Duloxetine, oral capsule

1. Duloxetine oral capsule is available as both a generic and a brand-name drug. Brand name: Cymbalta.
2. Duloxetine only comes as a capsule you take by mouth.
3. Duloxetine oral capsule is used to treat anxiety, depression, diabetic nerve pain, fibromyalgia, and chronic (long-lasting) muscle and joint pain.

• Drowsiness warning: This drug can cause sleepiness or affect your ability to make decisions, think clearly, or react quickly. You shouldn’t drive, use heavy machinery, or do other dangerous activities until you know how the drug affects you.
• Serotonin syndrome warning: This drug affects a chemical in your brain called serotonin. Taking this drug with other medications that affect serotonin may result in increased risk of a serious side effect called serotonin syndrome. Symptoms may include:
  • agitation
  • confusion
  • increased blood pressure or heart rate
  • sweating
  • loss of coordination
• Dizziness and falling warning: This drug can cause a sudden drop in blood pressure if you stand up too fast. This can cause dizziness and increase your risk of falling.

Duloxetine is a prescription drug. It only comes in the form of an oral capsule.

Duloxetine oral capsule is available as the brand-name drugs Cymbalta and Irenka. It’s also available as a generic drug. Generic drugs usually cost less than the brand-name version. In some cases, they may not be available in all strengths or forms as the brand-name drug.

Why it’s used

Duloxetine oral capsule is used to treat:

• generalized anxiety disorder
• major depressive disorder
• nerve pain caused by diabetes
• fibromyalgia pain
• chronic muscle and joint pain

How it works

Duloxetine belongs to a class of drugs called serotonin-norepinephrine reuptake inhibitors (SNRIs).

It works by balancing chemicals in your brain that cause depression and anxiety. By balancing these chemicals, this drug also helps inhibit pain signals from your nerves to your brain.

Duloxetine oral capsule can cause sleepiness or may affect your ability to make decisions, think clearly, or react quickly. You shouldn’t drive, use heavy machinery, or do other dangerous activities until you know how it affects you. It can also cause other side effects.

More common side effects

In adults, the more common side effects of duloxetine can include:

• nausea
• dry mouth
• sleepiness
• fatigue
• constipation
• loss of appetite
• increased sweating
• dizziness

In children, the more common side effects of duloxetine can include:

• nausea
• decreased weight
• dizziness
• diarrhea
• stomach pain

Serious side effects

Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:

• Liver damage. Symptoms can include:
  • itching
  • pain in the right side of your upper abdomen
  • dark-colored urine
  • yellowing of your skin or the whites of your eyes
• Changes in blood pressure. Symptoms can include:
  • dizziness or fainting when standing. This may occur more often when you first start duloxetine or when you increase the dose.
• Serotonin syndrome. Symptoms can include:
  • agitation
  • hallucinations
  • coma
  • coordination problems or muscle twitching
  • racing heart
  • high or low blood pressure
  • sweating or fever
  • nausea, vomiting, or diarrhea
  • muscle rigidity
  • dizziness
  • flushing
  • tremor
  • seizures
• Abnormal bleeding. Duloxetine may increase your risk of bleeding or bruising, especially if you take warfarin or nonsteroidal anti-inflammatory drugs.
• Severe skin reactions. Symptoms can include:
  • skin blisters
  • peeling rash
  • sores in your mouth
  • hives
• Manic episodes in people with depression or bipolar disorder. Symptoms can include:
  • greatly increased energy
  • severe trouble sleeping
  • racing thoughts
  • reckless behavior
  • unusually grand ideas
  • excessive happiness or irritability
  • talking more or faster than usual
• Vision problems. Symptoms can include:
  • eye pain
  • changes in vision
  • swelling or redness in or around your eye
• Seizures or convulsions
• Low salt (sodium) levels in your blood. Symptoms can include:
  • headache
  • weakness or feeling unsteady
  • confusion, problems concentrating, or thinking or memory problems
• Problems with urination. Symptoms can include:
  • decrease in your urine flow
  • trouble passing urine

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare provider who knows your medical history.

Duloxetine oral capsule can interact with other medications, vitamins, or herbs you may be taking. An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well.

To help avoid interactions, your doctor should manage all of your medications carefully. Be sure to tell your doctor about all medications, vitamins, or herbs you’re taking. To find out how this drug might interact with something else you’re taking, talk to your doctor or pharmacist.

Examples of drugs that can cause interactions with duloxetine are listed below.

Serotonergic drugs

Taking these drugs with duloxetine may increase your risk of serotonin syndrome, which can be fatal. If you take any of these drugs, your doctor will start you on a lowered dosage of duloxetine and monitor you for signs of serotonin syndrome. Symptoms can include agitation, sweating, muscle twitches, and confusion.

Examples of serotonergic drugs include:

• selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine and sertraline
• serotonin-norepinephrine reuptake inhibitors (SSNRIs) such as venlafaxine
• tricyclic antidepressants (TCAs) such as amitriptyline and clomipramine
• monoamine oxidase inhibitors (MAOIs) such as selegiline and phenelzine
• the opioids fentanyl and tramadol
• the anxiolytic buspirone
• triptans
• lithium
• tryptophan
• amphetamines
• St. John’s wort

Schizophrenia drug

Taking thioridazine with duloxetine can increase the amount of thioridazine in your body. This may increase your risk of arrhythmia (abnormal heart rate).

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Taking duloxetine with NSAIDs may increase your risk of abnormal bleeding. Examples of NSAIDs include:

• ibuprofen
• indomethacin
• naproxen

Mental health drug

Taking aripiprazole with duloxetine may increase the amount of aripiprazole in your body. This can lead to increased side effects.

Anticoagulants (blood thinners)

Taking blood thinners with duloxetine may increase your risk of abnormal bleeding. Examples of blood thinners include:

• apixaban
• warfarin
• clopidogrel
• dabigatran
• edoxaban
• prasugrel
• rivaroxaban
• ticagrelor

Gaucher disease drug

Taking eliglustat with duloxetine can increase the amount of eliglustat in your body. This may cause side effects on your heart.

Drug for depression and stopping smoking

Taking bupropion with duloxetine may increase the amount of duloxetine in your body. This may increase your risk of seizures.

Cancer drug

Taking doxorubicin with duloxetine may increase the amount of doxorubicin in your body. This can cause increased side effects.

Antibiotic

Taking ciprofloxacin with duloxetine may increase the amount of duloxetine in your body. Avoid taking these drugs together.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking.

Duloxetine oral capsule drug comes with several warnings.

Alcohol interaction warning

Drinking heavily while taking this drug increases your risk of severe liver injury. Talk to your doctor about how much alcohol you drink before starting duloxetine.

Allergy warning

This drug can cause a severe allergic reaction. Symptoms may include:

• trouble breathing
• swelling of your throat or tongue
• hives

If you develop these symptoms, call 911 or go to the nearest emergency room.

Don’t take this drug again if you’ve ever had an allergic reaction to it. Taking it again could be fatal (cause death).

Warnings for people with certain health conditions

For people with liver disease: Avoid taking this drug if you have chronic liver disease or cirrhosis of the liver. You may have trouble clearing the drug from your body. This can lead to further liver damage.

For people with kidney disease: Avoid taking this drug if you have severe kidney disease or if you receive dialysis. Your kidneys may have trouble removing the drug from your body. This could lead to a buildup of the drug and increase your risk of side effects.

For people with diabetes: This drug may affect your blood sugar levels. If you have diabetes, your doctor may want you to monitor your levels more closely and may need to change the dosage of your diabetes medication.

For people with bladder problems: This drug may affect your ability to urinate. Talk to your doctor if you have any problems with urine flow.

For people with bipolar disorder: This drug may cause mania or hypomania. If you or someone in your family has bipolar disorder, tell your doctor before starting duloxetine.

For people with bleeding problems: This drug may increase your risk of bleeding or bruising. If you already have bleeding problems or take certain medications, your risk may be higher. Before taking this drug, tell your doctor if you have any bleeding problems.

For people with glaucoma: This drug can increase your risk of having a glaucoma attack. If you have glaucoma, tell your doctor before starting this drug.

For people with high blood pressure: This drug may increase your blood pressure. If you already have high blood pressure, let your doctor know before starting duloxetine.

For people with a history of seizures or convulsions: This drug may cause seizures or convulsions. If you already experience these, your risk may be even higher if you take this drug. Tell your doctor about any seizures or convulsions before starting duloxetine.

For people with low sodium levels in the blood: This drug can cause very low sodium levels in your blood. If you already have a low sodium level, talk with your doctor before starting duloxetine.

Warnings for other groups

For pregnant women: This drug is a category C pregnancy drug. That means two things:

1. Research in animals has shown adverse effects to the fetus when the mother takes the drug.
2. There haven’t been enough studies done in humans to be certain how the drug might affect the fetus.

Talk to your doctor if you’re pregnant or plan to become pregnant. This drug should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

If you take this drug during pregnancy, you can take part in a registry that monitors outcomes in women exposed to duloxetine during pregnancy. To enroll, talk to your doctor or call 1-866-814-6975.

For women who are breastfeeding: This drug may pass into breast milk. If you take this drug while you breastfeed, your baby may have side effects of the drug. Tell your doctor if you wish to breastfeed. You may need to decide whether to breastfeed or take this drug.

For seniors: If you’re aged 65 years or older and you take this drug, you may be at a greater risk of falls due to blood pressure changes. You may also be at greater risk of low sodium (salt) in your blood. Symptoms may include:

• headache
• weakness or feeling unsteady
• confusion, problems concentrating, or thinking or memory problems

For children: This drug hasn’t been proved to be safe or effective in treating generalized anxiety disorder in children younger than 7 years. It hasn’t been proved to be safe or effective in treating other conditions in children younger than 18 years.

This dosage information is for duloxetine oral capsule. All possible dosages and forms may not be included here. Your dose, form, and how often you take it will depend on:

• your age
• the condition being treated
• the severity of your condition
• other medical conditions you have
• how you react to the first dose

Forms and strengths

Generic: Duloxetine

• Form: oral delayed-release capsule
• Strengths: 20 milligrams (mg), 30 mg, 40 mg, and 60 mg

Brand: Cymbalta

• Form: oral delayed-release capsule
• Strengths: 20 mg, 30 mg, 60 mg

Dosage for major depressive disorder

Adult dosage (ages 18 years and older)

• Typical starting dosage: 30–60 mg per day.
• Typical maintenance dosage: Total daily dose of 40 mg (given as 20-mg doses twice daily) or 60 mg (given either once daily or as 30-mg doses twice daily).
• Maximum dosage: 120 mg per day.

Child dosage (ages 0–17 years)

Dosage for people younger than 18 years hasn’t been established.

Dosage for generalized anxiety disorder

Adult dosage (ages 18–64 years)

• Typical starting dosage: 30–60 mg per day.
• Typical maintenance dosage: 60 mg per day.
• Maximum dosage: 120 mg per day.

Child dosage (ages 7–17 years)

• Typical starting dosage: 30 mg per day for 2 weeks.
• Typical maintenance dosage: 30–60 mg per day.
• Maximum dosage: 120 mg per day.

Child dosage (ages 0–6 years)

Dosage for people younger than 7 years hasn’t been established.

Senior dosage (ages 65 years and older)

• Typical starting dosage: 30 mg per day for 2 weeks.
• Typical maintenance dosage: 60 mg per day.
• Maximum dosage: 120 mg per day.

Nerve pain caused by diabetes

Adult dosage (ages 18–64 years)

• Typical starting dosage: 60 mg per day.
• Maximum dosage: 60 mg per day.

Child dosage (ages 0–17 years)

Dosage for people younger than 18 years hasn’t been established.

Dosage for fibromyalgia

Adult dosage (ages 18 years and older)

• Typical starting dosage: 30 mg per day for 1 week.
• Typical maintenance dosage: 30–60 mg per day.
• Maximum dosage: 60 mg per day.

Child dosage (ages 13–17 years)

• Typical starting dosage: 30 mg per day for 1 week.
• Typical maintenance dosage: 30–60 mg per day.
• Maximum dosage: 60 mg per day.

Child dosage (ages 0–12 years)

Dosage for people younger than 13 years hasn’t been established.

Dosage for chronic muscle and joint pain

Adult dosage (ages 18 years and older)

• Typical starting dosage: 30 mg per day for 1 week.
• Typical maintenance dosage: 60 mg per day.
• Maximum dosage: 60 mg per day.

Child dosage (ages 0–17 years)

Dosage for people younger than 18 years hasn’t been established.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always speak with your doctor or pharmacist about dosages that are right for you.

Duloxetine oral capsule is a long-term medication. It comes with risks if you don’t take it as prescribed by your doctor.

If you stop taking the drug or don’t take it at all: If you don’t take the drug, your symptoms won’t get better and could get worse. If you stop this drug quickly, you may have serious side effects, including:

• anxiety
• irritability
• feeling tired or problems sleeping
• headache
• sweating
• dizziness
• electric shock-like sensations
• vomiting or nausea
• diarrhea

If you miss doses or don’t take the drug on schedule: Your medication may not work as well or may stop working completely. For this drug to work well, a certain amount needs to be in your body at all times.

If you take too much: You could have dangerous levels of the drug in your body. Symptoms of an overdose of this drug can include:

• tiredness
• seizures
• dizziness
• increased heart rate
• high blood pressure
• vomiting

If you think you’ve taken too much of this drug, call your doctor or seek guidance from the American Association of Poison Control Centers at 1-800-222-1222 or through their online tool. But if your symptoms are severe, call 911 or go to the nearest emergency room right away.

What to do if you miss a dose: If you miss a dose, take it as soon as you remember. However, if it’s just a few hours until your next dose, skip the missed dose and take your next dose on schedule. Never try to catch up by taking two doses at once. This could result in dangerous side effects.

How to tell if the drug is working: The symptoms of the condition being treated should improve.

Keep these considerations in mind if your doctor prescribes duloxetine oral capsule for you.

General

Don’t crush or chew the delayed-release capsule.

Storage

• Store this drug at room temperature between 68°F and 77°F (20°C and 25°C).
• Keep this drug away from light.
• Don’t store this medication in moist or damp areas, such as bathrooms.

Refills

A prescription for this medication is refillable. You should not need a new prescription for this medication to be refilled. Your doctor will write the number of refills authorized on your prescription.

Travel

When traveling with your medication:

• Always carry your medication with you. When flying, never put it into a checked bag. Keep it in your carry-on bag.
• Don’t worry about airport X-ray machines. They won’t damage your medication.
• You may need to show airport staff the pharmacy label for your medication. Always carry the original prescription-labeled container with you.
• Don’t put this medication in your car’s glove compartment or leave it in the car. Be sure to avoid doing this when the weather is very hot or very cold.

Clinical monitoring

Your doctor may monitor you for new or worsening suicidal thoughts or behaviors.

Prior authorization

Many insurance companies require prior authorization for this drug. This means your doctor will need to get approval from your insurance company before your insurance company will pay for the prescription.

There are other drugs available to treat your condition. Some may be better suited for you than others. Talk to your doctor about other drug options that may work for you.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.