to take Cymbalta:
    3. 4.3 Titration schedule:
    4. 4.4 How to discontinue Cymbalta:
    5. 4.5 Discontinuation symptoms:
    6. 4.6 Notes, tips, etc. about discontinuing Cymbalta:
  5. 5. Pros, Cons, and Interesting Information
    1. 5.1 Pros
    2. 5.2 Cons
    3. 5.3 Interesting stuff your doctor probably didn’t tell you:
  6. 6. Side Effects and Pregnancy Category
    1. 6.1 Typical side effects
    2. 6.2 Uncommon side effects
    3. 6.3 Potentially dangerous side effects:
    4. 6.4 Freaky rare side effects:
    5. 6.5 Ways to counter / minimize / mitigate / deal with some side effects
    6. 6.6 Pregnancy category

This is essentially everything we know about Cymbalta (duloxetine) on two big-ass pages. On this page is brand / trade names to odds of working and comparisons with other meds, or pretty much everything most people want to know. Page two is pharmacokinetics to the bibliography, or: I’m sure somebody wants to about 0.1% of people who read about a med look at it.

The titles for most sections link to the pages for those sections. While all the information is on these two comprehensive pages, the individual section pages go into a little more detail about what it all means.

1.  Names, Availability, Brand vs. Generic Issues, Forms

1.1  US brand name: Cymbalta

Just because a drug is available in one country doesn’t mean you can get it everywhere. Even if a medication is available elsewhere, it won’t necessarily have the same brand, or trade name everywhere it is sold.

1.2  Available as Cymbalta in these countries1

  • Argentina
  • Brazil
  • Chile
  • Colombia
  • EU
  • Ireland
  • Japan
  • Korea
  • Mexico
  • Peru
  • UK

1.3  Other trade name(s) for Cymbalta used in these countries1

  • Ariclaim: EU (diabetic peripheral neuropathy)
  • Duxetin: Argentina
  • Xeristar: Argentina, Chile, Mexico, Spain
  • Yentreve: EU (stress urinary incontinence)

1.4  Generic Name and Availability

A drug’s generic, or international nonproprietary name (INN) is how it is uniquely identified around the world. Or not. The generic version of a med is are often available in other countries long before they are in the US.

Generic name/INN:duloxetine
US Generic available?Pending

1.5  duloxetine is available in these countries2

  • Venezuela - duloxetina

1.6  Branded generic names3

  • clorhidrato de duloxetina (Spanish-language INN)
  • duloxetina como clorhidrato (another Spanish-language INN)
  • Dakermina (Venezuela)

1.7  Specific generics with complaints, or preferred generics manufacturers

In theory the generic version of a med is the same as the brand-name version. In practice that is usually, but not always the case. Especially with crazy meds. If we know of any problems with particular generics, or if some generics are better than others, we’ll let you know.

1.8  Generics with independently-tested bioequivalence

1.9  Forms and Classes

Available/supplied as:

20, 30, and 60mg capsules.

Primary Drug Class:Antidepressants
Additional Drug Categories:
 Headache & Neuropathic Pain Medications, Anxiolytics / Anti-anxiety Medications, Serotonin and Norepinephrine Reuptake Inhibitors

2.  Approved and Off-Label Uses

Drugs are officially approved to be used for certain things, and they may be approved for one thing in one country but something else entirely in another.4

2.1  US FDA approved use(s)

  • Major Depressive Disorder (MDD) - approved August 2004
  • Diabetic Peripheral Neuropathic Pain - approved November 2004
  • Generalized Anxiety Disorder (GAD) - approved February 2007
  • Fibromyalgia - approved June 2008
  • Chronic Musculoskeletal Pain - approved November 2010

2.2  Cymbalta is approved elsewhere for

Urinary stress incontinence in the EU under the trade name Yentreve.

2.3  Common off-label uses

Meds are often prescribed for conditions or people they aren’t approved to treat. This is known as off-label prescribing. Some off-label prescribing is so common that lots of people think the medication is a first-line treatment for the condition it’s prescribed to treat.

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

2.4  Less common/experimental off-label uses

When all else fails and you’ve run out of other options, the experimental use of some drug may be your best chance at treating something. Be careful! Otherwise safe meds can be downright dangerous when used for some things.

2.5  Failed off-label uses

2.6  Potentially dangerous off-label uses

2.7  When / why you should take Cymbalta

Just because a medication is approved or commonly prescribed for a particular condition doesn’t necessarily mean you should be taking it for that condition. There could be a drug that might be better to try first, or at least talk to your doctor about trying first, or the condition you have isn’t bad enough to warrant medication at all.

  • Effexor and/or Pristiq sort of worked for you.
  • You failed two (or more) SSRIs, and Wellbutrin didn’t work, your doctor doesn’t want to try you on it yet, or you and your doctor know Wellbutrin is a Bad Idea.

2.8  When / why you should not take Cymbalta

  • Effexor and/or Pristiq didn’t do crap for you.
  • Especially if the discontinuation syndrome was an absolute nightmare.

3.  Chances of Working & Comparisons with Other Meds

Two of the most important things to know when deciding on which med is the best for a particular condition5: how likely is it to work and how long will it take.
The odds of a med working for a particular condition and how long it generally takes to work should be fairly easy to nail down, and not need to be summed up by the Internet shorthand YMMV (Your Mileage May Vary). Unfortunately because no one is quite sure exactly what causes various conditions - further complicated when everything is a spectrum disorder - and they’re never really sure about how a med works in the first place, especially when there are lots of contradictory and/or questionable studies,6 we can only give you an idea somewhat less vague than support groups and PI sheets, but certainly more accurate than the implied “it fixes everything all the time!” promises of pharmaceutical advertising.
See our page on the tests researchers use to measure the efficacy of medications, including during clinical trials to get FDA approval.

3.1  How long until Cymbalta starts working:

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

3.2  Likelihood Cymbalta will work for its approved indications:

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.

3.3  For off-label applications:

3.4  Cymbalta versus other Antidepressants for approved treatments:

3.5  For off-label uses:

4.  Dosage, Titration, and Discontinuation

One of the most important aspects of any medication is how to go about taking it. This includes:

  • how much to take (the dosage or dose)
  • when and how often to take it (dosing schedule or doses)
  • how much to start with and how to increase the dose/dosage until you’re taking the target amount (titration or titration schedule).

This information is always in the PI sheet, is usually in the information for patients leaflets, most doctors will give you some idea of what it will be like, and this is what every pharmacist is trained and paid to tell you.
We here at Crazymeds often disagree with the official schedules found in the PI sheets. We usually advocate starting at a lower dosage than recommended. One of our core philosophies is increasing the dosages as slowly as one’s condition allows, and staying at the dosage that works instead of a target dosage7. More and more doctors are agreeing with us8. You and your doctor can always discuss increasing the dosage when you need to in advance.

4.1  Dosage and doses:

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.

4.2  Best time / way to take Cymbalta:

4.3  Titration schedule:

4.4  How to discontinue Cymbalta:

One thing PI sheets and doctors infrequently discuss, and don’t go into enough detail about, is how to discontinue a medication. With some meds it’s not too bad, but with others it can be a nightmare.
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.

4.5  Discontinuation symptoms:

4.6  Notes, tips, etc. about discontinuing Cymbalta:

5.  Pros, Cons, and Interesting Information

Every med has its good points and its bad points. This is what we think those are.
Doctors don’t have the time to tell you everything about a drug. Patient information leaflets leave out a lot. Even if the PI sheet covers everything the language is so dense and obtuse that the good stuff is often lost in information overload. Most meds have something interesting about them.

5.1  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).

5.2  Cons

It’s an SNRI, which means a discontinuation syndrome from hell if you want/need to stop taking it.

5.3  Interesting stuff your doctor probably didn’t tell you:

  • 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 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.

6.  Side Effects and Pregnancy Category

Potential side effects are used as a rationalization to not take a medication. Many people will stop taking an otherwise working drug because of one or more relatively minor, or often temporary side effects. There may even be ways to counter or mitigate side effects.
It all comes down to a very important question: which sucks less?
No matter what crazy med you take, it will probably make you feel spacey and generally out of it for the first few days (i.e. don’t operate heavy machinery), as well as make you drowsy. Even stimulants can make you drowsy. Cymbalta will probably affect your dreams as well, and there’s no way to tell if that will be a temporary or permanent side effect. Don’t be surprised if your stomach and/or other parts of your GI system complain for at least the first few days.

6.1  Typical side effects

Most everyone gets at least one or two of these.
The usual for SNRIs:

  • headache
  • nausea
  • dry mouth
  • sweating
  • urinary hesitancy (it is a med for urinary incontinence after all)
  • sleepiness or insomnia
  • constipation
  • weight gain - although less likely than SSRIs
  • 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.

6.2  Uncommon side effects

You may or may not get one or more of these.

  • 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 - file under: not all side effects are bad, or for some people this is a problem

6.3  Potentially dangerous side effects:

If you have these, call your doctor ASAP. Or now. Or get the hell off of the Internet and go to the ER. NOW!
That liver thing can be really, really bad. It’s rare, but drinking and SNRIs don’t mix.

6.4  Freaky rare side effects:

You won’t get these. Unless you already have and that’s why you’re here.

6.5  Ways to counter / minimize / mitigate / deal with some side effects

6.6  Pregnancy category

C-Use with caution Expanded pregnancy category explanation.


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Cymbalta Index


1 EU: European Union. Currently Austria, Belgium, Bulgaria, Cyprus, the Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, the Netherlands, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden, and the United Kingdom. Not all drugs approved in any one EU country are approved in all, but most crazy meds approved in several EU countries are at least obtainable in all EU countries on the European mainland. I'm not sure about Britain, Cyprus, Ireland, and Malta.
The UK and Ireland are listed separately because we're a primarily English-language site. Plus the UK tends to be more independent on more matters than any other EU member state, so it should probably be listed separately no matter what language a site like this is in.
While the EU is moving toward one brand name for the same med, that's not going to happen overnight. And people will still refer to meds by old brand names. So we'll list old brand names until they vanish.

2 Generic availability isn't fully harmonized in the EU. Sometimes a drug is available everywhere as a generic, sometimes it's available only in a few member states. We'll provide the best information we have.

3 The term "branded generic" has three meanings:
1) A generic drug produced by a generics manufacturer that is a wholly-owned subsidiary of the company that makes the branded version. E.g. Greenstone Pharmaceuticals makes gabapentin**, and they are owned by Pfizer***, who also own Parke-Davis, the makers of Neurontin.
2) A branded generic is also a generic drug given a 'brand' name by the manufacturer (e.g. Teva's Budeprion), but otherwise has the same active ingredient as the original branded version (Wellbutrin).
3) A branded generic is also a generic drug given a 'brand' name by the manufacturer (e.g. Sanofi-Aventis' Aplenzin, which is bupropion hydrobromide) and uses a salt of the active ingredient that is different from the original branded version and other generics (Wellbutrin, Budeprion and all the others are bupropion hydrochloride). We aren't sure if that really makes a difference or not. The FDA says they're the same thing. As usual, the data are contradictory, but most evidence indicates that the FDA is right and the differences are negligible.
For our purposes a "branded generic name" refers to the second and third definitions. We'll note if any preferred generics are manufactured by the pioneering company's subsidiary.

4 Before Cymbalta (duloxetine) was approved as an antidepressant in the US it was already approved in the EU, but only for stress urinary incontinence and sold under the trade name Yentreve. Duloxetine is now sold in the EU as an antidepressant under the trade name Cymbalta.
A better known, if slightly different example is bupropion. According to the 2007 edition of Mosby's Drug Consult, in the US, Canada and Singapore you can get both Wellbutrin (bupropion) as an antidepressant or Zyban (bupropion) to stop smoking. In Korea, Thailand and most of South America (but not Brazil) you can get bupropion (under various trade names) only as an antidepressant. In Brazil, the EU & UK, Israel, India, Australia and New Zealand it's only available as Zyban to help you stop smoking.

5 Assuming you were correctly diagnosed in the first place.

6 Keep in mind that according to one study, most drug studies will skew in favor of the med made by the company that sponsored the study.***** That's one of my favorite "no shit Sherlock" studies, although it did help in getting conflicts of interest showing up on papers.
Two additional papers along similar lines are Why Current Publication Practices May Distort Science******* and Why Most Published Research Findings Are False********. So in addition to the books we use as source material, this is why we also factor a lot of anecdotal evidence (personal experience, experiences of people we know, case reports, what people have sent us in e-mail, and what is posted all over the Internet) into our conclusions regarding the likelihood of meds working, the prevalence of various side effects, etc.
While the drug companies are getting a lot more transparent and publishing more data in the PI sheets regarding the results of the clinical trials, they still don't publish how many times a drug failed a clinical trial.********

7 Although not everyone has the luxury of stopping at a dosage when the symptoms abate and not increasing it unless the return. Sometimes you just have to keep going up until you reach that target dosage. E.g. you have a history of seizures that haven't yet responded to several medications.

8 Most notably Dr. Edward Faught, founder and Director of the Epilepsy Center, and vice chairman of the Department of Neurology, at the University of Alabama School of Medicine in Birmingham. His article on new antiepileptic drugs in Volume 7 issue 1 of Peer Review in Review stressed starting at low dosages, doing a slow titration, and stopping at the dosage where symptoms were under control. In Topiramate in the treatment of partial and generalized epilepsy****, the one free, full-text article I could find (that's not about geriatric patients), he again stresses the low and slow approach to avoid or lessen most side effects, while still achieving seizure control in the same amount of time.

Date created {{$$newlycreated}} Page Creator: JerodPoore Last edited by: JerodPoore on September 22, 2013, at 09:02 PM


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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.
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.
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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.
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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 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]

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