Cymbalta
Cymbalta (generic name: Duloxetine) is a selective serotonin and norepinephrine reuptake inhibitor (SSNRI). It increases the amounts of serotonin and norepinephrine in the brain that help maintain mental balance and stop the movement of pain signals in the brain. As an anti-depressant, it shares its mechanism with venlafaxine (Effexor). Both of these medicines are related to the selective serotonin and norepinephrine reuptake inhibitor (SSRIs) – fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), and escitalopram (Lexapro). Similar to venlafaxine and the SSRIs, Cymbalta is also effective in managing generalized anxiety disorder. Additionally, Cymbalta has pain-reducing activity and has been used in the treatment of neuropathic pain associated with diabetic peripheral neuropathy. The mechanism responsible for its effectiveness in this pain state is not known, but is thought to involve its effects on serotonin and norepinephrine in the brain. Cymbalta Duloxetine was approved by the FDA in August 2004.
Cymbalta Duloxetine should not be used in combination with a monoamine oxidase inhibitor (MAOI) - phenelzine (Nardil), tranylcypromine (Parnate), isocarboxazid (Marplan), selegiline (Eldepryl) - or within at least 14 days of discontinuing the MAOI. At least 5 days should be allowed after stopping duloxetine before starting an MAOI. Combinations of SSRIs and MAOIs have led to serious, sometimes fatal, reactions including very high body temperature, rigidity, rapid fluctuations of heart rate and blood pressure, extreme agitation progressing to delirium and coma.
The use of Cymbalta with other medicines that can increase the amount of serotonin the body may result in “serotonin syndrome.” Serotonin syndrome symptoms may include agitation, hallucinations, coma, increased heart rate, changes in blood pressure, high body temperature, incoordination, nausea, vomiting, and diarrhea. Such medicines include MAOIs, the triptan class of anti-migraine medicines [e.g. sumatriptan (Imitrex)], as well as clomipramine (Anafranil), trazodone (Desyrel), tricyclic antidepressants such as amitriptyline (Elavil).
Cymbalta side effects
The most common side effects noted with duloxetine are nausea (experienced by about 1 to 2 of every 5 patients), dry mouth (1 of 6), constipation (1 of 9), diarrhea (1 of 10), fatigue (1 of 10), difficulty sleeping (1 of 9), dizziness (1 of 10). Between two and four times as many people who received duloxetine during clinical studies had to stop treatment and drop out of the study due to side effects than those receiving placebo.
Antidepressants may increase the risk of suicidal thinking and behavior in children and adolescents with depression. Patients who are started on duloxetine or another antidepressant should be observed closely for clinical worsening, suicidal thinking and behavior, or unusual behavior. The average risk of suicidal thinking and behavior in patients receiving antidepressants is about 4% (or 1 per 25), twice the placebo risk of 2%.