Cymbalta

Forms/Strengths

Age: 7 years for GAD
Considerations: Monitor for suicidal thoughts and behaviors, especially during initial treatment or dosage changes. Regularly monitor weight and growth in pediatric patients.
Initial Dose:
- Major Depressive Disorder (MDD): Start with 40–60 mg/day (e.g., 20 mg BID or 30 mg QD).
- Generalized Anxiety Disorder (GAD):
  - Adults: Start with 60 mg QD.
  - Pediatrics (≥ 7 years): Start with 30 mg QD, increase to 60 mg QD after 1 week.
Titration: Increase to 60 mg/day after one week if tolerated
Max Dose: 120 mg/day

Inhibits serotonin (5-HT) and norepinephrine (NE) reuptake for mood regulation and pain relief
Improves mood, alleviates anxiety, modulates pain
Oral capsule; doses >60 mg/day typically divided (e.g., 30 mg BID)
Common side effects: nausea, dry mouth, dizziness, constipation, fatigue
Dual action on mood and pain symptoms; monitor for suicidal ideation in younger patients

Common: Nausea, diarrhea, decreased weight, dizziness, decreased appetite, vomiting, fatigue
Serious: Suicidal thoughts and behaviors, severe skin reactions, activation of mania or hypomania, angle-closure glaucoma, seizures, blood pressure increases, hyponatremia

When to Call the Doctor:
- Severe mood changes, suicidal thoughts, or unusual behavior.
- Symptoms of serotonin syndrome (e.g., confusion, rapid heart rate, muscle rigidity, high fever).
- Signs of liver damage (e.g., yellowing of the skin/eyes, dark urine, persistent nausea).
- Unusual bruising or bleeding.
- Severe dizziness, fainting, or difficulty urinating.
Safety Tips:
- Monitor blood pressure regularly, as Cymbalta may increase blood pressure.
- Use caution when driving or operating machinery, as drowsiness and dizziness may occur.
- Avoid alcohol, as it may increase the risk of liver toxicity.
- May cause sexual dysfunction; discuss with provider if problematic.
- Taper gradually if discontinuing to minimize withdrawal effects (e.g., dizziness, nausea, irritability).
Parent Tips for Pediatric Patients:
- Monitor for suicidal thoughts, mood changes, or behavioral changes, especially during the first few weeks.
- May cause drowsiness or agitation; observe how the child responds to the medication.
- Encourage hydration and a balanced diet to help with potential nausea.
- If taken for chronic pain or fibromyalgia, assess response regularly.

Contraindications:
- Hypersensitivity to duloxetine or formulation components.
- Use within 14 days of MAOI therapy (risk of serotonin syndrome).
- Uncontrolled narrow-angle glaucoma.
- Severe hepatic or renal impairment.
Pregnancy:
- Category C; use only if benefits outweigh risks.
- May cause withdrawal symptoms in newborns if taken in the third trimester.
Lactation:
- Excreted in breast milk; use with caution as effects on the infant are unknown.
Drug Interactions:
- Serotonergic drugs (e.g., SSRIs, SNRIs, MAOIs, St. John’s Wort) increase serotonin syndrome risk.
- CYP1A2 and CYP2D6 inhibitors (e.g., fluvoxamine, quinidine) may increase duloxetine levels.
- NSAIDs, anticoagulants, and antiplatelets may increase bleeding risk.
- May enhance the hypertensive effects of stimulants or decongestants.