Each time you collect a new supply of capsules, make sure the brand name on the container is Cymbalta®. If the name is different to this, please speak with your pharmacist who will advise you.
Please tell your doctor if you feel that you are getting worse, or if you experience any troublesome side-effects.
Duloxetine can make you feel dizzy or sleepy. If this happens, do not drive or use tools or machines.
About duloxetine for mood and nerve disorders
|Type of medicine||A serotonin and noradrenaline reuptake inhibitor|
|Used for||Depression; anxiety disorder; pain caused by nerve damage in people with diabetes|
Duloxetine is prescribed for the treatment of some mood and nerve disorders. These include depression, some anxiety disorders and also a certain type of pain caused by nerve damage in people with diabetes, called diabetic neuropathy.
People with depression have a consistently low mood and other symptoms severe enough to interfere with normal day-to-day activities. Depression can develop for no apparent reason, or it may be triggered by a life event such as a relationship problem, bereavement or illness. Duloxetine is thought to work by regulating the levels of certain chemicals in your brain (called serotonin and noradrenaline/norepinephrine) which may be involved in causing the symptoms of depression.
The symptoms of diabetic neuropathy and some anxiety disorders can also be improved by controlling the levels of serotonin and noradrenaline. If you have been prescribed duloxetine for either of these conditions, it will help to ease your symptoms of pain or anxiety.
Duloxetine is also prescribed for the treatment of urinary symptoms, although a different brand and strength of capsule are used. There is a separate medicine leaflet called Duloxetine for urinary symptoms which gives more information about duloxetine when it is used for this condition.
Before taking duloxetine
Some medicines are not suitable for people with certain conditions, and sometimes a medicine may only be used if extra care is taken. For these reasons, before you start taking duloxetine it is important that your doctor knows:
- If you are pregnant, trying for a baby or breast-feeding.
- If you have any problems with the way your liver works, or any problems with the way your kidneys work.
- If you have a heart condition.
- If you have increased eye pressure (called glaucoma).
- If you have high blood pressure.
- If you have ever had 'high' moods, such as mania in bipolar disorder.
- If you have ever had a fit (seizure).
- If you have a blood disorder that increases your risk of bleeding.
- If you are taking or using any other medicines. This includes any medicines you are taking which are available to buy without a prescription, such as herbal and complementary medicines.
- If you have ever had an allergic reaction to a medicine.
How to take duloxetine
- Before you start the treatment, read the manufacturer's printed information leaflet from inside the pack. It will give you more information about duloxetine and will provide you with a full list of the side-effects which you may experience from taking it.
- Take duloxetine exactly as your doctor tells you to. The usual dose is one capsule of either 30 mg or 60 mg daily. When starting duloxetine, your doctor may give you the lower strength of capsules to begin with, and then increase the strength as you go on.
- Try to take your doses at the same time of day each day, as this will help you to remember to take your doses regularly. You can take duloxetine either before or after meals. Swallow the capsule whole with a drink of water to help you to swallow it.
- If you forget to take a dose at your usual time, take it when you remember. If you do not remember until the following day then leave out the forgotten dose and take your next dose when it is due. Do not take two doses together to make up for a missed dose.
Getting the most from your treatment
- Try to keep your regular appointments with your doctor. This is so your doctor can check on your progress and review your treatment.
- You may feel that duloxetine is not helping you straightaway. If you are taking duloxetine for depression or anxiety, it can take a week or two before the effect builds up and 2-4 weeks before you feel the full benefit. If you are taking duloxetine for nerve pain damage, it can take several weeks before you feel better. Do not stop taking the capsules after a week or so, thinking they are not working.
- If you are taking duloxetine for depression, you should expect that a normal course of treatment will last for around six months after your symptoms have eased. There are several types of antidepressants and they differ in their possible side-effects - if you find that duloxetine does not suit you then let your doctor know, as another may be found that will.
- If you drink alcohol, ask your doctor for advice about drinking while you are on duloxetine. Drinking alcohol can increase the risk of unwanted effects from duloxetine, such as dizziness and blurred vision.
- If you buy any medicines, check with a pharmacist that they are suitable to take with duloxetine. This is because some herbal medicines (such as St John's wort) can increase the risk that you will experience unwanted effects.
- If you are having an operation or dental treatment, please tell the person carrying out the treatment that you are taking duloxetine.
- Keep taking duloxetine until your doctor tells you otherwise. Your treatment is likely to last for a number of months. Stopping suddenly can cause symptoms such as headache, sickness, anxiety, dizziness, shakiness and sleeping problems. Your doctor will reduce your dose gradually over a week or two to reduce the risk of these sort of problems.
Can duloxetine cause problems?
Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. The table below contains some of the common ones associated with duloxetine. You will find a full list in the manufacturer's information leaflet supplied with your medicine. The unwanted effects often improve as your body adjusts to the new medicine, but speak with your doctor or pharmacist if any of the following continue or become troublesome.
|Very common duloxetine side-effects (these affect more than 1 in 10 people)||What can I do if I experience this?|
|Feeling sick||Eat simple meals - avoid rich or spicy foods|
|Dry mouth||Try chewing sugar-free gum or sucking sugar-free sweets|
|Constipation||Try to eat a well-balanced diet and drink several glasses of water each day|
|Common duloxetine side-effects (these affect less than 1 in 10 people)||What can I do if I experience this?|
|Blurred vision; feeling tired, dizzy or sleepy||Do not drive or use tools or machines while affected. Avoid alcohol|
|Diarrhoea||Drink plenty of water to replace lost fluids|
|Headache||Ask your pharmacist to recommend a suitable painkiller|
|Lack of appetite, indigestion, stomach pain, flushing, increased blood pressure, difficulty sleeping, feeling anxious, skin tinglings, feeling shaky, reduced interest in sex, increased sweating||Discuss these with your doctor if any become troublesome|
Important: if you develop any depressing or distressing thoughts or ideas, you should let your doctor know about this as soon as possible. When duloxetine is prescribed for people with depression or anxiety, it can increase the risk of suicidal thoughts, particularly when the treatment is first started.
If you experience any other symptoms which you think may be due to the capsules, please speak with your doctor or pharmacist for further advice.
How to store duloxetine
- Keep all medicines out of the reach and sight of children.
- Store in a cool, dry place, away from direct heat and light.
Important information about all medicines
Never take more than the prescribed dose. If you suspect that you or someone else might have taken an overdose of this medicine, go to the accident and emergency department of your local hospital. Take the container with you, even if it is empty.
This medicine is for you. Never give it to other people even if their condition appears to be the same as yours.
Do not keep out-of-date or unwanted medicines. Take them to your local pharmacy which will dispose of them for you.
If you have any questions about this medicine ask your pharmacist.
Further reading and references
Manufacturer's PIL, Cymbalta® 30 mg hard gastro-resistant capsules, Cymbalta® 60 mg hard gastro-resistant capsules; Eli Lilly and Company Ltd, The electronic Medicines Compendium. Dated October 2013.
British National Formulary; 69th Edition (Mar 2015) British Medical Association and Royal Pharmaceutical Society of Great Britain, London
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