What Is Cymbalta (Duloxetine)?

Date: Jul-24-2012Cymbalta (Duloxetine), which is also sold under the brand names Duzela, Yentreve, Xeristar, and Ariclaim, is an SNRI (serotonin-norepinephrine reuptake inhibitor). It is prescribed for the treatment of major depressive disorder, generalized anxiety disorder, painful peripheral neuropathy (especially diabetic neuropathy), and osteoarthritis pain. Duloxetine is also prescribed for patients with fibromyalgia.

Eli Lilly, the pharmaceutical company that markets duloxetine, submitted the medication to the FDA (Food and Drug Administration), USA, to be used for stress urinary incontinence - however, the application was turned down because of concerns regarding suicidal events and liver toxicity. EMA (European Medicines Agency), on the other hand, approved duloxetine for that indication, as an add-on instead of surgery.

Researchers from the University of Michigan School of Nursing reported that Cymbalta relieved symptoms of chemotherapy-induced peripheral neuropathy in 59% of patients in a clinical trial.
How does Cymbalta work?
Scientists are not 100% sure how and why Cymbalta works. They believe it is most likely related to it triggering a change in the activity of serotonin and norepinephrine.

Serotonin is a naturally-occurring neurotransmitter that plays a key role in mood regulation, gastrointestinal function, pain perception, as well as some other physical functions.

Norepinephrine, also known as noradrenaline, is both a hormone and a neurotransmitter. It acts mainly in the locus coeruleus, an area of the brainstem. Norepinephrine plays a role in our "fight-or-flight" response, which is how our body biologically responds to stress. It is also involved in the perception of pain, moods, emotions, movement, blood pressure and cognition (thinking).

Experts believe that duloxetine blocks the reuptake of serotonin, and most likely norepinephrine too within the CNS (central nervous system). Depression is probably partly caused by a surge in pro-inflammatory cytokines in the central nervous system. Duloxetine is thought to reduce pro-inflammatory cytokine activity, while at the same time raising anti-inflammatory cytokine activity. However, no scientific studies have proven that this is the case.

Duloxetine has analgesic effects, and helps control the pain symptoms present in fibromyalgia, bone pain, and diabetic neuropathy. Scientists believe this is due to the active ingredient's sodium ion channel blockade.

Cymbalta 60 mg capsule

Cymbalta's history of approvals with the FDA

November 5th, 2010 - Chronic musculoskeletal pain
November 30th, 2009 - Maintenance treatment of generalized anxiety disorder
June 16th, 2009 - Management of fibromyalgia
November 30th, 2007 - Maintenance treatment of major depressive disorder
February 26th, 2007 - Treatment of generalized anxiety disorder
September 7th, 2004 - Neuropathic pain associated with diabetes
August 4th, 2004 - Treatment of depression

What are the side effects linked to Cymbalta?
Approximately ten to 20 per cent of patients report the following side effects:

Dizziness
Sleepiness
Insomnia
Nausea

Patients may also experience headache and dry mouth.

As is the case with many SSRIs, duloxetine may cause sexual side effects in patients (both sexes).
Important information regarding Cymbalta
Cymbalta should not be used together with an MAO inhibitor, such as tranylcypromine (Parnate), selegiline (Eldepryl, Emsam, Zelapar), furazolidone (Furoxone), rasagiline (Azilect), phenelzine (Nardil), or isocarboxazid (Marplan). Neither should it be used with thioridazine (Mellaril). Cymbalta may interact with these drugs and cause serious side effects.

Patients younger than 24 years may initially have suicidal thoughts when starting on Cymbalta. It is important that the doctor monitors patients carefully during the initial four months of treatment.

If any of the following symptoms or situations occur, you should tell your doctor immediately, especially if they worsen: depressive symptoms get worse, thoughts of self-harm or suicide persist, hyperactivity, restlessness, aggression, hostility, agitation, irritability, and impulsivity.

When taking Cymbalta you should avoid all alcoholic beverages.

Be extra careful when doing activities that require a clear and alert mind, such as using heavy machinery or driving.

Your doctor needs to know whether you have any of the following illnesses, conditions or situations before considering Cymbalta: liver disease, kidney disease, epilepsy or any kind of seizures, glaucoma, bipolar disorder, a history of suicidal thoughts, a bleeding/clotting disorder, or a history of drug abuse.

Written by Chrisitan Nordqvist

View drug information on Cymbalta; Marplan Tablets; Selegiline tablets.

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