Cymbalta (Duloxetine) Medication

Cymbalta (Duloxetine HCL) is a new antidepressant medicine, approved by the FDA in August 2004. This medication is indicated for the treatment of major depressive disorder, and for the management of diabetic peripheral neuropathic pain (DPNP). The U.S. Food and Drug Administration (FDA) approved the antidepressant Cymbalta (duloxetine HCl) for the treatment of generalized anxiety disorder (GAD) in February 2007. This drug offers relief from both the emotional and painful physical symptoms associated with depression. Cymbalta medication can also improve symptoms of fibromyalgia - a chronic and painful musculoskeletal disorder in women.

Cymbalta comes in a capsules and can be taken once a day. The target daily dose is 60 mg. It is not recommended for those under 18. Controlled studies indicate a high degree of efficacy, tolerability, and safety for duloxetine in the treatment of major depressive disorder.

Cymbalta common side effects
The most common side effects associated with Cymbalta are nausea, dry mouth, constipation, insomnia, headache, dizziness, decreased appetite, fatigue, somnolence and increased sweating 2. Nausea usually resolves with continued treatment (duration of nausea is about 7 days) 4. However, insomnia may be a persistent side effect 13.

How long does it take for Cymbalta to work?
Several weeks are often required for duloxetine to reach its maximum effectiveness; however, improvement in some symptoms may occur after 1-2 weeks 15.

• Absorption: Well absorbed. Steady state reached after 3 days.
• Metabolism: Hepatic metabolism by CYP1A2 and CYP2D6 to numerous metabolites.
• Elimination half-life: 12 hours
• Excretion: 70% of medication is eliminated in the urine as metabolites and 20% is excreted in the feces.

• reduces painful physical symptoms of depression 7
• relatively fast onset of antidepressant effect - improvements may be noticed after 2 weeks 8
• lower rate of sexual side effects than the SSRIs 5
• short-term treatment is not associated with weight gain, and may cause weight loss 14
• convenience of once-daily dosing
• low risk of duloxetine emergent hypomania or mania 12

• risk of cardiovascular side effects (increased heart rate and blood pressure, changes in electrocardiogram)3
• high rate of insomnia, which may be a persistant13
• risk of weight gain with long-term use14
• risk of severe withdrawal symptoms16, though you should not change the dosage or stop taking duloxetine medication without your doctor's approval
• risk of serotonin syndrome when used with serotonergic agents (triptans, tramadol, and some other prescription medications)
• high cost

• Fibromyalgia 10
• Stress urinary incontinence 6
• Chronic fatigue syndrome
• Chronic pain syndromes
• Bulimia nervosa 17

Cymbalta for Fibromyalgia
Cymbalta is a medication approved by the FDA for the management of fibromyalgia in June 2008. It improves most fibromyalgia symptoms in about 60% of patients 9.

Evidence of the efficacy of duloxetine in fibromyalgia was demonstrated in good-quality randomized multicenter controlled trial, in which duloxetine (60 mg twice daily for 12 weeks) was associated with moderate reductions in the total score on the Fibromyalgia Impact Questionnaire and improvements in quality of life and disability scores. However, significant improvement with duloxetine occurred in the overall population and females only, whereas a treatment benefit was not shown in men 10.

In another randomized placebo-controlled trial more than half of patients treated with Cymbalta (60 mg once or twice daily), responded to treatment after 12 weeks, compared with 33% of those taking a placebo 11. Patients treated with Cymbalta had functional improvements on the Sheehan Disability Scale which measures disability at work, in family life and in social life, that were significantly greater than those of patients taking placebo. Cymbalta 60 mg once or twice daily directly reduced pain (75.7 and 87.5 percent, respectively) more than the indirect effect attributed to improvement in depressive symptoms (24.4 percent and 12.5 percent, respectively). Cymbalta also relieved the pain associated with tender points often associated with fibromyalgia.

Duloxetine hydrochloride is a potent and selective serotonin and norepinephrine reuptake inhibitor, that lacks significant affinity for muscarinic, histamine1, alpha1-adrenergic, dopamine, opioid receptors, and ion channels including Na+ channels.

If you plan to buy Cymbalta or generic medication Duloxetine hydrochloride you might whant to learn experience of other people using this medication.

• Cymbalta (Duloxetine) Reviews, Ratings by Patients on DrugLib.com
• User Reviews for Cymbalta on Drugs.Com
• Cymbalta Reviews - treatment success rate on DailyStrength.org
• Askapatient database: Cymbalta (Duloxetine HCL) ratings
• Cymbalta (duloxetine hydrochloride) ratings (recommended by 58% of reviewers) on PsychCentral.com
• Cymbalta discussion on Drugs.com

• Cymbalta official website

• 1. U.S. Food and Drug Administration. Cymbalta (Duloxetine) Prescribing Information
• 2. Hudson JI, Perahia DG, Gilaberte I, Wang F, Watkin JG, Detke MJ. Duloxetine in the treatment of major depressive disorder: an open-label study. BMC Psychiatry. 2007 Aug 28;7(1):43. PubMed
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• 9. Littlejohn GO, Guymer EK. Fibromyalgia syndrome: which antidepressant drug should we choose. Curr Pharm Des. 2006;12(1):3-9. PubMed
• 10. Arnold LM, Lu Y, Crofford LJ et al. A double-blind, multicenter trial comparing duloxetine with placebo in the treatment of fibromyalgia patients with or without major depressive disorder. Arthritis Rheum 2004;50:2974-84 PubMed
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• 12. Dunner DL, D'Souza DN, Kajdasz DK, Detke MJ, Russell JM. Is treatment-associated hypomania rare with duloxetine: secondary analysis of controlled trials in non-bipolar depression. J Affect Disord. 2005 Jul;87(1):115-9.
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• 15. Hirschfeld RM, Mallinckrodt C, Lee TC, Detke MJ. Time course of depression-symptom improvement during treatment with duloxetine. Depress Anxiety. 2005;21(4):170-7. PubMed
• 16. Petition to Cymbalta manufacturer, Eli Lilly and Company. PetitionOnline
• 17. Hazen E, Fava M. Successful treatment with duloxetine in a case of treatment refractory bulimia nervosa: a case report. J Psychopharmacol. 2006 Sep;20(5):723-4. Epub 2006 Jan 9. SagePub

Last modified: April, 2010