Generic name: duloxetine [du-LOX-e-teen]
Brand names: Cymbalta, Drizalma Sprinkle, Irenka
Dosage form: oral delayed release capsule (20 mg; 30 mg; 40 mg; 60 mg)
Drug class: Serotonin-norepinephrine reuptake inhibitors
Medically reviewed by Philip Thornton, DipPharm. Last updated on Mar 1, 2024.
What is duloxetine?
Duloxetine is a selective serotonin and norepinephrine reuptake inhibitor antidepressant (SSNRI). Duloxetine affects chemicals in the brain that may be unbalanced in people with depression.
Duloxetine is used to treat major depressive disorder in adults. It is also used to treat general anxiety disorder in adults and children who are at least 7 years old.
Duloxetine is also used in adults to treat nerve pain caused by diabetes (diabetic neuropathy), or chronic muscle or joint pain (such as low back pain and osteoarthritis pain).
Some brands of duloxetine are also used to treat fibromyalgia (a chronic pain disorder). Drizalma is for treating fibromyalgia only in adults. Cymbalta may be used to treat fibromyalgia in adults and children at least 13 years old.
Warnings
Do not take duloxetine within 5 days before or 14 days after you have used an MAO inhibitor, such as isocarboxazid, linezolid, methylene blue injection, phenelzine, tranylcypromine, and others. A dangerous drug interaction could occur.
People with depression or mental illness may have thoughts about suicide. Some young people may have increased suicidal thoughts when first starting a medicine to treat depression. Tell your doctor right away if you have any sudden changes in mood or behavior, or thoughts about suicide.
Do not stop using duloxetine without first talking to your doctor.
Before taking this medicine
You should not use duloxetine if you are allergic to it.
Do not take duloxetine within 5 days before or 14 days after you have used an MAO inhibitor, such as isocarboxazid, linezolid, methylene blue injection, phenelzine, or tranylcypromine. A dangerous drug interaction could occur.
Tell your doctor if you also use stimulant medicine, opioid medicine, herbal products, or medicine for depression, mental illness, Parkinson's disease, migraine headaches, serious infections, or prevention of nausea and vomiting. An interaction with duloxetine could cause a serious condition called serotonin syndrome.
Duloxetine is not approved for use by anyone younger than 7 years old.
To make sure duloxetine is safe for you, tell your doctor if you have:
heart problems, high blood pressure;
liver or kidney disease;
slow digestion;
a seizure;
bleeding problems;
sexual problems;
narrow-angle glaucoma;
bipolar disorder (manic depression);
drug addiction or suicidal thoughts; or
if you drink large amounts of alcohol.
People with depression or mental illness may have thoughts about suicide. Some young people may have increased suicidal thoughts when first starting a medicine to treat depression. Stay alert to changes in your mood or symptoms. Your family or caregivers should also watch for sudden changes in your behavior.
Taking an SNRI antidepressant during late pregnancy could increase your risk of excessive bleeding after you give birth, and may cause serious medical complications in the baby. However, stopping the medicine may not be safe if you have a relapse of depression. Do not start or stop duloxetine without asking your doctor.
If you are pregnant, your name may be listed on a pregnancy registry to track the effects of duloxetine on the baby.
If you are breastfeeding, tell your doctor if you notice drowsiness, feeding problems, and slow weight gain in the nursing baby.
Duloxetine pregnancy and breastfeeding warnings (more detail)
How should I take duloxetine?
Take duloxetine exactly as prescribed by your doctor. Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose.
Taking duloxetine in higher doses or more often than prescribed will not make it more effective, and may increase side effects.
Swallow the capsule whole and do not crush, chew, break, or open it.
You may take duloxetine with or without food.
Your blood pressure will need to be checked often.
Tell your doctor if you have any changes in sexual function, such as loss of interest in sex, trouble having an org*sm, or (in men) problems with erections or ejacul*tion. Some sexual problems can be treated.
Your symptoms may not improve for up to 4 weeks.
Do not stop using duloxetine suddenly, or you could have unpleasant symptoms (such as agitation, confusion, tingling or electric shock feelings). Ask your doctor before stopping the medicine.
Store at room temperature away from moisture and heat.
Dosing information
Usual Adult Dose for Depression:
Initial dose: 20 mg to 30 mg orally 2 times a day
Maintenance dose: 60 mg per day, given either once a day OR 30 mg orally 2 times a day
Maximum dose: 120 mg/day.
Usual Adult Dose for Fibromyalgia:
Initial dose: 30 mg orally once a day for at least 1 week
Maintenance dose: 30 to 60 mg orally once a day.
Usual Adult Dose for Generalized Anxiety Disorder:
Initial dose: 60 mg orally once a day
Maintenance dose: 60 to 120 mg orally once a day
Maximum dose: 120 mg/day.
Usual Adult Dose for Pain:
Initial dose: 30 to 60 mg orally once a day
Maintenance dose: 60 mg orally once a day.
Usual Adult Dose for Neuropathic Pain:
Initial dose: 30 to 60 mg orally once a day
Maintenance dose: 60 mg orally once a day.
Usual Adult Dose for Chronic Pain:
Initial dose: 30 to 60 mg orally once a day
Maintenance dose: 60 mg orally once a day.
Usual Geriatric Dose for Generalized Anxiety Disorder:
Initial dose: 30 mg orally once a day for at least 2 weeks
Maintenance dose: 60 mg orally once a day
Maximum dose: 120 mg/day.
Usual Pediatric Dose for Generalized Anxiety Disorder:
7 to 17 years:
-Initial dose: 30 mg orally once a day for at least 2 weeks
-Maintenance dose: 30 to 60 mg orally once a day
-Maximum dose: 120 mg/day.
Usual Pediatric Dose for Fibromyalgia:
13 years and older:
-Initial dose: 30 mg orally once a day for at least 1 week
-Maintenance dose: 30 to 60 mg orally once a day.
Detailed Duloxetine dosage information
What happens if I miss a dose?
Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time.
What happens if I overdose?
Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.
Overdose symptoms may include vomiting, dizziness or drowsiness, seizures, fast heartbeats, fainting, or coma.
What should I avoid while taking duloxetine?
Ask your doctor before taking a nonsteroidal anti-inflammatory drug (NSAID) such as aspirin, ibuprofen, naproxen, Advil, Aleve, Motrin, and others. Using an NSAID with duloxetine may cause you to bruise or bleed easily.
Avoid driving or hazardous activity until you know how duloxetine will affect you. Your reactions could be impaired. Dizziness or fainting can cause falls, accidents, or severe injuries.
Avoid getting up too fast from a sitting or lying position, or you may feel dizzy.
Drinking alcohol may increase your risk of liver damage, especially if you take Drizalma.
Duloxetine side effects
Get emergency medical help if you have signs of an allergic reaction to duloxetine (hives, difficult breathing, swelling in your face or throat) or a severe skin reaction (fever, sore throat, burning eyes, skin pain, red or purple skin rash with blistering and peeling).
Tell your doctor right away if you have new or sudden changes in mood or behavior, including new or worse depression or anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, more active or talkative, or have thoughts about suicide or hurting yourself.
Call your doctor at once if you have:
pounding heartbeats or fluttering in your chest;
a light-headed feeling, like you might pass out;
easy bruising, unusual bleeding;
vision changes;
painful or difficult urination;
liver problems - right-sided upper stomach pain, itching, dark urine, jaundice (yellowing of the skin or eyes);
low blood sodium - headache, confusion, problems with thinking or memory, weakness, feeling unsteady; or
manic episodes - racing thoughts, increased energy, decreased need for sleep, risk-taking behavior, being agitated or talkative.
Seek medical attention right away if you have symptoms of serotonin syndrome, such as: agitation, hallucinations, fever, sweating, shivering, fast heart rate, muscle stiffness, twitching, loss of coordination, nausea, vomiting, or diarrhea.
Common duloxetine side effects may include:
drowsiness;
nausea, constipation, loss of appetite;
dry mouth; or
increased sweating.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
Duloxetine side effects (more detail)
What other drugs will affect duloxetine?
Sometimes it is not safe to use certain medications at the same time. Some drugs can affect your blood levels of other drugs you take, which may increase side effects or make the medications less effective.
Ask your doctor before taking a nonsteroidal anti-inflammatory drug (NSAID) such as aspirin, ibuprofen, naproxen, Advil, Aleve, Motrin, and others. Using an NSAID with duloxetine may cause you to bruise or bleed easily.
Many drugs can interact with duloxetine. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed here. Tell your doctor about all other medicines you use.
Duloxetine drug interactions (more detail)
Popular FAQ
Cymbalta is used to treat depression, anxiety, and some pain syndromes. But what are the risks associated with this drug? Do most people who start it realize how hard it may be to stop? Continue reading
Slowly stopping Cymbalta treatment over 2 to 4 weeks is the best way to help avoid withdrawal symptoms like dizziness, nausea or headache. Talk with your doctor first if you want to stop treatment. Continue reading
Not being able to sleep (also called insomnia) is one of the most common side effects reported by people taking Cymbalta. In some people, this side effect improves after a couple of weeks of taking Cymbalta, but difficulty falling asleep or staying asleep can persist in others. Here are some ways you can improve sleep while taking Cymbalta:
- Take your dose of Cymbalta in the morning. Cymbalta may be given once a day or twice a day but for those people experiencing insomnia, it should be taken just once a day in the morning
- Swallow Cymbalta capsules whole; do not crush, chew, or open up the capsules and sprinkle them on food because this may cause Cymbalta to be absorbed more quickly than intended, increasing the risk of side effects such as insomnia...
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Cymbalta is more likely to cause weight loss early in the first 8 to 9 weeks of treatment, but result in a modest weight gain after 8 months of treatment. In general, these weight changes are minimal and may be due to temporary side effects like nausea or loss of appetite, some of the most common side effects of Cymbalta treatment. Continue reading
It may take up to 6 to 8 weeks for the full effects of Cymbalta to be seen, although some improvement in symptoms, such as sleep, energy, or appetite may show an improvement in 1-2 weeks. Symptoms such as depressed mood and lack of interest in activities may take the full 6-8 weeks to resolve. When Cymbalta is used for pain, it generally improves within two weeks. Continue reading
People have reported feeling electric shock-like sensations or “brain zaps” when starting Cymbalta (duloxetine) treatment, during treatment, and also when discontinuing it. Most report feeling these in the brain although some report them in other parts of the body. They have been described as feeling like a short, low voltage, electric shock. Continue reading
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Patient resources
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Other brands
Cymbalta, Drizalma Sprinkle, Irenka
Professional resources
- Duloxetine monograph
- Duloxetine Capsules (FDA)
Other brands
Cymbalta
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Further information
Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use duloxetine only for the indication prescribed.
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circ*mstances.
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