As depression affects our systemic health, antidepressants are advised to treat both physical and emotional symptoms. Duloxetine is an FDA-approved medication recommended for managing depression and anxiety disorders.
Before starting with Duloxetine, you should discuss your complete medical history and medications you are already taking with your doctor. Duloxetine, when taken during other medical conditions or with drugs, can cause side effects. This article will discuss the facts you should be aware of before starting your treatment with duloxetine.
Duloxetine (Cymbalta)
Duloxetine is a prescription drug used to treat depression; it belongs to the class of medicine known as serotonin-norepinephrine reuptake inhibitors (SNRIs). It is an FDA-approved drug recommended for people above 7 years of age (1).
Duloxetine can be used to treat;
- Generalized Anxiety Disorder (GAD)
- Major depressive disorder
- Diabetic Peripheral Neuropathic Pain(DPNP)
- Fibromyalgia (FM)
- Chronic Musculoskeletal Pain
Duloxetine increases the amounts of serotonin and norepinephrine hormones, which are naturally present in the brain. This helps to maintain mental balance and also helps blocks certain pain signals in the brain.
Serotonin is a neurotransmitter and is well known as the” feel-good “hormone. It plays a significant role in controlling your mood swings, feelings, and well-being (2). Norepinephrine is a natural chemical in your body that helps the body respond to stress (3).
Although the exact functionality and metabolism of duloxetine are not wholly studied, experts suggest that it increases these chemicals and helps maintain mental health..
Duloxetine Side Effects
Duloxetine is a prescription medication and should be taken only if advised by your healthcare provider. It is essential to share your complete medical history with your physician; because it may interact with other medications and supplements. It is important to read the warnings on the official drug information site (4).
Here is the list of the side effects seen with Duloxetine:
Common side effects of duloxetine are:
- Headache, nausea, fatigue
- Loss of appetite, stomach pain, diarrhea, weakness, constipation
- Trouble sleeping, dizziness
- Libido changes, erectile dysfunction
- Sweating, tremor
- Difficulty with urination
Duloxetine Warnings or Side Effects
Duloxetine might result in some severe adverse effects, as mentioned below.
1. Causes Liver Damage
People with reduced liver function or kidney diseases use duloxetine with caution as it may increase the risk of damage to both kidneys and liver. This drug is metabolized mostly through the kidneys and liver(5).
There are chances of hepatotoxicity, liver toxicity that may occur with duloxetine. While taking duloxetine, if you experience abdominal pain, itching, yellow skin or yellow eyes, dark urine, and increased liver enzyme, immediately report it to your physician (6).
2. Fluctuations in Blood Pressure
It is vital to keep track of your blood pressure during the whole treatment. Many people who were administered Duloxetine have experienced low blood pressure; this generally happens when you stand up from a sitting position, known as orthostatic hypotension.
However, in some cases, there are reports of increased blood pressure. When you start your treatment, you may experience decreased blood pressure, dizziness, or fainting. There may be an increased risk of fainting, especially in the old aged group.
Orthostatic hypotension is also known as postural hypotension, is a low blood pressure condition that happens when you stand up from sitting or lying down. This risk may increase if you take antihypertensive drugs (7).
3. May Cause Serotonin Syndrome
Serotonin syndrome is a condition when your body produces too much serotonin; this is usually because of medicine or a combination of medications.
Duloxetine increases your serotonin and norepinephrine levels in your brain; this may lead to serotonin syndrome; this is a severe side effect of antidepressant medications. It has been reported with duloxetine, even when taken alone. There is an increased risk if duloxetine is taken in combination with SNRIs and SSRIs or other medicines that boost serotonin (8).
You can observe symptoms such as loss of coordination, instability, nausea, vomiting, sweating, dizziness, instability, and increased heart rate if you have serotonin syndrome. If you notice any of these symptoms while taking duloxetine, immediately seek medical advice from your physician.
Triptans, Tricyclic antidepressants, Lithium, Tramadol, Buspirone, Amphetamines drugs can have potential interactions with duloxetine that can cause serotonin syndrome. Take the advice of your doctor before taking duloxetine with these medications.
4. Do Not Mix it With Monoamine Oxidase Inhibitors
Monoamine oxidase inhibitors (MAOIs) are a class of medicines that inhibit monoamine oxidase enzyme activity. They are well known but not commonly used antidepressants, also effective against panic disorders. Although these are effective, it has a higher risk of side effects when compared with SNRIs (9).
Do not take MAOIs and duloxetine together; do not take it five days before or 14 days after you have used an MAOI. Some of the common MAOIs are Isocarboxazid,, Methylene blue injection, Phenelzine, Rasagiline, Selegiline, Tranylcypromine.
Taking MAOIs with duloxetine may cause serotonin syndrome; it might lead to further complications. Follow the guidelines suggested by your doctor (10).
5. Abnormal Bleeding
Duloxetine should be used with caution with Aspirin, Warfarin, or other anticoagulants (blood thinners), anti-inflammatory drugs such as ibuprofen; this might increase the risk of bleeding. You might notice nose bleeds, bruising and it might even cause hemorrhages (11).
6. Skin Rashes
Adverse reactions of duloxetine may include skin reactions such as rashes, phototoxic reactions, eczema, and urticarias. It can occur during the initial stages of duloxetine treatment. Seek your doctor’s advice if you experience blisters, skin rashes, hypersensitivity (12).
7. You may Experience Withdrawal Symptoms on Discontinuation
In general, one should not stop any drug abruptly without completing the course of the treatment or as advised by your health care professional.
If you stop using duloxetine suddenly, you may experience some symptoms such as dizziness, vomiting, agitation, sweating, confusion, and feelings of electric shock. It’s essential to take the advice of your doctor before you stop any prescribed drug.
8. Suicidal Thoughts
Duloxetine has a black box warning from FDA. There is evidence that suggests this drug increases suicidal thoughts in young adults aged 18 to 24 years (13). In the early stages of treatment, if you experience more depressive feelings or suicidal thoughts with this drug, report to your doctor immediately.
Potential Drug Interactions
It’s important to discuss with your health care provider regarding your medical history and ongoing medications. It helps your doctor decide the dose of duloxetine. You may need fewer doses of duloxetine if you are using drugs such as :
- Cimetidine
- Quinolone antibiotics like ciprofloxacin and enoxacin
- Paroxetine
- Fluoxetine
- Quinidine
- Fluvoxamine
These medicines block the duloxetine metabolism and increase its level in the blood leading to further complications.
Final Words
In most patients, duloxetine can reduce the symptoms of depression and improve the quality of life. However, in some people, it may result in adverse effects. Consult your doctor before taking any antidepressants. If you observe any changes or side effects, report them to your health care provider immediately.