Duloxetin (Cymbalta) – How Should Duloxetin be Taken?

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Written By Dr. Marcus Yu Bin Pai

MD, PhD. Physical Medicine & Rehabilitation Physician from São Paulo - Brazil. Pain Fellowship in University of São Paulo.


Duloxetine, also known as Cymbalta, is an essential antidepressant widely used in psychiatric practice. In this article, we will explore the various aspects of duloxetine, including its analgesic effects, impact on anxiety and attention, available brands, dosages, potential side effects, and its relationship with weight.

These details are crucial and should be closely monitored in consultation with your healthcare provider.

How Duloxetine Works

Duloxetine was developed in the United States in 1990 and offers a unique approach as an antidepressant. It primarily targets two key neurotransmitters in the brain: serotonin and norepinephrine. By inhibiting their reuptake, duloxetine increases their availability, leading to changes in brain chemistry.

The medication affects serotonin levels in the brain, which influences mood, cognition, anxiety, impulsivity, concentration, and memory. Additionally, it enhances norepinephrine activity, which boosts energy levels and improves focus.

Understanding Duloxetine

Duloxetine, a serotonin and norepinephrine reuptake inhibitor, belongs to the class of antidepressants known as Selective Serotonin and Norepinephrine Reuptake Inhibitors (SSNRIs).

One distinguishing feature of duloxetine is its superior adrenergic potency compared to other medications in its class, such as venlafaxine and desvenlafaxine. This increased potency contributes to its analgesic properties, making it particularly effective in managing chronic pain.

Indications and Efficacy

Duloxetine is primarily indicated for major depressive disorder and has demonstrated superior efficacy compared to selective serotonin reuptake inhibitors (SSRIs) in clinical studies. However, it is important to note that its tolerability may be slightly lower for some individuals.

Despite this, duloxetine generally exhibits greater potency in treating depression compared to SSRIs. The impact on the noradrenaline system in the nervous system is more pronounced, especially at doses above 60 mg, with significant effects observed around 120 mg and higher.

Managing Chronic Pain and Related Conditions

Moreover, duloxetine has shown efficacy in conditions such as diabetic neuropathy, where patients experience depression accompanied by pain. It has also been beneficial for individuals with fibromyalgia, a condition characterized by widespread pain, by reinforcing central nervous system pathways that inhibit pain transmission.

Furthermore, it has been approved for generalized anxiety disorder, offering promising results at slightly lower doses. Recent studies have even highlighted the effectiveness of duloxetine in treating attention-deficit hyperactivity disorder (ADHD) in adults.

Uses of Duloxetine

The diverse range of conditions that can be treated with duloxetine includes:

  • Depression
  • Generalized anxiety disorder
  • Social phobia
  • Diabetic neuropathy
  • Fibromyalgia
  • Chronic pain
  • Inflammatory bowel diseases
  • Muscular pain
  • Premenstrual dysphoric disorder (PMDD)
  • Binge eating disorder
  • Migraine
  • Orthopedic conditions (lumbar pain, osteoarthritis, and knee arthritis)

Administration and Dosage

Duloxetine is generally suitable for adults, including the elderly, and children aged seven and above. It is available in dosages of 30 mg and 60 mg and is administered in capsule form. It is important to follow the prescribed dosage and not discontinue the medication abruptly.

Abrupt discontinuation can result in withdrawal symptoms such as nausea, vomiting, and discomfort. Therefore, it is recommended to gradually reduce the dosage under medical supervision to avoid any adverse effects.

Precautions and Considerations

Before starting duloxetine, it is advisable to monitor blood pressure regularly, especially for individuals with hypertension

When using duloxetine, there are certain precautions and considerations to keep in mind:

  • If you are a driver or operate heavy machinery, consult a psychiatrist before starting duloxetine.
  • Inform your doctor if you are taking medications like beta blockers or antihypertensives, as duloxetine may interact with these drugs.
  • Regular monitoring and periodic blood tests are advisable during treatment to detect any potential complications.
  • Do not switch brands of duloxetine without medical guidance, as different brands may have varying effects.

Side Effects

While duloxetine demonstrates efficacy in managing various conditions, it is essential to consider potential side effects. Commonly reported side effects include nausea, vomiting, dry mouth, and loss of appetite.

Some individuals may experience the desired effects of the medication, while others may face mild side effects such as drowsiness, fatigue, nighttime sweating, and increased blood pressure. However, it is crucial to remember that not everyone will experience these effects, and they are often transient and diminish over time.

Duloxetine may cause both common and rare side effects. Common side effects include:

  • Nausea
  • Vomiting
  • Diarrhea
  • Fatigue
  • Dry mouth
  • Constipation
  • Difficulty urinating

These effects usually subside within 15 to 30 days of treatment. Rare but more serious side effects may include increased bilirubin levels, jaundice, elevated liver enzymes, and seizures. Regular monitoring and periodic blood tests are advisable during treatment to detect any potential complications.

Usage During Pregnancy and Breastfeeding

During pregnancy, it is important to take precautions when using duloxetine. Three months before conception and until the fourth month of pregnancy, it is recommended to take folic acid to protect the developing neural tube of the fetus. While duloxetine can pass into breast milk in small amounts, it is generally not recommended for use during breastfeeding.


In conclusion, duloxetine is a versatile medication used to treat various conditions. It is important to follow the prescribed dosage and consult a psychiatrist for guidance throughout the treatment process.

By understanding the uses, side effects, and precautions associated with duloxetine, individuals can make informed decisions regarding their mental and physical well-being.

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MD, PhD. Physical Medicine & Rehabilitation Physician from São Paulo - Brazil. Pain Fellowship in University of São Paulo.

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