Cymbalta (Duloxetine Hydrochloride)
Compared with: Blackmores Conceive Well Gold 28 Tablets + 28 Capsules

Cymbalta (Duloxetine) is a serotonin-norepinephrine reuptake inhibitor (SNRI) used to treat major depressive disorder, generalized anxiety disorder, fibromyalgia, diabetic peripheral neuropathy, and chronic musculoskeletal pain. It works by increasing serotonin and norepinephrine levels in the brain, improving mood and relieving pain. Recommended dosage starts at 30–60 mg once daily, with a maximum dose of 120 mg per day.

Duloxetine Hydrochloride
(Available in delayed-release capsules: 20 mg, 30 mg, 60 mg)

Duloxetine

Generic Cymbalta

SNRI antidepressant

Dulot

Cymbalta is a serotonin-norepinephrine reuptake inhibitor (SNRI). It selectively inhibits the reuptake of serotonin (5-HT) and norepinephrine (NE) in the central nervous system, enhancing neurotransmitter activity in synaptic clefts. This dual-action mechanism improves mood, reduces anxiety, and provides central pain inhibition by modulating descending pain pathways in the brain and spinal cord.

Approved and Off-Label Uses
FDA-Approved Indications:

Major Depressive Disorder (MDD)

Generalized Anxiety Disorder (GAD)

Diabetic Peripheral Neuropathic Pain

Fibromyalgia

Chronic Musculoskeletal Pain (including osteoarthritis and chronic lower back pain)

Off-Label Uses:

Stress urinary incontinence

Chemotherapy-induced neuropathy

Migraine prophylaxis (limited evidence)

Condition Initial Dose Target/Max Dose
Major Depressive Disorder 30–60 mg once daily 60 mg (max 120 mg/day)
Generalized Anxiety Disorder 30 mg once daily 60–120 mg/day
Fibromyalgia 30 mg once daily 60 mg/day
Neuropathic Pain 60 mg once daily Up to 120 mg/day
Chronic Pain Disorders 30 mg once daily 60 mg once daily

Take with or without food, preferably at the same time daily.

Swallow whole; do not crush or chew capsules.

Prescribing & Monitoring Information
Therapeutic Class: SNRI Antidepressant

Legal Classification: Schedule H (Rx only in India)

Onset of Action: Improvement seen in 1–4 weeks

Discontinuation: Taper slowly to avoid withdrawal (discontinuation syndrome)

Monitoring Parameters: Mood, suicidal ideation, blood pressure, liver enzymes (ALT/AST), glucose in diabetics
Pregnancy: Category C – Use only if benefit outweighs fetal risk

Lactation: Excreted in breast milk; caution advised

Elderly: Increased risk of hyponatremia and falls

Pediatrics: Approved for GAD in patients ≥7 years

Hepatic/Renal Impairment: Avoid in severe hepatic impairment or creatinine clearance <30 mL/min

Common Side Effects:

Nausea

Dry mouth

Drowsiness

Dizziness

Constipation

Decreased appetite

Fatigue

Sweating

Serious Side Effects:

Serotonin syndrome (especially with other serotonergic drugs)

Hepatotoxicity

Stevens-Johnson Syndrome (rare)

Increased blood pressure/heart rate

Suicidal thoughts and behaviors (especially in young adults and adolescents)
Suicidality Risk: Monitor especially during initial treatment or dose adjustments.

Serotonin Syndrome: Risk with SSRIs, MAOIs, tramadol, triptans—avoid combinations.

Liver Injury: Avoid use in chronic alcohol users or hepatic disease.

Bleeding Risk: Especially when used with NSAIDs, anticoagulants.

Hypertension: Monitor BP regularly—duloxetine can raise blood pressure.
Interacting Drug/Class Effect Clinical Advice
MAOIs (e.g., phenelzine) Risk of serotonin syndrome Contraindicated within 14 days
SSRIs/SNRIs, Tramadol, Triptans Increased serotonergic toxicity risk Avoid concurrent use
CYP1A2 inhibitors (e.g., fluvoxamine) Increase duloxetine levels Consider dose reduction
Alcohol Increased hepatotoxicity Avoid concurrent consumption
Anticoagulants, NSAIDs Increased bleeding risk Monitor for bruising/bleeding
Efficacy in Depression: Duloxetine 60 mg/day showed superior remission vs. placebo at 8 weeks (HAM-D score reduction)
Reference: Goldstein DJ, et al. J Clin Psychiatry. 2004

Fibromyalgia: Demonstrated ≥30% pain reduction in 51% of patients vs 31% on placebo
Reference: Arnold LM, et al. Pain. 2004

Neuropathic Pain: Effective for diabetic neuropathy; NNT = 5.2 for ≥50% pain reduction
Reference: Wernicke JF, et al. Pain. 2006

FAQs – Cymbalta (Duloxetine)
Q1. How long does Cymbalta take to work?
A: Some patients may notice mood improvement within 1–2 weeks, but full therapeutic effects may take 4–6 weeks.

Q2. Can I take Cymbalta long-term?
A: Yes, many patients benefit from continued therapy; long-term safety is established but requires monitoring.

Q3. Is Cymbalta addictive?
A: It is not habit-forming, but abrupt discontinuation can cause withdrawal-like symptoms.

Q4. Can I take Cymbalta with other antidepressants?
A: Generally not recommended due to the risk of serotonin syndrome unless supervised by a physician.

Q5. What happens if I miss a dose?
A: Take it as soon as remembered. If it’s close to the next dose, skip the missed dose. Do not double dose.

Q6. Is Cymbalta suitable for diabetic nerve pain?
A: Yes, Cymbalta is FDA-approved for diabetic peripheral neuropathic pain and widely used for it.

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