CYMBALTA Rx

Select the drug indication to add to your list

CYMBALTA

Anxiety/OCD
Fibromyalgia
Mood disorders
Musculoskeletal pain
Nonnarcotic analgesics
Only 4 drugs may be compared at once

Generic Name and Formulations:

Duloxetine (as HCl) 20mg, 30mg, 60mg; e-c pellets in caps.

Select therapeutic use:

Indications for CYMBALTA:

Generalized anxiety disorder (GAD).

Adult:

Swallow whole. Initially 60mg once daily (may start at 30mg once daily for 1 week then increase to 60mg once daily); usual target 60mg/day (doses up to 120mg/day have been given; if needed, may increase by increments of 30mg/day). Maintenance: 60–120mg once daily. Elderly: Initially 30mg once daily for 2 weeks then increase to 60mg once daily; if needed, may increase by increments of 30mg/day; max 120mg/day.

Children:

<7yrs: not established. 7–17yrs: Initially 30mg once daily for 2 weeks then increase to 60mg once daily; usual target 30–60mg/day; if needed, may increase by increments of 30mg/day; max 120mg/day.

Contraindications:

During or within 14 days of MAOIs. Concomitant MAOIs within 5 days of discontinuing duloxetine. Concomitant linezolid or IV methylene blue.

Warnings/Precautions:

Increased risk of suicidal thoughts and behavior in children, adolescents and young adults; monitor for clinical worsening and unusual changes. Screen for bipolar disorder. Monitor for emergence of serotonin syndrome; discontinue if occurs. Consider dose reduction or discontinuation if orthostatic hypotension, falls and/or syncope occur. Monitor BP prior to and during therapy. History of seizure or mania/hypomania. Angle-closure glaucoma. Decreased GI motility. Cardiac disease. Diabetes. Monitor weight and growth in children. Severe renal impairment (CrCl<30mL/min), end stage renal disease, hepatic insufficiency, evidence of chronic liver disease, or substantial alcohol use: not recommended. Avoid abrupt cessation. Reevaluate periodically. Elderly. Pregnancy (Cat.C) (avoid 3rd trimester; consider tapering, see full labeling for effects on neonate). Nursing mothers.

Interactions:

See Contraindications. Concomitant thioridazine (may cause arrhythmias): not recommended. Increased risk of serotonin syndrome with other serotonergic drugs (eg, triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone, amphetamines, St. John's Wort) or with drugs that impair serotonin metabolism (eg, MAOIs, linezolid, IV methylene blue). Potentiated by CYP1A2 inhibitors (eg, cimetidine, fluvoxamine, quinolones): avoid. May potentiate or be potentiated by CYP2D6 inhibitors (eg, paroxetine, fluoxetine, quinidine) or substrates (eg, tricyclics, phenothiazines, type 1C antiarrhythmics) or other highly protein-bound drugs; caution with CYP2D6 substrates with narrow therapeutic indexes. Caution with potent CYP1A2 inhibitors, antihypertensives, other drugs that induce orthostatic hypotension. Monitor concomitant CNS-acting drugs, and with those that affect gastric pH (eg, proton pump inhibitors). Increased risk of bleeding with NSAIDs, aspirin, or others that affect coagulation.

Pharmacological Class:

SNRI.

Adverse Reactions:

Nausea, dry mouth, constipation, somnolence, hyperhidrosis, decreased appetite, fatigue, dizziness, mania/hypomania, insomnia, urinary hesitation/retention, sexual dysfunction, increased BP, orthostatic hypotension, syncope, falls, hyponatremia, hepatotoxicity (eg, elevated liver transaminases, cholestatic jaundice); discontinue if occurs; rare: seizure, serious skin reactions (eg, Stevens-Johnson Syndrome).

Generic Availability:

YES

How Supplied:

Caps 20mg—60; 30mg—30, 90; 60mg—30, 1000

CYMBALTA 60mg capsules (Qty:30)

appx. price $232.00

Indications for CYMBALTA:

Fibromyalgia.

Adult:

Swallow whole. Initially 30mg once daily for 1 week, then increase to 60mg once daily.

Children:

Not recommended.

Contraindications:

During or within 14 days of MAOIs. Concomitant MAOIs within 5 days of discontinuing duloxetine. Concomitant linezolid or IV methylene blue.

Warnings/Precautions:

Increased risk of suicidal thoughts and behavior in children, adolescents and young adults; monitor for clinical worsening and unusual changes. Screen for bipolar disorder. Monitor for emergence of serotonin syndrome; discontinue if occurs. Consider dose reduction or discontinuation if orthostatic hypotension, falls and/or syncope occur. Monitor BP prior to and during therapy. History of seizure or mania/hypomania. Angle-closure glaucoma. Decreased GI motility. Cardiac disease. Diabetes. Monitor weight and growth in children. Severe renal impairment (CrCl<30mL/min), end stage renal disease, hepatic insufficiency, evidence of chronic liver disease, or substantial alcohol use: not recommended. Avoid abrupt cessation. Reevaluate periodically. Elderly. Pregnancy (Cat.C) (avoid 3rd trimester; consider tapering, see full labeling for effects on neonate). Nursing mothers.

Interactions:

See Contraindications. Concomitant thioridazine (may cause arrhythmias): not recommended. Increased risk of serotonin syndrome with other serotonergic drugs (eg, triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone, amphetamines, St. John's Wort) or with drugs that impair serotonin metabolism (eg, MAOIs, linezolid, IV methylene blue). Potentiated by CYP1A2 inhibitors (eg, cimetidine, fluvoxamine, quinolones): avoid. May potentiate or be potentiated by CYP2D6 inhibitors (eg, paroxetine, fluoxetine, quinidine) or substrates (eg, tricyclics, phenothiazines, type 1C antiarrhythmics) or other highly protein-bound drugs; caution with CYP2D6 substrates with narrow therapeutic indexes. Caution with potent CYP1A2 inhibitors, antihypertensives, other drugs that induce orthostatic hypotension. Monitor concomitant CNS-acting drugs, and with those that affect gastric pH (eg, proton pump inhibitors). Increased risk of bleeding with NSAIDs, aspirin, or others that affect coagulation.

Pharmacological Class:

SNRI.

Adverse Reactions:

Nausea, dry mouth, constipation, somnolence, hyperhidrosis, decreased appetite, fatigue, dizziness, mania/hypomania, insomnia, urinary hesitation/retention, sexual dysfunction, increased BP, orthostatic hypotension, syncope, falls, hyponatremia, hepatotoxicity (eg, elevated liver transaminases, cholestatic jaundice); discontinue if occurs; rare: seizure, serious skin reactions (eg, Stevens-Johnson Syndrome).

Generic Availability:

YES

How Supplied:

Caps 20mg—60; 30mg—30, 90; 60mg—30, 1000

CYMBALTA 60mg capsules (Qty:30)

appx. price $232.00

Indications for CYMBALTA:

Major depressive disorder.

Adult:

Swallow whole. Initially 40mg/day (given as 20mg twice daily) to 60mg/day (given either once daily or as 30mg twice daily); may start at 30mg once daily for 1 week, if needed; usual target 60mg once daily (doses up to 120mg/day have been given). Maintenance: 60mg once daily.

Children:

<18yrs: not recommended.

Contraindications:

During or within 14 days of MAOIs. Concomitant MAOIs within 5 days of discontinuing duloxetine. Concomitant linezolid or IV methylene blue.

Warnings/Precautions:

Increased risk of suicidal thoughts and behavior in children, adolescents and young adults; monitor for clinical worsening and unusual changes. Screen for bipolar disorder. Monitor for emergence of serotonin syndrome; discontinue if occurs. Consider dose reduction or discontinuation if orthostatic hypotension, falls and/or syncope occur. Monitor BP prior to and during therapy. History of seizure or mania/hypomania. Angle-closure glaucoma. Decreased GI motility. Cardiac disease. Diabetes. Monitor weight and growth in children. Severe renal impairment (CrCl<30mL/min), end stage renal disease, hepatic insufficiency, evidence of chronic liver disease, or substantial alcohol use: not recommended. Avoid abrupt cessation. Reevaluate periodically. Elderly. Pregnancy (Cat.C) (avoid 3rd trimester; consider tapering, see full labeling for effects on neonate). Nursing mothers.

Interactions:

See Contraindications. Concomitant thioridazine (may cause arrhythmias): not recommended. Increased risk of serotonin syndrome with other serotonergic drugs (eg, triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone, amphetamines, St. John's Wort) or with drugs that impair serotonin metabolism (eg, MAOIs, linezolid, IV methylene blue). Potentiated by CYP1A2 inhibitors (eg, cimetidine, fluvoxamine, quinolones): avoid. May potentiate or be potentiated by CYP2D6 inhibitors (eg, paroxetine, fluoxetine, quinidine) or substrates (eg, tricyclics, phenothiazines, type 1C antiarrhythmics) or other highly protein-bound drugs; caution with CYP2D6 substrates with narrow therapeutic indexes. Caution with potent CYP1A2 inhibitors, antihypertensives, other drugs that induce orthostatic hypotension. Monitor concomitant CNS-acting drugs, and with those that affect gastric pH (eg, proton pump inhibitors). Increased risk of bleeding with NSAIDs, aspirin, or others that affect coagulation.

Pharmacological Class:

SNRI.

Adverse Reactions:

Nausea, dry mouth, constipation, somnolence, hyperhidrosis, decreased appetite, fatigue, dizziness, mania/hypomania, insomnia, urinary hesitation/retention, sexual dysfunction, increased BP, orthostatic hypotension, syncope, falls, hyponatremia, hepatotoxicity (eg, elevated liver transaminases, cholestatic jaundice); discontinue if occurs; rare: seizure, serious skin reactions (eg, Stevens-Johnson Syndrome).

Generic Availability:

YES

How Supplied:

Caps 20mg—60; 30mg—30, 90; 60mg—30, 1000

CYMBALTA 60mg capsules (Qty:30)

appx. price $232.00

Indications for CYMBALTA:

Chronic musculoskeletal pain (eg, low back pain, osteoarthritis pain).

Adult:

Swallow whole. Initially 30mg once daily for 1 week, then increase to 60mg once daily.

Children:

Not recommended.

Contraindications:

During or within 14 days of MAOIs. Concomitant MAOIs within 5 days of discontinuing duloxetine. Concomitant linezolid or IV methylene blue.

Warnings/Precautions:

Increased risk of suicidal thoughts and behavior in children, adolescents and young adults; monitor for clinical worsening and unusual changes. Screen for bipolar disorder. Monitor for emergence of serotonin syndrome; discontinue if occurs. Consider dose reduction or discontinuation if orthostatic hypotension, falls and/or syncope occur. Monitor BP prior to and during therapy. History of seizure or mania/hypomania. Angle-closure glaucoma. Decreased GI motility. Cardiac disease. Diabetes. Monitor weight and growth in children. Severe renal impairment (CrCl<30mL/min), end stage renal disease, hepatic insufficiency, evidence of chronic liver disease, or substantial alcohol use: not recommended. Avoid abrupt cessation. Reevaluate periodically. Elderly. Pregnancy (Cat.C) (avoid 3rd trimester; consider tapering, see full labeling for effects on neonate). Nursing mothers.

Interactions:

See Contraindications. Concomitant thioridazine (may cause arrhythmias): not recommended. Increased risk of serotonin syndrome with other serotonergic drugs (eg, triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone, amphetamines, St. John's Wort) or with drugs that impair serotonin metabolism (eg, MAOIs, linezolid, IV methylene blue). Potentiated by CYP1A2 inhibitors (eg, cimetidine, fluvoxamine, quinolones): avoid. May potentiate or be potentiated by CYP2D6 inhibitors (eg, paroxetine, fluoxetine, quinidine) or substrates (eg, tricyclics, phenothiazines, type 1C antiarrhythmics) or other highly protein-bound drugs; caution with CYP2D6 substrates with narrow therapeutic indexes. Caution with potent CYP1A2 inhibitors, antihypertensives, other drugs that induce orthostatic hypotension. Monitor concomitant CNS-acting drugs, and with those that affect gastric pH (eg, proton pump inhibitors). Increased risk of bleeding with NSAIDs, aspirin, or others that affect coagulation.

Pharmacological Class:

SNRI.

Adverse Reactions:

Nausea, dry mouth, constipation, somnolence, hyperhidrosis, decreased appetite, fatigue, dizziness, mania/hypomania, insomnia, urinary hesitation/retention, sexual dysfunction, increased BP, orthostatic hypotension, syncope, falls, hyponatremia, hepatotoxicity (eg, elevated liver transaminases, cholestatic jaundice); discontinue if occurs; rare: seizure, serious skin reactions (eg, Stevens-Johnson Syndrome).

Generic Availability:

YES

How Supplied:

Caps 20mg—60; 30mg—30, 90; 60mg—30, 1000

CYMBALTA 60mg capsules (Qty:30)

appx. price $232.00

Indications for CYMBALTA:

Diabetic peripheral neuropathic pain.

Adult:

Swallow whole. 60mg once daily (may start at lower dose if 60mg not tolerated); renal impairment: consider lower starting dose and slow titration.

Children:

Not recommended.

Contraindications:

During or within 14 days of MAOIs. Concomitant MAOIs within 5 days of discontinuing duloxetine. Concomitant linezolid or IV methylene blue.

Warnings/Precautions:

Increased risk of suicidal thoughts and behavior in children, adolescents and young adults; monitor for clinical worsening and unusual changes. Screen for bipolar disorder. Monitor for emergence of serotonin syndrome; discontinue if occurs. Consider dose reduction or discontinuation if orthostatic hypotension, falls and/or syncope occur. Monitor BP prior to and during therapy. History of seizure or mania/hypomania. Angle-closure glaucoma. Decreased GI motility. Cardiac disease. Diabetes. Monitor weight and growth in children. Severe renal impairment (CrCl<30mL/min), end stage renal disease, hepatic insufficiency, evidence of chronic liver disease, or substantial alcohol use: not recommended. Avoid abrupt cessation. Reevaluate periodically. Elderly. Pregnancy (Cat.C) (avoid 3rd trimester; consider tapering, see full labeling for effects on neonate). Nursing mothers.

Interactions:

See Contraindications. Concomitant thioridazine (may cause arrhythmias): not recommended. Increased risk of serotonin syndrome with other serotonergic drugs (eg, triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone, amphetamines, St. John's Wort) or with drugs that impair serotonin metabolism (eg, MAOIs, linezolid, IV methylene blue). Potentiated by CYP1A2 inhibitors (eg, cimetidine, fluvoxamine, quinolones): avoid. May potentiate or be potentiated by CYP2D6 inhibitors (eg, paroxetine, fluoxetine, quinidine) or substrates (eg, tricyclics, phenothiazines, type 1C antiarrhythmics) or other highly protein-bound drugs; caution with CYP2D6 substrates with narrow therapeutic indexes. Caution with potent CYP1A2 inhibitors, antihypertensives, other drugs that induce orthostatic hypotension. Monitor concomitant CNS-acting drugs, and with those that affect gastric pH (eg, proton pump inhibitors). Increased risk of bleeding with NSAIDs, aspirin, or others that affect coagulation.

Pharmacological Class:

SNRI.

Adverse Reactions:

Nausea, dry mouth, constipation, somnolence, hyperhidrosis, decreased appetite, fatigue, dizziness, mania/hypomania, insomnia, urinary hesitation/retention, sexual dysfunction, increased BP, orthostatic hypotension, syncope, falls, hyponatremia, hepatotoxicity (eg, elevated liver transaminases, cholestatic jaundice); discontinue if occurs; rare: seizure, serious skin reactions (eg, Stevens-Johnson Syndrome).

Generic Availability:

YES

How Supplied:

Caps 20mg—60; 30mg—30, 90; 60mg—30, 1000

CYMBALTA 60mg capsules (Qty:30)

appx. price $232.00