Cymbalta (duloxetine) Full Prescribing Information DailyMed Drug Information Forms/Strengths  Capsules: 20 mg, 30 mg, 60 mg Dosing 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 Quick Facts 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 Indications  Generalized Anxiety Disorder (F41.1) Off-Label Uses Major Depressive Disorder  (F32.x) Diabetic Peripheral Neuropathic Pain (G63.2) Chronic Musculoskeletal Pain (M79.1) How to Take Take once daily , preferably at the same time each day . Can be taken with or without food ; taking with food may help reduce nausea. Swallow capsule whole ; do not crush, chew, or open. Do not abruptly stop ; tapering is required to prevent withdrawal symptoms. Side Effects   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 Monitoring / Labs Monitor for suicidal thoughts and behaviors. Regularly monitor weight and growth. Monitor blood pressure periodically. Education 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. Additional Information 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.