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Cymbalta (duloxetine) is an SNRI (serotonin-norepinephrine reuptake inhibitor) which has been used since the 1990s in patients with depression or anxiety. It is additionally used to manage symptoms in:

• Diabetic peripheral neuropathy
• Fibromyalgia
• Chronic musculoskeletal pain
• Stress urinary incontinence

Because the conditions it treats are usually chronic, Cymbalta is typically used long-term, for months or years.

Treatment Guidelines

Treatment will vary, of course, depending on the condition as well as an individual's age, health, and other factors. Children may require smaller doses than adults, which should be determined by a doctor. There are some general guidelines for all cases, however:

• Cymbalta capsules should be swallowed whole; do not open, mix in food, dissolve in liquid, or otherwise alter capsules.
• Taking on a full stomach is optional; doing so may ease side effects of nausea.
• If possible take doses at the same time each day so the medication stays at consistent levels.
• Do not abruptly stop treatment; doing so may cause psychological and physical withdrawal symptoms.

In otherwise healthy adults, dosage and administration is fairly straightforward:

• Major depressive disorder - 30 to 60 mg each day, depending on severity of the condition. Doses may be taken all at once or split into two smaller doses.
• Generalized anxiety disorder - 60 mg once daily.
• Diabetic peripheral neuropathy - 60 mg once daily.
• Fibromyalgia - 60 mg once daily.
• Chronic musculoskeletal pain - 60 mg once daily.
• Stress urinary incontinence - 80 mg per day, split into two 40 mg doses.

Most patients are started on a smaller half-dose for the first week of treatment. For instance, if 60 mg per day is prescribed, only 30 mg per day is taken the first 7 days. This allows the body to more gradually adjust to treatment, reducing the severity of side effects. Similarly, when treatment ends, doses should be gradually tapered off over several weeks.

Improvements are often noticed within one or two weeks of treatment, but Cymbalta's full effects are usually not realized until after three or four weeks. If treatment is disrupted, symptoms will likely gradually return over several weeks.

Before Taking Cymbalta

Certain preexisting conditions greatly increase the risk of severe side effects. Discuss risks with a doctor before using Cymbalta if you have:

• Liver or kidney disease
• Alcoholism
• Epilepsy
• Glaucoma
• High Blood Pressure
• Bleeding or blood clotting disorders

Use should be avoided if taking MOAIs, other SNRIs, and powerful stimulants such as cocaine, amphetamine or methamphetamine. There is a chance Cymbalta will interact with other prescription or non-prescription drugs as well; check with a pharmacist if unsure of safety.

Cymbalta should not be used while breast-feeding; it is known to pass through breast milk. Its safety in pregnancy is disputed; parents should discuss risks versus benefits with a trusted doctor or pharmacist before use.

Adverse Reactions

In otherwise healthy adults, side effects are typically mild and may disappear completely as treatment continues:

• Nausea or vomiting
• Dizziness or mild disorientation
• Drowsiness
• Physical or mental restlessness
• Difficulty falling asleep
• Loss of libido
• Impotence
• Dry mouth
• Sweating, especially at night
• Vivid dreams or nightmares
• Constipation

The above side effects are generally not cause for concern unless severe enough to interfere with daily activities. A doctor may be able to suggest treatments to address specific side effects. All side effects will likely reverse completely within a few weeks of the cessation of treatment.

A more rare SNRI side effect, particularly in patients under 24 years of age, is an increase in depression, which may lead to suicidal thoughts. Be alert for symptoms of increasing depression for the duration of treatment.

Alcohol consumption, even in moderation, may increase the severity of side effects and increases risk of liver damage.