Cymbalta - Use | Dose | Side Effects

This article was medically reviewed by M.Pharm, Marko Tanaskovic on August 12, 2018. To read more about an author, click here.

Cymbalta is a medicine that contains an active substance called duloxetine. It belongs to a group of medicines called selective serotonin and norepinephrine reuptake inhibitors (SNRIs). It is used to treat major depressive disorder, generalized anxiety disorder and diabetic peripheral neuropathic pain.


Cymbalta should be avoided in the following conditions:

  • In patients who are allergic to the active substance - duloxetine or other similar medicines, such as:
    • paroxetine,
    • fluoxetine, and others.
  • Patients with liver or kidney diseases.
  • In patients with uncontrolled hypertension (high blood pressure).
  • In patients who are taking MAO inhibitors (also a medicines used to treat depression) or have used any of MAO inhibitors within the past two weeks, such as:
    • isocarboxazid,
    • selegiline,
    • tranylcypromine,
    • moclobemide,
    • rasagiline, and others. Concomitant use of Cymbalta with these medicines can lead to serious side effects.

Cymbalta should be used only with extra precautions in the following conditions:

  • Epilepsy.
  • In patients who have a low sodium level in the blood (hyponatremia).
  • Bleeding disorders.
  • In patients with ocular hypertension (glaucoma).
  • Patients with mania or bipolar disorder.
  • In patients who have had suicidal thoughts. This medicine, like almost all other antidepressants, can cause suicidal thoughts. Therefore, patient and his family should be advised to immediately report any behavior changes that may indicate that the patient has suicidal thoughts. Suicidal thoughts occur more commonly in patients under the age of 25, therefore this medicine should be used only with extra precautions in these patients.

Never use this medicine in combination with alcoholic beverages, because it increases the risk of side effects.

Do not use St. John's wort while taking this medicine because it may reduce its effectiveness.

This medicine should be used with extra precautions in patients under the age of 18.

Use of Cymbalta during pregnancy and breastfeeding

Cymbalta should be avoided during pregnancy and breastfeeding because it may harm your baby.

Infants whose mothers was taking this medicine during pregnancy, may have persistent pulmonary hypertension within the first 24 hours after birth (a life-threatening condition).

Avoid breastfeeding while using this medicine.

How to use


Condition Dose
Major depressive disorder 60 mg once daily
Diabetic peripheral neuropathic pain 60 mg once daily
Generalized anxiety disorder The usual starting dose is 30 mg once daily. Dosage can be increased to up to 120 mg daily until a adequate effect is achieved.

Swallow the tablet whole with a glass of water. It can be taken regardless of meals. Try to take this medicine at the same time every day.

Expected onset of action of this medicine in the treatment of depression and generalized anxiety disorder is 2-4 weeks, while expected onset of action of this medicine in the treatment of diabetic peripheral neuropathic pain is one week.

You should never stop taking this medicine without first consulting your doctor.

Do not stop taking this medicine suddenly. If you stop taking this medicine suddenly, following symptoms may occur:

  • headache,
  • dizziness,
  • insomnia,
  • nightmares,
  • anxiety,
  • nausea,
  • vomiting,
  • excessive sweating and others. You need to reduce dose gradually before stopping this medicine. If you need to stop taking this medicine, your doctor will tell you how to gradually lower the dose before stopping this medicine.

Use with other medicines (Interactions)

Cymbalta should be avoided in combination with the following medicines:

  • Other medications used to treat depression, so-called MAO inhibitors, such as:
    • tranylcypromine,
    • moclobemide,
    • selegiline,
    • rasagiline,
    • isocarboxazid, and others. Concomitant use of Cymbalta with these medicines can cause serious side effects that can be fatal. This medicine should not be taken with or within 14 days of taking MAO inhibitors.
  • Benzodiazepines, medicines used to treat anxiety and insomnia, such as:
    • diazepam (Bensedin),
    • bromazepam,
    • lorazepam,
    • nitrazepam and others.
  • Analgesics (painkillers), such as:
    • tramadol,
    • morphine, and others.
  • Medicines used to treat migraine, such as:
    • sumatriptan,
    • zolmitriptan,
    • rizatriptan, and others. These medicines, like Cymbalta, can increase the level of serotonin in the blood. Therefore the concomitant use of Cymbalta with these medicines can lead to serious side effects.
  • Other antidepressants, such as:
    • imipramine,
    • desipramine,
    • amitriptyline,
    • nortriptyline,
    • paroxetine,
    • fluoxetine,
    • fluvoxamine and others.
  • Anticoagulant medicines (blood thinners), such as:
    • warfarin (Farin),
    • acenocoumarol (Sinkum 4, Sintrom 4) and others. Concomitant use of Cymbalta with these medicines increases the risk of bleeding.
  • St. John's Wort.

Tell your doctor about all medications and herbal products you are taking.

Side effects

Cymbalta may cause the following side effects:

  1. nausea,
  2. vomiting,
  3. diarrhea,
  4. constipation,
  5. abdominal pain,
  6. indigestion,
  7. loss of appetite,
  8. weight loss,
  9. anxiety,
  10. agitation,
  11. insomnia,
  12. nightmares,
  13. ringing in the ears,
  14. ear pain,
  15. blurred vision,
  16. taste impairment,
  17. dizziness,
  18. orgasmic disorder,
  19. erection problems,
  20. secretion of breast milk in men or in women who are not breastfeeding (galactorrhea),
  21. fatigue,
  22. drowsiness,
  23. tachycardia (fast heart rate),
  24. hepatic impairment,
  25. difficulty urinating,
  26. frequent urination,
  27. menstrual disorders,
  28. high blood cholesterol,
  29. low sodium concentration in the blood (hyponatremia),
  30. aggression,
  31. bad breath (halitosis),
  32. sore throat,
  33. restless legs syndrome,
  34. allergy and others.

Tell your doctor if you are experiencing any side effects.

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If you have any concerns or questions about your health, you should always consult with a physician or other health-care professional.

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