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Duloxetine, Oral Capsule

Highlights for Duloxetine

  1. Duloxetine oral capsule is available as both a generic and brand-name drug. Brand names: Cymbalta and Irenka.
  2. Duloxetine is used to treat anxiety, depression, diabetes nerve pain, fibromyalgia, and chronic muscle and joint pain.
  3. Common side effects include nausea, dry mouth, sleepiness, fatigue, and constipation.
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Important warnings

Important warnings

FDA warning: Suicidal thoughts and behaviors
  • This drug has a Black Box Warning. This is the most serious warning from the Food and Drug Administration (FDA). A black box warning alerts doctors and patients to potentially dangerous effects.
  • This drug may increase the risk of suicidal thoughts and behaviors in people aged 24 years and younger. This drug can make depression worse in the early stages of treatment. Tell your doctor right away if your depression gets worse or if you have thoughts about suicide.
  • Drowsiness warning: This drug can cause sleepiness or affect your ability to make decisions, think clearly, or react quickly. You shouldn’t drive, operate heavy machinery, or do other dangerous activities until you know how the drug affects you.
  • Serotonin syndrome warning: This drug affects a chemical in your brain called serotonin. Taking this drug with other medications that affect serotonin may result in increased risk of a serious side effect called serotonin syndrome. Symptoms may include:
    • agitation
    • confusion
    • increased blood pressure or heart rate
    • sweating
    • loss of coordination
  • Dizziness and falling warning: This drug can cause a sudden drop in blood pressure if you stand up too fast. This can cause dizziness and increase your risk of falling.

About

What is duloxetine?

Duloxetine is a prescription oral capsule that’s available as the brand-name drugs Cymbalta and Irenka. It’s also available as a generic drug. Generic drugs usually cost less. In some cases, they may not be available in every strength or form as the brand-name product.

Why it's used

This drug is used to treat:

  • generalized anxiety disorder
  • major depressive disorder
  • nerve pain caused by diabetes
  • fibromyalgia pain
  • chronic muscle and joint pain

How it works

This drug belongs to a class of drugs called serotonin and norepinephrine reuptake inhibitors.

It works by balancing chemicals in your brain that cause depression and anxiety. By balancing these chemicals, this drug also helps inhibit pain signals from your nerves to your brain.

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Side effects

Duloxetine side effects

Duloxetine oral capsule can cause sleepiness or may affect your ability to make decisions, think clearly, or react quickly. You shouldn’t drive, operate heavy machinery, or do other dangerous activities until you know how it affects you. It can also cause other side effects.

Most common side effects

The most common side effects of duloxetine include:

  • in adults:
    • nausea
    • dry mouth
    • sleepiness
    • fatigue
    • constipation
    • loss of appetite
    • increased sweating
    • dizziness
  • in children:
    • nausea
    • decreased weight
    • dizziness
    • diarrhea
    • stomach pain

Serious side effects

If you experience any of these serious side effects, call your doctor right away. If your symptoms are potentially life threatening, or if you think you’re experiencing a medical emergency, call 911.

  • liver damage. Symptoms may include:
    • itching
    • right upper abdominal pain
    • dark urine
    • yellowing of your skin or whites of your eyes
  • changes in blood pressure. Symptoms may include:
    • dizziness or fainting when standing. This may occur more often when you first start duloxetine or when you increase the dose.
  • serotonin syndrome. Symptoms may include:
    • agitation
    • hallucinations
    • coma
    • coordination problems or muscle twitching
    • racing heart
    • high or low blood pressure
    • sweating or fever
    • nausea, vomiting, or diarrhea
    • muscle rigidity
    • dizziness
    • flushing
    • tremor
    • seizures
  • abnormal bleeding. Duloxetine may increase your risk of bleeding or bruising, especially if you take warfarin or nonsteroidal anti-inflammatory drugs.
  • severe skin reactions. Symptoms may include:
    • skin blisters
    • peeling rash
    • sores in your mouth
    • hives
  • manic episodes in people with depression or bipolar disorder. Symptoms may include:
    • greatly increased energy
    • severe trouble sleeping
    • racing thoughts
    • reckless behavior
    • unusually grand ideas
    • excessive happiness or irritability
    • talking more or faster than usual
  • vision problems. Symptoms may include:
    • eye pain
    • changes in vision
    • swelling or redness in or around your eye
  • seizures or convulsions
  • low salt (sodium) levels in your blood. Symptoms may include:
    • headache
    • weakness or feeling unsteady
    • confusion, problems concentrating, or thinking or memory problems
  • problems with urination. Symptoms may include:
    • decrease in your urine flow
    • trouble passing urine

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare provider who knows your medical history.

Interactions

Duloxetine may interact with other medications

Duloxetine oral capsule can interact with other medications, vitamins, or herbs you may be taking. An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well.

To help avoid interactions, your doctor should manage all of your medications carefully. Be sure to tell your doctor about all medications, vitamins, or herbs you’re taking. To find out how this drug might interact with something else you’re taking, talk to your doctor or pharmacist.

Examples of drugs that can cause interactions with promethazine are listed below.

Serotonergic drugs

Taking these drugs with duloxetine may increase your risk of serotonin syndrome, which can be fatal. If you take any of these drugs, your doctor will start you on a lowered dosage of duloxetine and monitor you for signs of serotonin syndrome. Symptoms can include agitation, sweating, muscle twitches, and confusion. Examples are: 

  • selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine and sertraline
  • serotonin-norepinephrine reuptake inhibitors (SSNRIs) such as venlafaxine
  • tricyclic antidepressants (TCAs) such as amitriptyline and clomipramine
  • monoamine oxidase inhibitors (MAOIs) such as selegiline and phenelzine
  • the opioids fentanyl and tramadol
  • the anxiolytic buspirone
  • triptans
  • lithium
  • tryptophan
  • St. John’s wort
  • amphetamines

Schizophrenia drug

An example of this drug is:

  • thioridazine

Taking both duloxetine and thioridazine can increase the amount of thioridazine in your body. This may increase your risk of an abnormal heart rate, or arrhythmia.

Nonsteroidal anti-inflammatory drugs

Taking both duloxetine and NSAIDs may increase your risk of abnormal bleeding. Examples are:

  • ibuprofen
  • indomethacin
  • naproxen

Mental health drug

An example of this drug is:

  • aripiprazole

Taking both duloxetine and aripiprazole may increase the amount of aripiprazole in your body. This can lead to unwanted side effects.

Iron toxicity drug

An example of this drug is:

  • deferasirox

Taking both duloxetine and deferasirox may increase the amount of duloxetine in your body. This can lead to side effects.

Anticoagulants, blood thinners

These include:

  • apixaban
  • warfarin
  • clopidogrel
  • dabigatran
  • edoxaban
  • prasugrel
  • rivaroxaban
  • ticagrelor

Taking both duloxetine and blood thinners may increase your risk of abnormal bleeding.

Gaucher disease drug

An example of this drug is:

  • eliglustat

Taking both duloxetine and eliglustat can increase the amount of eliglustat in your body. This may cause side effects on your heart.

Depression, and drug to stop smoking

  • bupropion

Taking both duloxetine and bupropion may increase your risk of seizures.

Cancer drug

  • doxorubicin

Taking both duloxetine and doxorubicin may increase the amount of doxorubicin in your body. This can lead to side effects.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking.

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Other warnings

Duloxetine warnings

Duloxetine oral capsule drug comes with several warnings.

Alcohol Interaction

Drinking heavily while taking this drug increases your risk of severe liver injury. Talk to your doctor about how much alcohol you drink before starting duloxetine.

Allergy warning

This drug can cause a severe allergic reaction. Symptoms may include:

  • trouble breathing
  • swelling of your throat or tongue
  • hives

Warnings for people with certain health conditions

For people with liver disease: Avoid taking this drug if you have a chronic liver disease or cirrhosis of the liver. You may have trouble clearing the drug from your body. This can lead to further liver damage.

For people with kidney disease: Avoid taking this drug if you have severe kidney disease or if you receive dialysis. Your kidneys may have trouble removing the drug from your body. This could lead to a buildup of the drug and increase your risk of side effects.

For people with diabetes: This drug may affect your blood sugar levels. If you have diabetes your doctor may want you to monitor your levels more closely and may need to change the dose of your diabetes medication.

For people with bladder problems: This drug may affect your ability to urinate. Consult your doctor if you have any problems with urine flow.

Warnings for other groups

For pregnant women: This drug is a category C pregnancy drug. That means two things:

  1. Research in animals has shown adverse effects to the fetus when the mother takes the drug.
  2. There haven’t been enough studies done in humans to be certain how the drug might affect the fetus.

Speak with your doctor if you’re pregnant or plan to become pregnant. This drug should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

For women who are breastfeeding: This drug may pass into breast milk. If you take this drug while you breastfeed, your baby may have side effects of the drug. Tell your doctor if you wish to breastfeed. You may need to decide whether to breastfeed or take this drug.

For seniors: If you’re aged 65 years or older and you take this drug, you may be at a greater risk for falls due to blood pressure changes. You may also be at greater risk for low sodium (salt) in your blood. Symptoms may include:

  • headache
  • weakness or feeling unsteady
  • confusion, problems concentrating, or thinking or memory problems

For children: This drug hasn’t been proved to be safe or effective in treating major depressive disorder in people younger than 18 years. It hasn’t been proved to be safe or effective in treating generalized anxiety disorder in people younger than 7 years.

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Dosage

How to take duloxetine

This dosage information is for duloxetine oral capsule. All possible dosages and forms may not be included here. Your dose, form, and how often you take it will depend on:

  • your age
  • the condition being treated
  • how severe your condition is
  • other medical conditions you have
  • how you react to the first dose

Forms and strengths

Generic: Duloxetine

  • Form: Oral delayed-release capsule
  • Strengths: 20 mg, 30mg, 40 mg, and 60 mg

Major depressive disorder

Adult Dosage (ages 18 years and older)

  • The starting dose may be 30–60 mg per day.
  • The usual dose is 40–60 mg per day.
  • The maximum dose is 120 mg per day.

Child Dosage (ages 0-17 years)

Dosage for people younger than 18 years hasn’t been established.

Generalized anxiety disorder

Adult Dosage (ages 18-64 years)

  • The starting dose may be 30–60 mg per day.
  • The usual dose is 60 mg per day.
  • The maximum dose is 120 mg per day.

Child Dosage (ages 7-17 years)

  • The starting dose is 30 mg per day.
  • The target dose is 30–60 mg per day.
  • The maximum dose is 120 mg per day.

Child Dosage (ages 0-6 years)

Dosage for people younger than 7 years hasn’t been established.

Senior Dosage (ages 65 years and older)

  • The starting dose may be 30 mg per day for 2 weeks.
  • The usual dose is 60 mg per day.

Nerve pain caused by diabetes

Adult Dosage (ages 18-64 years)

  • The starting dose is 60 mg per day.
  • The maximum dosage is 60 mg per day.

Child Dosage (ages 0-17 years)

Dosage for people younger than 18 years hasn’t been established.

Senior Dosage (ages 65 years and older)

  • The starting dose is 30 mg per day.
  • The target dose is 60 mg per day.
  • The maximum dose is 120 mg per day.

Fibromyalgia

Adult Dosage (ages 18 years and older)

  • The starting dose is 30 mg per day.
  • The target dose is 60 mg per day.
  • The maximum dosage is 60 mg per day.

Child Dosage (ages 0-17 years)

Dosage for people younger than 18 years hasn’t been established.

Dosage for chronic muscle and joint pain

Adult Dosage (ages 18 years and older)

  • The starting dose is 30 mg per day.
  • The target dose is 60 mg per day.
  • The maximum dosage is 60 mg per day.

Child Dosage (ages 0-17 years)

Dosage for people younger than 18 years hasn’t been established.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always to speak with your doctor or pharmacist about dosages that are right for you.

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Take as directed

Take as directed

Duloxetine oral capsule is a long-term medication. It comes with risks if you don’t take it as prescribed by your doctor.

If you don't take it at all: Your symptoms won’t get better and could get worse.

If you stop taking it suddenly: Stopping this drug too quickly may result in serious side effects, including:

  • anxiety
  • irritability
  • feeling tired or problems sleeping
  • headache
  • sweating
  • dizziness
  • electric shock-like sensations
  • vomiting or nausea
  • diarrhea

What to do if you miss a dose: If you miss a dose, take it as soon as you remember. However, if it’s just a few hours until your next dose, skip the missed dose and take your next dose on schedule. Never try to catch up by taking two doses at once. This could result in toxic side effects.

How can I tell if the drug is working: Your response to treatment will vary depending on the condition you’re treating.

Important considerations

Important considerations for taking this duloxetine

Keep these considerations in mind if your doctor prescribes duloxetine oral capsule for you.

General

Don’t crush or chew the delayed-release capsule.

Storage

Store this drug at room temperature: 68–77°F (20-25°C).

Refills

A prescription for this medication is refillable. You should not need a new prescription for this medication to be refilled. Your doctor will write the number of refills authorized on your prescription.

Travel

When traveling with your medication:

  • Always carry it with you or in your carry-on bag.
  • Don’t worry about airport X-ray machines. They can’t hurt your medication.
  • You may need to show your pharmacy’s preprinted label to identify the medication. Keep the original prescription-labeled box with you when traveling.

Clinical monitoring

Your doctor may monitor you for worsening or new suicidal thoughts and behaviors.

Insurance

Many insurance companies will require a prior authorization before they approve the prescription and pay for this drug.

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Alternatives

Are there any alternatives?

There are other drugs available to treat your condition. Some may be more suitable for you than others. Talk to your doctor about possible alternatives.

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

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