Cymbalta

Cymbalta (Duloxetine)

Uses:

• Commonly used to treat
  • Fibromyalgia
  • Anxiety
  • Depression
  • Chronic musculoskeletal pain, such as back pain, arthritis pain
  • Nerve pain, such as peripheral neuropathy
  • Stress urinary incontinence

Advantage of this medication:

• Not habit forming
• Low chance of major side effect
• Effective when taken once a day
• Cost: generic available, covered by most insurance
  • Based on GoodRx: cash price
  • 60 mg: 30 cap about $11, 90 cap about $20

Dosing

• Most commonly used forms: 30 to 60 mg capsule
• Usually taken once a day, may be taken in am or before bed time
• May take 14 days or longer before it is effective.
• Kidney disease:
  • Mild kidney disease: no change in dose is needed
  • CrCl less than 30: use a lower dose or avoid use
  • Hemodialysis patients: Not dialyzable. Avoid or use a very low dose.

Side effects:

• Over 10%
  • Weight loss
  • Abdominal pain, nausea, dry mouth
  • Drowsiness, fatigue
  • Headache
• 1 to 10%
  • Flushing, increased blood pressure, palpitation
  • Sweat, itching
  • hot flashes, sexual dysfunction (3%)
  • constipation, diarrhea
• Suicidal thinking
  • May increase for age 18-24
  • studies did not show increase in risk for over 24 years old
  • decreased risk for those over 65 years old

How it works:

• Increase amount of serotonin and norepinephrine in brain
• Slight increase of dopamine in brain