Cymbalta

Cymbalta is the trade name for a medicine whose main active ingredient is duloxetine. Duloxetine belongs to a class of drugs called serotonin and norepinephrine reuptake inhibitors (SNRIs). It is used to treat a variety of mental and neurological conditions.

Cymbalta is available in the form of capsules of different dosage. Dosage and regimen are determined by the doctor depending on the patient's characteristics and treatment goals. It is important to use the drug only under the supervision of a doctor and strictly follow his recommendations.

Indications Cymbalta

1. Depression: Cymbalta is used to treat depressive disorders in adults. It helps improve mood, energy, and ability to perform daily activities.
2. GeneralizedAnxiety Disorder (GAD): Duloxetine may be prescribed to treat generalized anxiety disorder, which is characterized by excessive and unreasonable anxiety and worry.
3. Pain syndromes: Cymbalta is used to treat chronic pain syndromes such as neuropathic pain, osteoarthritic pain, chronic back pain and fibromyalgia.
4. Peripheral neuropathy of diabetic origin: The drug may be used to treat pain symptoms associated with peripheral neuropathy in diabetic patients.

Release form

Here are the main Cymbalta dosages available:

• 20 mg
• 30 mg
• 60 mg

Each capsule is designed to be taken whole to ensure gradual release of duloxetine and minimize side effects. Cymbalta capsules are designed to be taken once daily and the exact dosage and treatment regimen should be determined by the treating physician based on clinical indications.

Pharmacodynamics

Its pharmacodynamics is related to its ability to inhibit the reuptake of the neurotransmitters serotonin and norepinephrine in the synaptic clefts of the central nervous system. This leads to an increase in the concentration of these neurotransmitters in the synaptic clefts and an improvement in signal transduction between neurons. Duloxetine may also have an alpha2-adrenoblocking effect, which may contribute to its analgesic effect in neuropathic pain.

Pharmacokinetics

Absorption: Duloxetine is rapidly absorbed from the gastrointestinal tract after oral administration. Food may slow its absorption but usually does not affect its bioavailability.

Metabolism: Duloxetine is metabolized in the liver via cytochrome P450, mainly involving the CYP2D6 isoenzyme. There is also a contribution from CYP1A2. The major metabolites are dydesmethylduloxetine and glucuronide conjugates.

Elimination: Metabolites of duloxetine are excreted mainly through the kidneys. The plasma elimination half-life of duloxetine and its metabolites is approximately 12 hours.

Pharmacokinetic variations: In elderly people and patients with hepatic dysfunction, changes in pharmacokinetics of duloxetine may be observed. In patients with severe renal impairment (CKD classification) dose reduction is recommended.

Interactions: Duloxetine may interact with other drugs, including inhibitors and inducers of CYP2D6 and CYP1A2 isoenzymes.

Dosing and administration

For the treatment of depression and generalized anxiety disorder:

• Starting dose: Usually 60 mg once a day. In some cases, your doctor may recommend starting treatment with a lower dose to minimize side effects.
• Maximum Dose: For depression, may be up to 120 mg daily in divided doses if recommended by a physician.

For the treatment of diabetic neuropathic pain:

• Initial dose: Usually 60 mg once daily.

For the treatment of fibromyalgia:

• Initial dose: May begin at 30 mg daily, with possible increases to 60 mg once daily based on individual tolerance and treatment efficacy.

For the treatment of chronic musculoskeletal pain:

• Initial and recommended dose: Usually 60 mg once daily.

Method of admission:

• Cymbalta capsules should be taken whole without chewing, crushing or opening. They may be taken with or without food to reduce the risk of stomach upset.
• It is important to take the drug every day at the same time to maintain an even level of the drug in your body.
• Do not stop taking Cymbalta without consulting your doctor, as this may cause unwanted withdrawal symptoms.

On discontinuation of treatment:

• Your doctor may recommend gradually reducing your Cymbalta dose before stopping completely to minimize the risk of withdrawal.

Use Cymbalta during pregnancy

The use of Cymbalta during pregnancy may be associated with risks to the fetus.

Standard guidelines discourage the use of Cymbalta during pregnancy, especially during the first trimester, when the baby's organs and systems are at their most vulnerable. If a pregnant woman needs treatment for depression or an anxiety disorder, her doctor may consider alternative treatments or other safe medications. If a woman is already taking Cymbalta and discovers that she is pregnant, she should tell her doctor immediately.

Contraindications

1. Hypersensitivity: People with known hypersensitivity to duloxetine or any other component of the drug should not take it.
2. MAO inhibition: Duloxetine should not be taken concomitantly with monoamine oxidase inhibitors (MAOIs) as serious interaction reactions, including serotonin syndrome, may result.
3. Pediatric: Duloxetine is not recommended for children and adolescents without proper supervision and advice from a physician.
4. Pregnancy and lactation: There are no sufficient data on the safety of duloxetine during pregnancy and lactation. Therefore, its use in these cases should be carried out only on strict indications and under medical supervision.
5. Liver and kidney disease: Duloxetine may be undesirable or require dosage adjustments in people with severe liver or kidney dysfunction.
6. Hypertension: Duloxetine may cause an increase in blood pressure, so patients with hypertension should take it with caution and under medical supervision.
7. Seizure threshold: In patients with epilepsy or disorders that increase the risk of seizures, the use of duloxetine may increase the likelihood of seizures.
8. Other Conditions: Duloxetine should be used with caution in patients with an increased risk of bleeding, in the presence of cardiovascular disease, or before surgical procedures.

Side effects Cymbalta

1. Headache: Headache may be one of the most common side effects when using Cymbalta. It may manifest as a mild to moderate headache.
2. Drowsinessor restlessness: Some patients may experience drowsiness or restlessness during the day. This may affect the ability to concentrate and complete daily tasks.
3. Dry mouth: Cymbalta may cause dry mouth in some people. This side effect is usually mild and can be managed.
4. Loss of appetite or weight changes: Cymbalta may cause loss of appetite or weight changes, including both weight loss and weight gain, in some patients.
5. Loss of sex drive or sexual dysfunction: This is one of the potential side effects of antidepressants, including Cymbalta. It can manifest as a decreased sex drive, problems with arousal or orgasm.
6. Fatigue or weakness: Cymbalta may cause fatigue, weakness, or a feeling of general malaise in some patients.
7. Increase in blood pressure: Some people may experience an increase in blood pressure while using Cymbalta.

Overdose

An overdose of duloxetine (brand name Cymbalta) can lead to serious side effects and complications. Symptoms of overdose may include drowsiness, dizziness, increased blood pressure, abnormal heart rhythm, nausea, vomiting, diarrhea, seizures, and psychomotor agitation and hallucinations.

Interactions with other drugs

1. Liver enzyme inhibitors: Drugs that affect the activity of liver enzymes, such as cytochrome P450 inhibitors (e.g. Fluconazole, fluoxetine), may affect the metabolism of duloxetine, which may lead to an increase in its concentration in the blood and enhance its effect.
2. Serotonin reuptake inhibitors: Combination with other drugs that increase serotonin levels in the brain (e.g., selective serotonin reuptake inhibitors, triptans, tricyclic antidepressants) may lead to the development of serotonin excess syndrome.
3. Drugs depressing the central nervous system: Combination with other drugs depressing the central nervous system (e.g. Alcohol, benzodiazepines, sleeping pills, strong painkillers) may lead to increased action of duloxetine and increased risk of drowsiness and delayed reactions.
4. Drugs that increase the risk of bleeding: Some drugs, such as acetylsalicylic acid, anticoagulants (e.g. Warfarin), nextatin, may increase the risk of bleeding when combined with duloxetine.
5. Drugs that increase blood pressure: Combination with drugs that may increase blood pressure (e.g. Sympathomimetics) may increase the risk of hypertensive crisis.