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Cymbalta withdrawal. Cymbalta withdrawal side effects, Cymbalta withdrawal warnings, Cymbalta withdrawal precautions, Cymbalta withdrawal adverse effects, overdose, withdrawal symptoms and Cymbalta natural alternatives. Before you begin the spiral down with Cymbalta try giving your body what it really wants.

Cymbalta Withdrawal
Cymbalta Side Effects

Cymbalta side effects can be debilitating and most side effects are not understood by patients due to the medical terminology used to define the side effects.

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Cymbalta - Alert from the F.D.A.

FDA ALERT [07/2005]: Suicidal Thoughts or Actions in Children and Adults

Patients with depression or other mental illnesses often think about or attempt suicide. Closely watch anyone taking antidepressants, especially early in treatment or when the dose is changed. Patients who become irritable or anxious, or have new or increased thoughts of suicide or other changes in mood or behavior (or their care givers) should contact their healthcare professional right away.

Children

Taking antidepressants may increase suicidal thoughts and actions in about 1 out of 50 people 18 years or younger. FDA has approved Zoloft for use in children only if they have obsessive-compulsive disorder.

Adults

Several recent scientific publications report the possibility of an increased risk for suicidal behavior in adults who are being treated with antidepressant medications. Even before these reports became available, FDA began a complete review of all available data to determine whether there is an increased risk of suicidal thinking or behavior in adults being treated with antidepressant medications. It is expected that this review will take a year or longer to complete. In the meantime, FDA is highlighting that adults being treated with antidepressant medication, particularly those being treated for depression, should be watched closely for worsening of depression and for increased suicidal thinking or behavior.

This information reflects FDA’s preliminary analysis of data concerning this drug. FDA is considering, but has not reached a final conclusion about, this information. FDA intends to update this sheet when additional information or analyses become available.

Cymbalta withdrawal Body

Cymbalta withdrawal Dry Mouth - The usual amount to moisture in the mouth is noticeably less.

Cymbalta withdrawal Sweating Increased - A large quantity of perspiration that is medically caused.

Cymbalta withdrawal Cardiovascular (Involving the heart and the blood vessels)

Cymbalta withdrawal Palpitation - Unusual and not normal heartbeat, that is sometimes irregular, but rapid and forceful thumping or fluttering. It can be brought on by shock, excitement, exertion, or medical stimulants. A person is normally unaware of his/her heartbeat.

Cymbalta withdrawal Hypertension - is high blood pressure, which is a symptom of disease in the blood vessels leading away from the heart. Hypertension is known as the “silent killer”. The symptoms are usually not obvious, however it can lead to damage to the heart, brain, kidneys and eye, and even to stroke and kidney failure. Treatment includes dietary and lifestyle changes.

Cymbalta withdrawal Bradycardia - The heart rate is slowed from 72 beats per minute, which is normal, to below 60 beats per minute in an adult.

Cymbalta withdrawal Tachycardia - The heart rate is speeded up to above 100 beats per minute in an adult. Normal adult heart rate is 72 beats per minute.

Cymbalta withdrawal ECG Abnormal - A test called an electrocardiogram (ECG) that records the activity of the heart. It measures heartbeats as will as the position and size of the heart’s four chambers. It also measures if there is damage to the heart and the effects of drugs or mechanical devices like a pacemaker on the heart. When the test is abnormal this means that one or more of the following are present: heart disease, defects, beating too fast or too slow, disease of the blood vessels leading from the heart or of the heart valves, and/or a past or about to occur heart attack.

Cymbalta withdrawal Flushing - The skin all over the body turns red.

Cymbalta withdrawal Varicose Vein - Unusually swollen veins near the surface of the skin that sometimes appear twisted and knotted, but always enlarged. They are called hemorrhoids when they appear around the rectum. The cause is attributed to hereditary weakness in the veins aggravated by obesity, pregnancy, pressure from standing, aging, etc. Severe cases may develop swelling in the legs, ankles and feet, eczema and/or ulcers in the affected areas.

Cymbalta withdrawal Gastrointestinal (Involving the stomach and the intestines)

Cymbalta withdrawal Abdominal Cramp/Pain - Sudden, severe, uncontrollable and painful shortening and thickening of the muscles in the belly. The belly includes the stomach as well as the intestines, liver, kidneys, pancreas, spleen, gall bladder, and urinary bladder.

Cymbalta withdrawal Belching - Noisy release of gas from the stomach through the mouth; a burp.

Cymbalta withdrawal Bloating - Swelling of the belly caused by excessive intestinal gas.

Cymbalta withdrawal Constipation - Difficulty in having a bowel movement where the material in the bowels is hard due to a lack of exercise, fluid intake, and roughage in the diet, or due to certain drugs.

Cymbalta withdrawal Diarrhea - Unusually frequent and excessive, runny bowel movements that may result in severe dehydration and shock.

Cymbalta withdrawal Dyspepsia - Indigestion. This is the discomfort you experience after eating. It can be heartburn, gas, nausea, a bellyache or bloating.

Cymbalta withdrawal Flatulence - More gas than normal in the digestive organs.

Cymbalta withdrawal Gagging - Involuntary choking and/or involuntary throwing up.

Cymbalta withdrawal Gastritis - A severe irritation of the mucus lining of the stomach either short in duration or lasting for a long period of time.

Cymbalta withdrawal Gastroenteritis - A condition where the membranes of the stomach and intestines are irritated.

Cymbalta withdrawal Gastroesophageal Reflux - A continuous state where stomach juices flow back into the throat causing acid indigestion and heartburn and possibly injury to the throat.

Cymbalta withdrawal Heartburn - A burning pain in the area of the breastbone caused by stomach juices flowing back up into the throat.

Cymbalta withdrawal Hemorrhoids - Small rounded purplish swollen veins that either bleed, itch or are painful and appear around the anus.

Cymbalta withdrawal Increased Stool frequency - Diarrhea.

Cymbalta withdrawal Indigestion - Unable to properly consume and absorb food in the digestive tract causing constipation, nausea, stomach ache, gas, swollen belly, pain and general discomfort or sickness.

Cymbalta withdrawal Nausea - Stomach irritation with a queasy sensation similar to motion sickness and a feeling that one is going to vomit.

Cymbalta withdrawal Polyposis Gastric - Tumors that grow on stems in the lining of the stomach, which usually become cancerous.

Cymbalta withdrawal Swallowing Difficulty - A feeling that food is stuck in the throat or upper chest area and won’t go down, making it difficult to swallow.

Cymbalta withdrawal Toothache - Pain in a tooth above and below the gum line.

Cymbalta withdrawal Vomiting - Involuntarily throwing up the contents of the stomach and usually getting a nauseated, sick feeling just prior to doing so.

Cymbalta withdrawal General

Cymbalta withdrawal Allergy - The extreme sensitivity of body tissues triggered by substances in the air, drugs, or foods causing a reaction like sneezing, itching, asthma, hay fever, skin rashes, nausea and/or vomiting.

Cymbalta withdrawal Anaphylaxis - A violent, sudden, and severe drop in blood pressure caused by a re-exposure to a foreign protein or a second dosage of a drug that may be fatal unless emergency treatment is given right away.

Cymbalta withdrawal Asthenia - A physically weak condition.

Cymbalta withdrawal Chest Pains - Severe discomfort in the chest caused by not enough oxygen going to the heart because of narrowing of the blood vessels or spasms.

Cymbalta withdrawal Chills - Appearing pale while cold and shivering; sometimes with a fever.

Cymbalta withdrawal Edema of Extremities - Abnormal swelling of the body’s tissue caused by the collection of fluid.

Cymbalta withdrawal Fall - To suddenly lose your normal standing upright position as if you were shot.

Cymbalta withdrawal Fatigue - Loss of normal strength so as to not be able to do the usual physical and mental activities.

Cymbalta withdrawal Fever - Abnormally high body temperature, the normal being 98 degrees Fahrenheit or 37 degrees Centigrade in humans, which is a symptom of disease or disorder in the body. The body is affected by feeling hot, chilled, sweaty, weak and exhausted. If the fever goes too high, death can result.

Cymbalta withdrawal Hot Flashes - Brief, abnormal enlargement of the blood vessels that causes a sudden heat sensation over the entire body. Women in menopause will sometimes experience this.

Cymbalta withdrawal Influenza-like Symptoms - Demonstrating irritation of the respiratory tract (organs of breathing) such as a cold, sudden fever, aches and pains, as well as feeling weak and seeking bed rest, which is similar to having the flu.

Cymbalta withdrawal Leg Pain - A hurtful sensation in the legs that is caused by excessive stimulation of the nerve endings in the legs and results in extreme discomfort.

Cymbalta withdrawal Malaise - The somewhat unclear feeling of discomfort you get when you start to feel sick.

Cymbalta withdrawal Pain in Limb - Sudden, sharp and uncontrolled leg discomfort.

Cymbalta withdrawal Syncope - A short period of light headedness or unconsciousness (black-out) also know as fainting caused by lack of oxygen to the brain because of an interruption in blood flowing to the brain.

Cymbalta withdrawal Tightness of Chest - Mild or sharp discomfort, tightness or pressure in the chest area (anywhere between the throat and belly). The causes can be mild or seriously life-threatening because they include the heart, lungs and surrounding muscles.

Cymbalta withdrawal Hemic and Lymphatic Disorders (Involving the blood and the clear fluids in the tissues that contain white blood cells)

Cymbalta withdrawal Bruise - Damage to the skin resulting in a purple-green-yellow skin coloration that’s caused by breaking the blood vessels in the area without breaking the surface of the skin.

Cymbalta withdrawal Anemia - A condition where the blood is no longer carrying enough oxygen, so the person looks pale and easily gets dizzy, weak and tired. More severely, a person can end up with an abnormal heart, as well as breathing and digestive difficulties. The causes of anemia are not enough protein in the red blood cells, or missing and chemically destroyed red blood cells, as well as diseased or destroyed bone marrow.

Cymbalta withdrawal Nosebleed - Blood lost from the part of the face that has the organs of smell and is where the body takes in oxygen.

Cymbalta withdrawal Hematoma - Broken blood vessels that cause a swelling in an area on the body.

Cymbalta withdrawal Lymphadenopathy Cervical - The lymph nodes in the neck, which are part of the body’s immune system get swollen and enlarge by reacting to the presence of a drug. The swelling is the result of the white blood cells multiplying in order to fight the invasion of the drug.

Cymbalta withdrawal Metabolic and Nutritional Disorders (Energy and health)

Cymbalta withdrawal Arthralgia - Sudden sharp nerve pain in one or more joints.

Cymbalta withdrawal Arthropathy - Having joint disease or abnormal joints.

Cymbalta withdrawal Arthritis - Painfully inflamed and swollen joints. The reddened and swollen condition is brought on by a serious injury or shock to the body either from physical or emotional causes.

Cymbalta withdrawal Back Discomfort - Severe physical distress in the area from the neck to the pelvis along the backbone.

Cymbalta withdrawal Bilirubin Increased - Bilirubin is a waste product of the breakdown of old blood cells. Bilirubin is sent to the liver to be made water-soluble so it can be eliminated from the body through emptying the bladder. A drug can interfere with or damage this normal liver function creating liver disease.

Cymbalta withdrawal Decreased Weight - Uncontrolled and measured loss of heaviness or weight.

Cymbalta withdrawal Gout - A severe arthritis condition that is caused by the dumping of a waste product called uric acid in the tissues and joints. It can become worse and cause the body to develop a deformity after going through stages of pain, inflammation, severe tenderness, and stiffness.

Cymbalta withdrawal Hepatic Enzymes Increased - An increase in the amount of paired liver proteins that regulate liver processes causing a condition where the liver functions abnormally.

Cymbalta withdrawal Hypercholesterolemia - Too much cholesterol in the blood cells.

Cymbalta withdrawal Hyperglycemia - An unhealthy amount of sugar in the blood.

Cymbalta withdrawal Increased Weight - A concentration and storage of fat in the body accumulating over a period of time caused by unhealthy eating patterns, that can predispose the body to many disorders and diseases.

Cymbalta withdrawal Jaw Pain - The pain due to irritation and swelling of the nerves associated with the mouth area where it opens and closes just in front of the ear. Some of the symptoms are pain when chewing, head aches, losing your balance, stuffy ears or ringing in the ears, and teeth grinding.

Cymbalta withdrawal Jaw Stiffness - The result of squeezing and grinding the teeth while asleep that can cause your teeth to deteriorate as well as the muscles and joints of the jaw.

Cymbalta withdrawal Joint Stiffness - A loss of free motion and easy flexibility where any two bones come together.

Cymbalta withdrawal Muscle Cramp - When muscles contract uncontrollably without warning and do not relax. The muscles of any of the body’s organs can cramp.

Cymbalta withdrawal Muscle Stiffness - Tightening of muscles making it difficult to bend.

Cymbalta withdrawal Muscle Weakness - Loss of physical strength.

Cymbalta withdrawal Myalgia - A general widespread pain and tenderness of the muscles.

Cymbalta withdrawal Thirst - A strong, unnatural craving for moisture/water in the mouth and throat.

Cymbalta withdrawal Nervous System (Sensory channels)

Cymbalta withdrawal Carpal Tunnel Syndrome - A pinched nerve in the wrist that causes pain, tingling, and numbing.

Cymbalta withdrawal Coordination Abnormal - A lack of normal, harmonious interaction of the parts of the body when it is in motion.

Cymbalta withdrawal Dizziness - Losing one’s balance while feeling unsteady and lightheaded which may lead to fainting.

Cymbalta withdrawal Disequilibrium - Lack of mental and emotional balance.

Cymbalta withdrawal Faintness - A temporary condition where one is likely to go unconscious and fall.

Cymbalta withdrawal Headache - A sharp or dull persistent pain in the head

Cymbalta withdrawal Hyperreflexia - A not normal and involuntary increased response in the tissues connecting the bones to the muscles.

Cymbalta withdrawal Light-headed Feeling – Uncontrolled and usually brief loss of consciousness caused by lack of oxygen to the brain.

Cymbalta withdrawal Migraine - Reoccurring severe head pain usually with nausea, vomiting, dizziness, flashes or spots before the eyes, and ringing in the ears

Cymbalta withdrawal Muscle Contractions Involuntary - Spontaneous and uncontrollable tightening reaction of the muscles caused by electrical impulses from the nervous system.

Cymbalta withdrawal Muscular Tone Increased - Uncontrolled and exaggeration muscle tension. Muscles are normally partially tensed and this is what gives us muscle tone.

Cymbalta withdrawal Paresthesia - Burning, prickly, itchy, or tingling skin with no obvious or understood physical cause.

Cymbalta withdrawal Restless Legs - A need to move the legs without any apparent reason. Sometimes there is pain, twitching, jerking, cramping, burning, or a creepy-crawly sensation associated with the movements. It worsens when a person is inactive and can interrupt one’s sleep so one feels the need to move to gain some relief.

Cymbalta withdrawal Shaking - Uncontrolled quivering and trembling as if one is cold and chilled.

Cymbalta withdrawal Sluggishness - Lack of alertness and energy, as well as being slow to respond or perform in life.

Cymbalta withdrawal Tics - A contraction of a muscle causing a repeated movement not under the control of the person usually on the face or limbs.

Cymbalta withdrawal Tremor - A nervous and involuntary vibrating or quivering of the body.

Cymbalta withdrawal Twitching - Sharp, jerky and spastic motion sometimes with a sharp sudden pain.

Cymbalta withdrawal Vertigo - A sensation of dizziness with disorientation and confusion.

Cymbalta withdrawal Psychiatric Disorders (Mental and emotional)

Cymbalta withdrawal Aggravated Nervousness - A progressively worsening, irritated and troubled state of mind.

Cymbalta withdrawal Agitation - Suddenly violent and forceful, emotionally disturbed state of mind.

Cymbalta withdrawal Amnesia - Long term or short term, partial or full memory loss created by emotional or physical shock, severe illness, or a blow to the head where the person was caused pain and became unconsciousness.

Cymbalta withdrawal Anxiety Attack - Sudden and intense feelings of fear, terror, and dread physically creating shortness of breath, sweating, trembling and heart palpitations.

Cymbalta withdrawal Apathy - Complete lack of concern or interest for things that ordinarily would be regarded as important or would normally cause concern.

Cymbalta withdrawal Appetite Decreased - Having a lack of appetite despite the ordinary caloric demands of living with a resulting unintentional loss of weight.

Cymbalta withdrawal Appetite Increased - An unusual hunger causing one to overeat.

Cymbalta withdrawal Auditory Hallucination - Hearing things without the voices or noises being present.

Cymbalta withdrawal Bruxism - Grinding and clenching of teeth while sleeping.

Cymbalta withdrawal Carbohydrate Craving - A drive and craving to eat foods rich in sugar and starches (sweets, snacks and junk foods) that intensifies as the diet becomes more and more unbalanced due to the unbalancing of the proper nutritional requirements of the body.

Cymbalta withdrawal Concentration Impaired - Unable to easily focus your attention for long periods of time.

Cymbalta withdrawal Confusion - Not able to think clearly and understand in order to make a logical decision.

Cymbalta withdrawal Crying Abnormal - Unusual and not normal fits of weeping for short or long periods of time for no apparent reason.

Cymbalta withdrawal Depersonalization - A condition where one has lost a normal sense of personal identity.

Cymbalta withdrawal Depression - A hopeless feeling of failure, loss and sadness that can deteriorate into thoughts of death.

Cymbalta withdrawal Disorientation - A loss of sense of direction, place, time or surroundings as well as mental confusion on personal identity.

Cymbalta withdrawal Dreaming Abnormal - Dreaming that leaves a very clear, detailed picture and impression when awake that can last for a long period of time and sometimes be unpleasant.

Cymbalta withdrawal Emotional Lability - Suddenly breaking out in laughter or crying or doing both without being able to control the outburst of emotion. These episodes are unstable as they are caused by things that normally would not have this effect on an individual.

Cymbalta withdrawal Excitability - Uncontrollably responding to stimuli.

Cymbalta withdrawal Feeling Unreal - The awareness that one has an undesirable emotion like fear but can’t seem to shake off the irrational feeling. For example, feeling like one is going crazy but rationally knowing that it is not true. The quality of this side effect resembles being in a bad dream and not being able to wake up.

Cymbalta withdrawal Forgetfulness - Unable to remember what one ordinarily would remember.

Cymbalta withdrawal Insomnia - Sleeplessness caused by physical stress, mental stress or stimulants such as coffee or medications; it is a condition of being abnormally awake when one would ordinarily be able to fall and remain asleep.

Cymbalta withdrawal Irritability - Abnormally annoyed in response to a stimulus.

Cymbalta withdrawal Jitteriness - Nervous fidgeting without an apparent cause.

Cymbalta withdrawal Lethargy - Mental and physical sluggishness and apathy that can deteriorate into an unconscious state resembling deep sleep. A numbed state of mind.

Cymbalta withdrawal Libido Decreased - An abnormal loss of sexual energy or desire.

Cymbalta withdrawal Panic Reaction - A sudden, overpowering, chaotic and confused mental state of terror resulting in being doubt ridden often accompanied with hyperventilation, and extreme anxiety.

Cymbalta withdrawal Restlessness Aggravated - A constantly worsening troubled state of mind characterized by the person being increasingly nervous, unable to relax, and easily angered.

Cymbalta withdrawal Somnolence - Feeling sleepy all the time or having a condition of semi-consciousness.

Cymbalta withdrawal Suicide Attempt - An unsuccessful deliberate attack on one’s own life with the intention of ending it.

Cymbalta withdrawal Suicidal Tendency - Most likely will attempt to kill oneself.

Cymbalta withdrawal Tremulousness Nervous - Very jumpy, shaky, and uneasy while feeling fearful and timid. The condition is characterized by thoughts of dreading the future, involuntary quivering, trembling, and feeling distressed and suddenly upset.

Cymbalta withdrawal Yawning - involuntary opening of the mouth with deep inhalation of air.

Cymbalta withdrawal Reproductive Disorder Female

Cymbalta withdrawal Breast Neoplasm - A tumor or cancer, of either of the two milk-secreting organs on the chest of a woman.

Cymbalta withdrawal Menorrhagia - Abnormally heavy menstrual period or a menstrual flow that has continued for an unusually long period of time.

Cymbalta withdrawal Menstrual Cramps - Painful, involuntary uterus contractions that women experience around the time of their menstrual period, sometimes causing pain in the lower back and thighs.

Cymbalta withdrawal Menstrual Disorder - A disturbance or derangement in the normal function of a woman’s menstrual period.

Cymbalta withdrawal Pelvic Inflammation - The reaction of the body to infectious, allergic, or chemical irritation, which in turn causes tissue irritation, injury, or bacterial infection characterized by pain, redness, swelling, and sometimes loss of function. The reaction usually begins in the uterus and spreads to the fallopian tubes, ovaries, and other areas in the hipbone region of the body.

Cymbalta withdrawal Premenstrual Syndrome - Various physical and mental symptoms commonly experienced by women of childbearing age usually 2 to 7 days before the start of their monthly period. There are over 150 symptoms including eating binges, behavioral changes, moodiness, irritability, fatigue, fluid retention, breast tenderness, headaches, bloating, anxiety, and depression. The symptoms cease shortly after the period begins, and disappear with menopause.

Cymbalta withdrawal Spotting Between Menses - Abnormal bleeding between periods. Unusual spotting between menstrual cycles.

Cymbalta withdrawal RESPIRATORY SYSTEM (Organs involved in breathing)

Cymbalta withdrawal Asthma - A disease of the breathing system initiated by and allergic reaction or a chemical with repeated attacks of coughing, sticky mucus, wheezing, shortness of breath, and a tight feeling in the chest. The disease can reach a state where it stops a person from exhaling, leading to unconsciousness and death.

Cymbalta withdrawal Breath Shortness - Unnatural breathing using a lot off effort resulting in not enough air taken in by the body.

Cymbalta withdrawal Bronchitis - Inflammation of the two main breathing tubes leading from the windpipe to the lungs. The disease is marked with coughing, a low-grade fever, chest pains, and hoarseness, caused by an allergic reaction.

Cymbalta withdrawal Coughing - A cough is the response to an irritation, such as mucus, that causes the muscles controlling the breathing process to expel air from the lungs suddenly and noisily to keep the air passages free from the irritating material.

Cymbalta withdrawal Laryngitis - Inflammation of the voice box characterized by hoarseness, sore throat, and coughing. It can be cause by straining the voice or exposure to infectious, allergic or chemical irritation.

Cymbalta withdrawal Nasal Congestion - The presence of an abnormal amount of fluid in the nose.

Cymbalta withdrawal Pneumonia Tracheitis - Bacterial infection of the air passageways and lungs that causes redness, swelling and pain in the windpipe. Other symptoms are high fever, chills, pain in the chest, difficulty in breathing, and coughing with mucus discharge.

Cymbalta withdrawal Rhinitis - Chemical irritation causing pain, redness and swelling in the mucus membranes of the nose.

Cymbalta withdrawal Sinus Congestion - The mucus-lined areas of the bones in the face that are thought to help warm and moisten air to the nose. These areas become clogged with excess fluid or infected.

Cymbalta withdrawal Sinus Headache - The abnormal amount of fluid in the hollows of the face bone area especially around the nose. This excess fluid creates pressure, causing pain in the head.

Cymbalta withdrawal Sinusitis - The body reacting to chemical irritation causing redness, swelling and pain in the area of the hollows in the facial bones especially around the nose.

Cymbalta withdrawal SKELETAL

Cymbalta withdrawal Neck/Shoulder Pain - Hurtful sensations of the nerve endings caused by damage to the tissues in the neck and shoulder signaling danger of disease.

Cymbalta withdrawal SKIN and APPENDAGES DISORDERS (Skin, legs and arms)

Cymbalta withdrawal Acne - Eruptions of the oils glands of the skin, especially on the face, marked by pimples, blackheads, whiteheads, bumps, and more severely, by cysts and scarring.

Cymbalta withdrawal Alopecia - The loss of hair or baldness.

Cymbalta withdrawal Eczema - A severe or continuing skin disease marked by redness, crusting and scaling with watery blisters and itching. It is often difficult to treat and will sometimes go away only to reappear again.

Cymbalta withdrawal Dermatitis - Generally irritated skin that can be caused by any of a number of irritating things such as parasites, fungus, bacteria, or foreign substances causing an allergic reaction. It is a general inflammation of the skin.

Cymbalta withdrawal Dry Lips - The lack of normal moisture in the fleshy folds that surround the mouth.

Cymbalta withdrawal Dry Skin - The lack of normal moisture/oils in the surface layer of the body. The skin is the body’s largest organ.

Cymbalta withdrawal Folliculitis - Inflammation of a follicle (small body sac) especially a hair follicle. A hair follicle contains the root of a hair.

Cymbalta withdrawal Furunculosis - Skin boils that show up repeatedly.

Cymbalta withdrawal Lipoma - A tumor of mostly fat cells that is not health endangering.

Cymbalta withdrawal Pruritus - Extreme itching of often-undamaged skin.

Cymbalta withdrawal Rash - A skin eruption or discoloration that may or may not be itching, tingling, burning, or painful. It may be caused by an allergy, an skin irritation, a skin disease.

Cymbalta withdrawal Skin Nodule - A bulge, knob, swelling or outgrowth in the skin that is a mass of tissue or cells.

Cymbalta withdrawal SPECIAL SENSES

Cymbalta withdrawal Conjunctivitis - Infection of the membrane that covers the eyeball and lines the eyelid, caused by a virus, allergic reaction, or an irritating chemical. It is characterized by redness, a discharge of fluid and itching.

Cymbalta withdrawal Dry Eyes - Not enough moisture in the eyes.

Cymbalta withdrawal Earache - Pain in the ear.

Cymbalta withdrawal Eye Infection - The invasion of the eye tissue by a bacteria, virus, fungus, etc, causing damage to the tissue, with toxicity. Infection spreading in the body progresses into disease.

Cymbalta withdrawal Eye Irritation - An inflammation of the eye.

Cymbalta withdrawal Metallic Taste - A range of taste impairment from distorted taste to a complete loss of taste.

Cymbalta withdrawal Pupils Dilated - Abnormal expansion of the blace circular opening in the center of the eye.

Cymbalta withdrawal Taste alteration - Abnormal flavor detection in food.

Cymbalta withdrawal Tinnitus - A buzzing, ringing, or whistling sound in one or both ears occurring from the internal use of certain drugs.

Cymbalta withdrawal Vision Abnormal - Normal images are seen differently by the viewer.

Cymbalta withdrawal Vision Blurred - Eyesight is dim or indistinct and hazy in outline or appearance.

Cymbalta withdrawal Visual Disturbance - Eyesight is interfered with or interrupted. Some disturbances are light sensitivity and the inability to easily distinguish colors.

Cymbalta withdrawal URINARY SYSTEM DISORDER

Cymbalta withdrawal Blood in Urine - Blood is present when one empties liquid waste product of the kidneys through the bladder by urinating in the toilet turning the water pink to bright red. Or you could see pots of blood in the water after urinating.

Cymbalta withdrawal Dysuria - Difficult or painful urination.

Cymbalta withdrawal Kidney Stone - Small hard masses of salt deposits that the kidney forms.

Cymbalta withdrawal Urinary Frequency - Having to urinate more often than usual or between unusually short time periods.

Cymbalta withdrawal Urinary Tract Infection - An invasion of bacteria, viruses, fungi, etc., of the system in the body that starts with the kidneys and eliminates urine from the body. If the invasion goes unchecked it can injure tissue and progress into disease.

Cymbalta withdrawal Urinary Urgency - A sudden compelling urge to urinate, accompanied by discomfort in the bladder.

Cymbalta withdrawal UROGENITAL (Urinary tract and genital structures or functions)

Cymbalta withdrawal Anorgasmia - Failure to experience an orgasm.

Cymbalta withdrawal Ejaculation Disorder - Dysfunction of the discharge of semen during orgasm.

Cymbalta withdrawal Menstrual Disorder - Dysfunction of the discharge during the monthly menstrual cycle.

Cymbalta withdrawal Acute Renal Failure - The kidneys stop functioning properly to excrete wastes.

Cymbalta withdrawal Angioedema - Intensely itching and swelling welts on the skin called hives caused by an allergic reaction to internal or external agents. The reaction is common to a food or a drug. Chronic cases can last for a long period of time.

Cymbalta withdrawal Toxic Epidermal Necrolysis - An abnormal condition where a large portion of skin becomes intensely red and peels off like a second-degree burn. Often the symptoms include blistering.

Cymbalta withdrawal Gastrointestinal Hemorrhage - Stomach and intestinal excessive internal bleeding.

Cymbalta withdrawal Grand Mal Seizures (or Convulsions) - A recurring sudden violent and involuntary attack of muscle spasms with a loss of consciousness.

Cymbalta withdrawal Neuroleptic Malignant Syndrome - A life threatening, rare reaction to an anti-psychotic drug marked by fever, muscular rigidity, changed mental status, and dysfunction of the autonomic nervous system.

Cymbalta withdrawal Pancreatitis - Chemical irritation with redness, swelling, and pain in the pancreas where digestive enzymes and hormones are secreted.

Cymbalta withdrawal QT Prolongation - A very fast heart rhythm disturbance that is too fast for the heart to beat effectively so the blood to the brain falls causing a sudden loss of consciousness and may cause sudden cardiac death.

Cymbalta withdrawal Rhabdomyolysis - The breakdown of muscle fibers that releases the fibers into the circulatory system. Some of the fibers are poisonous to the kidney and frequently result in kidney damage.

Cymbalta withdrawal Serotonin Syndrome - A disorder brought on by excessive levels of serotonin caused by drugs and can be fatal as death from this side effect can come very rapidly.

Cymbalta withdrawal Thrombocytopenia - An abnormal decrease in the number of blood platelets in the circulatory system. A decrease in platelets would cause a decrease in the ability of the blood to clot when necessary.

Cymbalta withdrawal Torsades de Pointes - Unusual rapid heart rhythm starting in the lower heart chambers. If the short bursts of rapid heart rhythm continue for a prolonged period it can degenerate into a more rapid rhythm and can be fatal.

Cymbalta Clinical Trials

High-dose duloxetine for treatment-resistant obsessive-compulsive disorder: a case report with sustained full remission.

Yeh YW, Chen CH, Kuo SC, Wang SC, Chen CK, Feng HM.

Clin Neuropharmacol. 2009 May-Jun;32(3):174-6. No abstract available.

PMID: 19483491 [Cymbalta - in process]

Duloxetine: a review of its use in the treatment of generalized anxiety disorder.

Carter NJ, McCormack PL.

CNS Drugs. 2009;23(6):523-41. doi: 10.2165/00023210-200923060-00006.

PMID: 19480470 [Cymbalta - in process]

Fibromyalgia: a complex syndrome requiring a multidisciplinary approach.

Spaeth M, Briley M.

Hum Psychopharmacol. 2009 May 28;24(S1):S3-S10. [Epub ahead of print]

PMID: 19479907 [Cymbalta - as supplied by publisher]

The psychiatrist confronted with a fibromyalgia patient.

Kasper S.

Hum Psychopharmacol. 2009 May 28;24(S1):S25-S30. [Epub ahead of print]

PMID: 19479904 [Cymbalta - as supplied by publisher]

Total residue analysis of swabs by ion mobility spectrometry.

Strege MA.

Anal Chem. 2009 Jun 1;81(11):4576-80.

PMID: 19476393 [Cymbalta - in process]

A double-blind, randomized trial of duloxetine versus placebo in the management of chronic low back pain.

Skljarevski V, Ossanna M, Liu-Seifert H, Zhang Q, Chappell A, Iyengar S, Detke M, Backonja M.

Eur J Neurol. 2009 May 12. [Epub ahead of print]

PMID: 19469829 [Cymbalta - as supplied by publisher]

A 1-year safety and efficacy study of duloxetine in patients with fibromyalgia.

Chappell AS, Littlejohn G, Kajdasz DK, Scheinberg M, D'Souza DN, Moldofsky H.

Clin J Pain. 2009 Jun;25(5):365-75.

PMID: 19454869 [Cymbalta - in process]

Brain Functional Changes and Duloxetine Treatment Response in Fibromyalgia: A Pilot Study.

Hunter AM, Leuchter AF, Cook IA, Abrams M, Siegman BE, Furst DE, Chappell AS.

Pain Med. 2009 Apr 22. [Epub ahead of print]

PMID: 19453962 [Cymbalta - as supplied by publisher]

Serotonin syndrome induced by duloxetine.

Hadikusumo B, Ng B.

Aust N Z J Psychiatry. 2009 Jun;43(6):581-2. No abstract available.

PMID: 19452666 [Cymbalta - in process]

Chronic oral nicotine increases brain [(3)H]epibatidine binding and responsiveness to antidepressant drugs, but not nicotine, in the mouse forced swim test.

Andreasen JT, Nielsen EO, Redrobe JP.

Psychopharmacology (Berl). 2009 May 12. [Epub ahead of print]

PMID: 19452140 [Cymbalta - as supplied by publisher]

Stress incontinence.

Onwude JL.

Clin Evid (Online). 2009 Apr 14;2009. pii: 0808.

PMID: 19445750 [Cymbalta - in process]

Treatment-emergent sexual dysfunction related to antidepressants: a meta-analysis.

Serretti A, Chiesa A.

J Clin Psychopharmacol. 2009 Jun;29(3):259-66.

PMID: 19440080 [Cymbalta - in process]

Antidepressant-associated myoclonic status in a patient with symptomatic generalized epilepsy: does risk occur with therapeutic doses?

Melani F, Rosati E, Chiocchetti B, Muscas GC.

Epilepsy Behav. 2009 Apr;14(4):681-3. Epub 2009 Jan 31.

PMID: 19435583 [Cymbalta - in process]

Advances in the management of diabetic peripheral neuropathy.

Tesfaye S.

Curr Opin Support Palliat Care. 2009 Jun;3(2):136-43.

PMID: 19421063 [Cymbalta - in process]

Nontricyclic antidepressants for neuropathic pain #187.

Hawley P.

J Palliat Med. 2009 May;12(5):476-7.

PMID: 19416046 [Cymbalta - in process]

Pharmacotherapy of chronic pain: a synthesis of recommendations from systematic reviews.

Kroenke K, Krebs EE, Bair MJ.

Gen Hosp Psychiatry. 2009 May-Jun;31(3):206-19. Epub 2009 Mar 4.

PMID: 19410099 [Cymbalta - in process]

Clinical outcome and tolerability of duloxetine in the treatment of major depressive disorder: a 12-week study with plasma levels.

Volonteri L, Colasanti A, Cerveri G, Fiorentini A, De Gaspari I, Mauri M, Valli A, Papa P, Mencacci C.

J Psychopharmacol. 2009 Apr 30. [Epub ahead of print]

PMID: 19406851 [Cymbalta - as supplied by publisher]

Anti-nociceptive effect of duloxetine in mouse model of diabetic neuropathic pain.

Kuhad A, Bishnoi M, Chopra K.

Indian J Exp Biol. 2009 Mar;47(3):193-7.

PMID: 19405385 [Cymbalta - indexed for Cymbalta Withdrawal Cymbalta Side Effects]

Quality of Life Measurement in Antidepressant Trials. Is There an Added Value?

De Fruyt J, Demyttenaere K.

Psychother Psychosom. 2009 Apr 28;78(4):212-219. [Epub ahead of print]

PMID: 19401621 [Cymbalta - as supplied by publisher]

[Severe forms of depression: The efficacy of escitalopram.]

Spadone C.

Encephale. 2009 Apr;35(2):152-9. Epub 2009 Mar 31. French.

PMID: 19393384 [Cymbalta - in process]

Effectiveness of the psychological and pharmacological treatment of catastrophization in patients with fibromyalgia: a randomized controlled trial.

Garcia-Campayo J, Serrano-Blanco A, Rodero B, Magallon R, Alda M, Andres E, Luciano JV, Lopez-Del Hoyo Y.

Trials. 2009 Apr 23;10(1):24. [Epub ahead of print]

PMID: 19389246 [Cymbalta - as supplied by publisher]

Duloxetine in fibromyalgia: rejection. Marketing authorization rejected and rightly so.

[No authors listed]

Prescrire Int. 2009 Feb;18(99):14.

PMID: 19388210 [Cymbalta - indexed for Cymbalta Withdrawal Cymbalta Side Effects]

Population pharmacokinetics of orally administered duloxetine in patients: implications for dosing recommendation.

Lobo ED, Quinlan T, O'Brien L, Knadler MP, Heathman M.

Clin Pharmacokinet. 2009;48(3):189-97. doi: 10.2165/00003088-200948030-00005.

PMID: 19385712 [Cymbalta - in process]

Pharmacological modulation of movement-evoked pain in a rat model of osteoarthritis.

Chandran P, Pai M, Blomme EA, Hsieh GC, Decker MW, Honore P.

Eur J Pharmacol. 2009 Jun 24;613(1-3):39-45. Epub 2009 Apr 16.

PMID: 19376109 [Cymbalta - as supplied by publisher]

Insomnia in patients with depression: some pathophysiological and treatment considerations.

Jindal RD.

CNS Drugs. 2009;23(4):309-29. doi: 10.2165/00023210-200923040-00004.

PMID: 19374460 [Cymbalta - in process]

Escitalopram versus other antidepressive agents for depression.

Cipriani A, Santilli C, Furukawa TA, Signoretti A, Nakagawa A, McGuire H, Churchill R, Barbui C.

Cochrane Database Syst Rev. 2009 Apr 15;(2):CD006532.

PMID: 19370639 [Cymbalta - in process]

[Cymbalta in the treatment of chronic pain syndromes]

[No authors listed]

Zh Nevrol Psikhiatr Im S S Korsakova. 2009;109(3):32-4. Russian.

PMID: 19365388 [Cymbalta - in process]

[Cymbalta (duloxetine) in the treatment of anxiety-depressive disorders in patients with discirculatory encephalopathy]

Rzheusskaia GV, Listopadov IuI, Bobrova MV, Umrudina AG.

Zh Nevrol Psikhiatr Im S S Korsakova. 2009;109(2):26-30. Russian.

PMID: 19365368 [Cymbalta - indexed for Cymbalta Withdrawal Cymbalta Side Effects]

Improvement With Duloxetine in an Adult ADHD Patient.

Tourjman SV, Bilodeau M.

J Atten Disord. 2009 Apr 9. [Epub ahead of print]

PMID: 19359667 [Cymbalta - as supplied by publisher]

Extended release quetiapine fumarate monotherapy in major depressive disorder: a placebo- and duloxetine-controlled study.

Cutler AJ, Montgomery SA, Feifel D, Lazarus A, Aström M, Brecher M.

J Clin Psychiatry. 2009 Apr;70(4):526-39. Epub 2009 Apr 7.

PMID: 19358790 [Cymbalta - in process]

Is the significant superiority of escitalopram compared with other antidepressants clinically relevant?

Montgomery SA, Möller HJ.

Int Clin Psychopharmacol. 2009 May;24(3):111-8.

PMID: 19357527 [Cymbalta - in process]

Duloxetine in the management of elderly patients with major depressive disorder: an analysis of published data.

Mancini M, Gianni W, Rossi A, Amore M.

Expert Opin Pharmacother. 2009 Apr;10(5):847-60.

PMID: 19351233 [Cymbalta - in process]

Cooperative opioid and serotonergic mechanisms generate superior antidepressant-like effects in a mice model of depression.

Berrocoso E, Mico JA.

Int J Neuropsychopharmacol. 2009 Apr 3:1-12. [Epub ahead of print]

PMID: 19341511 [Cymbalta - as supplied by publisher]

Duloxetine in the treatment of generalized anxiety disorder.

Norman TR, Olver JS.

Neuropsychiatr Dis Treat. 2008 Dec;4(6):1169-80.

PMID: 19337457 [Cymbalta - in process]

Related Articles Free article in PMC

Treatment options and patient perspectives in the management of fibromyalgia: future trends.

Lawson K.

Neuropsychiatr Dis Treat. 2008 Dec;4(6):1059-71.

PMID: 19337451 [Cymbalta - in process]

Related Articles Free article in PMC

Newer treatments for fibromyalgia syndrome.

Harris RE, Clauw DJ.

Ther Clin Risk Manag. 2008 Dec;4(6):1331-42.

PMID: 19337439 [Cymbalta - in process]

Related Articles Free article in PMC

Patient-Assessed Versus Physician-Assessed Disease Severity and Outcome in Patients With Nonspecific Pain Associated With Major Depressive Disorder.

Demyttenaere K, Desaiah D, Petit C, Croenlein J, Brecht S.

Prim Care Companion J Clin Psychiatry. 2009;11(1):8-15.

PMID: 19333404 [Cymbalta - as supplied by publisher]

Baseline severity of depression predicts antidepressant drug response relative to escitalopram.

Kilts CD, Wade AG, Andersen HF, Schlaepfer TE.

Expert Opin Pharmacother. 2009 Apr;10(6):927-36.

PMID: 19317630 [Cymbalta - in process]

Determination of duloxetine in human plasma by capillary electrophoresis with laser-induced fluorescence detection.

Musenga A, Amore M, Mandrioli R, Kenndler E, de Martino L, Raggi MA.

J Chromatogr B Analyt Technol Biomed Life Sci. 2009 Apr 15;877(11-12):1126-32. Epub 2009 Mar 3.

PMID: 19285923 [Cymbalta - indexed for Cymbalta Withdrawal Cymbalta Side Effects]

Patient reported outcomes tools in an observational study of female stress urinary incontinence.

van de Vaart H, Falconer C, Quail D, Timlin L, Manning M, Tincello D, Tunn R.

Neurourol Urodyn. 2009 Mar 12. [Epub ahead of print]

PMID: 19283868 [Cymbalta - as supplied by publisher]

Effects of adjunctive reboxetine in patients with duloxetine-resistant depression: a 12-week prospective study.

Seguí J, López-Muñoz F, Alamo C, Camarasa X, García-García P, Pardo A.

J Psychopharmacol. 2009 Mar 12. [Epub ahead of print]

PMID: 19282423 [Cymbalta - as supplied by publisher]

The facilitatory effect of duloxetine combined with pelvic floor muscle training on the excitability of urethral sphincter motor neurons.

Mehnert U, Boy S, Widmer-Simitovic S, Reitz A, Schurch B.

Int Urogynecol J Pelvic Floor Dysfunct. 2009 Jun;20(6):659-66. Epub 2009 Mar 7.

PMID: 19271093 [Cymbalta - in process]

Gateways to clinical trials. December 2008.

Tomillero A, Moral MA.

Methods Find Exp Clin Pharmacol. 2008 Dec;30(10):761-82.

PMID: 19271026 [Cymbalta - indexed for Cymbalta Withdrawal Cymbalta Side Effects]

Duloxetine treatment for women with premenstrual dysphoric disorder: a single-blind trial.

Ramos MG, Hara C, Rocha FL.

Int J Neuropsychopharmacol. 2009 Feb 27:1-8. [Epub ahead of print]

PMID: 19250561 [Cymbalta - as supplied by publisher]

When worlds collide: urinary incontinence and female sexuality.

Katz A.

Am J Nurs. 2009 Mar;109(3):59-63. Review. No abstract available.

PMID: 19240500 [Cymbalta - indexed for Cymbalta Withdrawal Cymbalta Side Effects]

Duloxetine in acute major depression: review of comparisons to placebo and standard antidepressants using dissimilar methods.

Girardi P, Pompili M, Innamorati M, Mancini M, Serafini G, Mazzarini L, Del Casale A, Tatarelli R, Baldessarini RJ.

Hum Psychopharmacol. 2009 Apr;24(3):177-90.

PMID: 19229839 [Cymbalta - in process]

Open-label support for duloxetine for the treatment of panic disorder.

Simon NM, Kaufman RE, Hoge EA, Worthington JJ, Herlands NN, Owens ME, Pollack MH.

CNS Neurosci Ther. 2009 Winter;15(1):19-23.

PMID: 19228176 [Cymbalta - indexed for Cymbalta Withdrawal Cymbalta Side Effects]

Fibromyalgia: presentation and management with a focus on pharmacological treatment.

Sumpton JE, Moulin DE.

Pain Res Manag. 2008 Nov-Dec;13(6):477-83. Review.

PMID: 19225604 [Cymbalta - indexed for Cymbalta Withdrawal Cymbalta Side Effects]

A validated stability indicating rapid LC method for duloxetine HCl.

Srinivasulu P, Srinivas KS, Reddy RS, Mukkanti K, Buchireddy R.

Pharmazie. 2009 Jan;64(1):10-3.

PMID: 19216224 [Cymbalta - indexed for Cymbalta Withdrawal Cymbalta Side Effects]

Pilot study of augmentation with aripiprazole for incomplete response in late-life depression: getting to remission.

Sheffrin M, Driscoll HC, Lenze EJ, Mulsant BH, Pollock BG, Miller MD, Butters MA, Dew MA, Reynolds CF 3rd.

J Clin Psychiatry. 2009 Feb;70(2):208-13. Epub 2009 Feb 10.

PMID: 19210951 [Cymbalta - indexed for Cymbalta Withdrawal Cymbalta Side Effects]

Duloxetine in the treatment of generalized anxiety disorder.

Kornstein SG, Russell JM, Spann ME, Crits-Christoph P, Ball SG.

Expert Rev Neurother. 2009 Feb;9(2):155-65. Review.

PMID: 19210191 [Cymbalta - indexed for Cymbalta Withdrawal Cymbalta Side Effects]

Escitalopram in the treatment of major depressive disorder: a meta-analysis.

Kennedy SH, Andersen HF, Thase ME.

Curr Med Res Opin. 2009 Jan;25(1):161-75.

PMID: 19210149 [Cymbalta - indexed for Cymbalta Withdrawal Cymbalta Side Effects]

Serious suicide attempt with duloxetine treatment.

Reeves RR, Brister JC.

South Med J. 2008 Jul;101(7):769. No abstract available.

PMID: 19209119 [Cymbalta - indexed for Cymbalta Withdrawal Cymbalta Side Effects]

Meta-analysis of duloxetine vs. pregabalin and gabapentin in the treatment of diabetic peripheral neuropathic pain.

Quilici S, Chancellor J, Löthgren M, Simon D, Said G, Le TK, Garcia-Cebrian A, Monz B.

BMC Neurol. 2009 Feb 10;9:6.

PMID: 19208243 [Cymbalta - indexed for Cymbalta Withdrawal Cymbalta Side Effects]

Early symptom change prediction of remission in depression treatment.

Katz MM, Meyers AL, Prakash A, Gaynor PJ, Houston JP.

Psychopharmacol Bull. 2009;42(1):94-107.

PMID: 19204654 [Cymbalta - in process]

An 8-week, open-label trial of duloxetine for comorbid major depressive disorder and chronic headache.

Volpe FM.

J Clin Psychiatry. 2008 Sep;69(9):1449-54.

PMID: 19193344 [Cymbalta - indexed for Cymbalta Withdrawal Cymbalta Side Effects]

A randomized, double-blind study of increasing or maintaining duloxetine dose in patients without remission of major depressive disorder after initial duloxetine therapy.

Kornstein SG, Dunner DL, Meyers AL, Whitmyer VG, Mallinckrodt CH, Wohlreich MM, Detke MJ, Hollandbeck MS, Greist JH.

J Clin Psychiatry. 2008 Sep;69(9):1383-92.

PMID: 19193339 [Cymbalta - indexed for Cymbalta Withdrawal Cymbalta Side Effects]

Solid-phase microextraction using poly(pyrrole) film and liquid chromatography with UV detection for analysis of antidepressants in plasma samples.

Chaves AR, Chiericato Júnior G, Queiroz ME.

J Chromatogr B Analyt Technol Biomed Life Sci. 2009 Mar 1;877(7):587-93. Epub 2009 Jan 16.

PMID: 19185550 [Cymbalta - indexed for Cymbalta Withdrawal Cymbalta Side Effects]

Comparative efficacy and acceptability of 12 new-generation antidepressants: a multiple-treatments meta-analysis.

Cipriani A, Furukawa TA, Salanti G, Geddes JR, Higgins JP, Churchill R, Watanabe N, Nakagawa A, Omori IM, McGuire H, Tansella M, Barbui C.

Lancet. 2009 Feb 28;373(9665):746-58. Review.

PMID: 19185342 [Cymbalta - indexed for Cymbalta Withdrawal Cymbalta Side Effects]

[Is medical therapy useful in the management of stress urinary incontinence?]

Oelke M, Seidler M, Uckert S, Gabuev A.

Urologe A. 2009 Mar;48(3):228-32. German.

PMID: 19183930 [Cymbalta - in process]

The role of duloxetine in the treatment of anxiety disorders.

De Berardis D, Serroni N, Carano A, Scali M, Valchera A, Campanella D, D'Albenzio A, Di Giuseppe B, Moschetta FS, Salerno RM, Ferro FM.

Neuropsychiatr Dis Treat. 2008 Oct;4(5):929-35.

PMID: 19183783 [Cymbalta - in process]

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Current considerations in the treatment of generalized anxiety disorder.

Katzman MA.

CNS Drugs. 2009;23(2):103-20. doi: 10.2165/00023210-200923020-00002. Review.

PMID: 19173371 [Cymbalta - indexed for Cymbalta Withdrawal Cymbalta Side Effects]

Pharmacological assessment of the rat formalin test utilizing the clinically used analgesic drugs gabapentin, lamotrigine, morphine, duloxetine, tramadol and ibuprofen: influence of low and high formalin concentrations.

Munro G.

Eur J Pharmacol. 2009 Mar 1;605(1-3):95-102. Epub 2009 Jan 11.

PMID: 19168051 [Cymbalta - in process]

Role of alpha2-adrenoceptors and glutamate mechanisms in the external urethral sphincter continence reflex in rats.

Furuta A, Asano K, Egawa S, de Groat WC, Chancellor MB, Yoshimura N.

J Urol. 2009 Mar;181(3):1467-73. Epub 2009 Jan 20.

PMID: 19157445 [Cymbalta - indexed for Cymbalta Withdrawal Cymbalta Side Effects]

Long-Term Safety, Tolerability, and Efficacy of Duloxetine in the Treatment of Fibromyalgia.

Mease PJ, Russell IJ, Kajdasz DK, Wiltse CG, Detke MJ, Wohlreich MM, Walker DJ, Chappell AS.

Semin Arthritis Rheum. 2009 Jan 17. [Epub ahead of print]

PMID: 19152958 [Cymbalta - as supplied by publisher]

Safety and efficacy of duloxetine in the treatment of diabetic peripheral neuropathic pain in older patients.

Wasan AD, Ossanna MJ, Raskin J, Wernicke JF, Robinson MJ, Hall JA, Edwards SE, Lipsius S, Meyers AL, McCarberg BH.

Curr Drug Saf. 2009 Jan;4(1):22-9.

PMID: 19149522 [Cymbalta - indexed for Cymbalta Withdrawal Cymbalta Side Effects]

A continuous responder analysis from a long-term trial of duloxetine treatment for generalized anxiety disorder: implications for the randomized withdrawal relapse prevention study design.

Llorca PM, Bodkin JA, Spann M, Ball SG, Russell JM, Ball SG.

J Clin Psychopharmacol. 2009 Feb;29(1):96-7. No abstract available.

PMID: 19142122 [Cymbalta - indexed for Cymbalta Withdrawal Cymbalta Side Effects]

[Chronic pain and depression]

Voznesenskaia TG.

Zh Nevrol Psikhiatr Im S S Korsakova. 2008;108(11):98-101. Russian. No abstract available.

PMID: 19137666 [Cymbalta - indexed for Cymbalta Withdrawal Cymbalta Side Effects]

Duloxetine for the treatment of fibromyalgia.

Acuna C.

Drugs Today (Barc). 2008 Oct;44(10):725-34. Review.

PMID: 19137126 [Cymbalta - indexed for Cymbalta Withdrawal Cymbalta Side Effects]

Effects of selective serotonin reuptake and dual serotonergic-noradrenergic reuptake treatments on memory and mental processing speed in patients with major depressive disorder.

Herrera-Guzmán I, Gudayol-Ferré E, Herrera-Guzmán D, Guàrdia-Olmos J, Hinojosa-Calvo E, Herrera-Abarca JE.

J Psychiatr Res. 2009 Jun;43(9):855-63. Epub 2009 Jan 6.

PMID: 19128810 [Cymbalta - in process]

Central sensitisation phenomena in primary headaches: overview of a preventive therapeutic approach.

de Tommaso M, Sardaro M, Vecchio E, Serpino C, Stasi M, Ranieri M.

CNS Neurol Disord Drug Targets. 2008 Dec;7(6):524-35.

PMID: 19128209 [Cymbalta - in process]

Fibromyalgia coverage uneven despite recent drug approvals.

Sipkoff M.

Manag Care. 2008 Dec;17(12):9-10. No abstract available.

PMID: 19127758 [Cymbalta - indexed for Cymbalta Withdrawal Cymbalta Side Effects]

Polydimethylsiloxane/polypyrrole stir bar sorptive extraction and liquid chromatography (SBSE/LC-UV) analysis of antidepressants in plasma samples.

Melo LP, Nogueira AM, Lanças FM, Queiroz ME.

Anal Chim Acta. 2009 Feb 2;633(1):57-64. Epub 2008 Nov 25.

PMID: 19110116 [Cymbalta - indexed for Cymbalta Withdrawal Cymbalta Side Effects]

Variation in catechol-O-methyltransferase is associated with duloxetine response in a clinical trial for major depressive disorder.

Perlis RH, Fijal B, Adams DH, Sutton VK, Trivedi MH, Houston JP.

Biol Psychiatry. 2009 May 1;65(9):785-91. Epub 2008 Dec 18.

PMID: 19095219 [Cymbalta - in process]

Gateways to clinical trials.

Tomillero A, Moral MA.

Methods Find Exp Clin Pharmacol. 2008 Oct;30(8):643-72.

PMID: 19088949 [Cymbalta - indexed for Cymbalta Withdrawal Cymbalta Side Effects]

Effect of desvenlafaxine on the cytochrome P450 2D6 enzyme system.

Preskorn SH, Nichols AI, Paul J, Patroneva AL, Helzner EC, Guico-Pabia CJ.

J Psychiatr Pract. 2008 Nov;14(6):368-78. Review.

PMID: 19057238 [Cymbalta - indexed for Cymbalta Withdrawal Cymbalta Side Effects]

Factors predicting reduced antidepressant response: experience with the SNRI duloxetine in patients with major depression.

Howland RH, Wilson MG, Kornstein SG, Clayton AH, Trivedi MH, Wohlreich MM, Fava M.

Ann Clin Psychiatry. 2008 Oct-Dec;20(4):209-18.

PMID: 19034753 [Cymbalta - indexed for Cymbalta Withdrawal Cymbalta Side Effects]

The effect of pain on outcomes in a trial of duloxetine treatment of major depressive disorder.

Arnold LM, Meyers AL, Sunderajan P, Montano CB, Kass E, Trivedi M, Wohlreich MM.

Ann Clin Psychiatry. 2008 Oct-Dec;20(4):187-93.

PMID: 19034749 [Cymbalta - indexed for Cymbalta Withdrawal Cymbalta Side Effects]

Prioritizing future research on off-label prescribing: results of a quantitative evaluation.

Walton SM, Schumock GT, Lee KV, Alexander GC, Meltzer D, Stafford RS.

Pharmacotherapy. 2008 Dec;28(12):1443-52.

PMID: 19025425 [Cymbalta - indexed for Cymbalta Withdrawal Cymbalta Side Effects]

Acute stress responsiveness of the neurotrophin BDNF in the rat hippocampus is modulated by chronic treatment with the antidepressant duloxetine.

Molteni R, Calabrese F, Cattaneo A, Mancini M, Gennarelli M, Racagni G, Riva MA.

Neuropsychopharmacology. 2009 May;34(6):1523-32. Epub 2008 Nov 19.

PMID: 19020498 [Cymbalta - in process]

Comparative benefits and harms of second-generation antidepressants: background paper for the American College of Physicians.

Gartlehner G, Gaynes BN, Hansen RA, Thieda P, DeVeaugh-Geiss A, Krebs EE, Moore CG, Morgan L, Lohr KN.

Ann Intern Med. 2008 Nov 18;149(10):734-50. Review.

PMID: 19017592 [Cymbalta - indexed for Cymbalta Withdrawal Cymbalta Side Effects]

Using second-generation antidepressants to treat depressive disorders: a clinical practice guideline from the American College of Physicians.

Qaseem A, Snow V, Denberg TD, Forciea MA, Owens DK; Clinical Efficacy Assessment Subcommittee of American College of Physicians.

Ann Intern Med. 2008 Nov 18;149(10):725-33. Erratum in: Ann Intern Med. 2009 Jan 20;150(2):148.

PMID: 19017591 [Cymbalta - indexed for Cymbalta Withdrawal Cymbalta Side Effects]

A cost-utility comparison of four first-line medications in painful diabetic neuropathy.

O'Connor AB, Noyes K, Holloway RG.

Pharmacoeconomics. 2008;26(12):1045-64. doi: 10.2165/0019053-200826120-00007.

PMID: 19014205 [Cymbalta - indexed for Cymbalta Withdrawal Cymbalta Side Effects]

Antidepressant-induced sweating alleviated by aripiprazole.

Lu BY, Cullen CE, Eide CE, Williams CC, Apfeldorf WJ.

J Clin Psychopharmacol. 2008 Dec;28(6):710-1. No abstract available.

PMID: 19011447 [Cymbalta - indexed for Cymbalta Withdrawal Cymbalta Side Effects]

Successful duloxetine treatment of a binge eating disorder: a case report.

Bernardi S, Pallanti S.

J Psychopharmacol. 2008 Nov 14. [Epub ahead of print]

PMID: 19010975 [Cymbalta - as supplied by publisher]

Development and validation of chiral LC method for the enantiomeric separation of duloxetine on amylose based stationary phase.

Rane VP, Shinde DB.

J Chromatogr Sci. 2008 Oct;46(9):772-6.

PMID: 19007477 [Cymbalta - indexed for Cymbalta Withdrawal Cymbalta Side Effects]

Gateways to clinical trials.

Tomillero A, Moral MA.

Methods Find Exp Clin Pharmacol. 2008 Sep;30(7):543-88.

PMID: 18985183 [Cymbalta - indexed for Cymbalta Withdrawal Cymbalta Side Effects]

First pregabalin and now duloxetine for fibromyalgia syndrome: closer to a brave new world?

Boomershine CS.

Nat Clin Pract Rheumatol. 2008 Dec;4(12):636-7. Epub 2008 Nov 4. No abstract available.

PMID: 18982001 [Cymbalta]

A single-blind, placebo run-in study of duloxetine for activity-limiting osteoarthritis pain.

Sullivan MD, Bentley S, Fan MY, Gardner G.

J Pain. 2009 Feb;10(2):208-13. Epub 2008 Oct 31.

PMID: 18976962 [Cymbalta - indexed for Cymbalta Withdrawal Cymbalta Side Effects]

Neurobehavioral and genotoxic parameters of duloxetine in mice using the inhibitory avoidance task and comet assay as experimental models.

Pereira P, Gianesini J, da Silva Barbosa C, Cassol GF, Von Borowski RG, Kahl VF, Cappelari SE, Picada JN.

Pharmacol Res. 2009 Jan;59(1):57-61. Epub 2008 Oct 5.

PMID: 18973814 [Cymbalta - indexed for Cymbalta Withdrawal Cymbalta Side Effects]

Pragmatic consideration of recent randomized, placebo-controlled clinical trials for treatment of fibromyalgia.

Holman AJ.

Curr Pain Headache Rep. 2008 Dec;12(6):393-8. Review.

PMID: 18973730 [Cymbalta - indexed for Cymbalta Withdrawal Cymbalta Side Effects]

High-performance liquid chromatographic method for the simultaneous estimation of the key intermediates of duloxetine.

Soni P, Mariappan TT, Banerjee UC.

Talanta. 2005 Oct 31;67(5):975-8.

PMID: 18970267 [Cymbalta - in process]

Postprostatectomy Incontinence: All About Diagnosis and Management.

Bauer RM, Bastian PJ, Gozzi C, Stief CG.

Eur Urol. 2008 Oct 23. [Epub ahead of print]

PMID: 18963418 [Cymbalta - as supplied by publisher]

[Dermatological side effects during therapy with serotonin noradrenaline reuptake inhibitors]

Gross CM, Klöcker M, Jakob T, Klecha D.

Nervenarzt. 2008 Nov;79(11):1304, 1307-9. German.

PMID: 18958440 [Cymbalta - indexed for Cymbalta Withdrawal Cymbalta Side Effects]

Clinical milestones predict symptom remission over 6-month and choice of treatment of patients with major depressive disorder (MDD).

Wade AG, Schlaepfer TE, Andersen HF, Kilts CD.

J Psychiatr Res. 2009 Feb;43(5):568-75. Epub 2008 Oct 26.

PMID: 18954875 [Cymbalta - indexed for Cymbalta Withdrawal Cymbalta Side Effects]

[Combination of Dialectical Behavioral Therapy (DBT) and Duloxetin in Kleptomania.]

Rudel A, Hubert C, Juckel G, Edel MA.

Psychiatr Prax. 2008 Oct 15. [Epub ahead of print] German.

PMID: 18924062 [Cymbalta - as supplied by publisher]

Is duloxetine effective treatment for depression with atypical features?

Stewart JW, Deliyannides DA, McGrath PJ.

Int Clin Psychopharmacol. 2008 Nov;23(6):333-6.

PMID: 18854721 [Cymbalta - indexed for Cymbalta Withdrawal Cymbalta Side Effects]

Clinical impact of duloxetine treatment on sleep in patients with major depressive disorder.

Brecht S, Kajdasz D, Ball S, Thase ME.

Int Clin Psychopharmacol. 2008 Nov;23(6):317-24.

PMID: 18854719 [Cymbalta - indexed for Cymbalta Withdrawal Cymbalta Side Effects]

Duloxetine and pregabalin: safe and effective for the long-term treatment of fibromyalgia?

Serra E.

Nat Clin Pract Neurol. 2008 Nov;4(11):594-5. Epub 2008 Oct 14.

PMID: 18852724 [Cymbalta]

Escitalopram and duloxetine in major depressive disorder: a pharmacoeconomic comparison using UK cost data.

Wade AG, Fernández JL, François C, Hansen K, Danchenko N, Despiegel N.

Pharmacoeconomics. 2008;26(11):969-81.

PMID: 18850765 [Cymbalta - indexed for Cymbalta Withdrawal Cymbalta Side Effects]

Efficacy, tolerability, and safety of duloxetine.

Wise TN.

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Russell IJ, Mease PJ, Smith TR, Kajdasz DK, Wohlreich MM, Detke MJ, Walker DJ, Chappell AS, Arnold LM.

Pain. 2008 Jun;136(3):432-44. Epub 2008 Apr 18.

PMID: 18395345 [Cymbalta - indexed for Cymbalta Withdrawal Cymbalta Side Effects]

The treatment of urinary incontinence with Duloxetine.

Basu M, Duckett J.

J Obstet Gynaecol. 2008 Feb;28(2):166-9. Review.

PMID: 18393011 [Cymbalta - indexed for Cymbalta Withdrawal Cymbalta Side Effects]

Gateways to clinical trials.

Bayés M, Rabasseda X.

Methods Find Exp Clin Pharmacol. 2008 Jan-Feb;30(1):67-99.

PMID: 18389098 [Cymbalta - indexed for Cymbalta Withdrawal Cymbalta Side Effects]

Pain management in fibromyalgia.

Crofford LJ.

Curr Opin Rheumatol. 2008 May;20(3):246-50. Review.

PMID: 18388513 [Cymbalta - indexed for Cymbalta Withdrawal Cymbalta Side Effects]

Long-term trials of pregabalin and duloxetine for fibromyalgia symptoms: how study designs can affect placebo factors.

Staud R, Price DD.

Pain. 2008 Jun;136(3):232-4. Epub 2008 Apr 1. No abstract available.

PMID: 18384959 [Cymbalta - indexed for Cymbalta Withdrawal Cymbalta Side Effects]

[Treatment of chronic back pain with antidepressant cymbalta: an experimental study]

Voznesenskaia TG, Leonova AR, Kaverina IV.

Zh Nevrol Psikhiatr Im S S Korsakova. 2007;107(7):20-4. Russian.

PMID: 18379477 [Cymbalta - indexed for Cymbalta Withdrawal Cymbalta Side Effects]

[Efficacy of duloxetine in the treatment of chronic daily headache]

Artemenko AR, Kurenkov AL, Filatova EG.

Zh Nevrol Psikhiatr Im S S Korsakova. 2007;107(8):24-8. Russian.

PMID: 18379468 [Cymbalta - indexed for Cymbalta Withdrawal Cymbalta Side Effects]

Study on fluorescence characteristics of duloxetine hydrochloride.

Liu X, Du Y, Wu X.

Spectrochim Acta A Mol Biomol Spectrosc. 2008 Dec 1;71(3):915-20. Epub 2008 Feb 16.

PMID: 18374628 [Cymbalta - indexed for Cymbalta Withdrawal Cymbalta Side Effects]

Fibromyalgia: harmonizing science with clinical practice considerations.

Perrot S, Dickenson AH, Bennett RM.

Pain Pract. 2008 May-Jun;8(3):177-89. Epub 2008 Mar 18. Review.

PMID: 18363616 [Cymbalta - indexed for Cymbalta Withdrawal Cymbalta Side Effects]

The hepatic safety profile of duloxetine: a review.

McIntyre RS, Panjwani ZD, Nguyen HT, Woldeyohannes HO, Alsuwaidan M, Soczynska JK, Lourenco MT, Konarski JZ, Kennedy SH.

Expert Opin Drug Metab Toxicol. 2008 Mar;4(3):281-5. Review.

PMID: 18363543 [Cymbalta - indexed for Cymbalta Withdrawal Cymbalta Side Effects]

Efficacy of duloxetine for the treatment of depression: relationship to most recent antidepressant trial.

Petersen T, Perlis RH, Ticknor C, Lohr J, Solvason HB, O'Reardon JP, Wohlreich MM, Andreotti C, Wilson M, Fava M.

Psychopharmacol Bull. 2008;41(1):34-45.

PMID: 18362869 [Cymbalta - in process]

Duloxetine in the treatment of stress urinary incontinence.

Jost WH, Marsalek P.

Ther Clin Risk Manag. 2005 Dec;1(4):259-64.

PMID: 18360568 [Cymbalta - in process]

Related Articles Free article in PMC

What is Cymbalta?

Cymbalta is a new antidepressant manufactured by Eli Lilly and Company, the approval of which Has finally been granted by the U.S. Food and Drug Administration. This happens on the heals of one suicide of a 19 year-old, in perfect health, no mental disorder, hanging herself at the Eli Lilly complex, after taking Cymbalta. This is approved when pressure is being put on all of the pharmaceutical firs to fully disclose their clinical trials.

Did the FDA feel a little pressure from the current Administration? If you have an adverse event or commit suicide while taking Cymbalta, odds are the current Administration will pay for and support Eli Lilly to beat you in court. The current administration admits this.

August 11, 2004 - The FDA states Cymbalta had nothing to do with the hanging death at the Eli Lilly facility. Let's look at the known data here:

You have a healthy 19 year old female as part of the Cymbalta clinical trials.
She is given a much higher dosage then recommended.
Part of her trial was to quit the Cymbalta quickly
She hangs herself
She has no mental illness
She was in perfect physical health per Eli Lilly
She was in the trial to earn money for college
The current administration will supply Eli Lilly with their attorneys to help fight consumer lawsuits because "the FDA is never wrong"
The FDA uses their own lead attorney to help Eli Lilly and others fight consumer lawsuits because the FDA is never wrong.
The current administration is full of Eli Lilly past executives.
You would think if the FDA clears Cymbalta as the cause of death, they would disclose why or what the reason was.
Amazing, the FDA statement of Cymbalta having nothing to do with this suicide, would come within 1 week of Cymbalta being approved by the FDA and within 3 weeks of the massive launch of Cymbalta by Eli Lilly. Eli Lilly will have more drug reps hit the streets to visit physicians then with any other drug of theirs in the past.
If Cymbalta fails, Eli Lilly will suffer on Wall Street.

Eli Lilly is being sued again after a SWAT captain commits suicide after only 3 days of Prozac use. Eli Lilly has already settled 2 suits out of court for the same issue. Know what can happen before you take these medications. There is a way to know. Click here for story. (Opens new browser)

August 4, 2004 - Now that Cymbalta is approved by the FDA will Eli Lilly disclose all of their clinical trials? With a high profile suicide occurring during the clinical trial, will the pressure be enough on Eli Lilly? When a healthy volunteer, with no known mental illness or physical problem commits suicide on Cymbalta, will Eli Lilly disclose all of the facts?

Eli Lilly, I know you are on this Web Site daily, especially when it comes up first on most search engines for your new antidepressant Cymbalta, what are you going to do? Disclose all of the facts or not? If you work with Eli Lilly and feel it is time for you to come clean and disclose all you know about Cymbalta hidden information, Click here and send an e-mail.

Click here for Cymbalta Adverse Reactions and more

What is Cymbalta?

Cymbalta is a brand-name for a drug called duloxetine. It is in a class of drugs known as dual uptake inhibitors. So what is a dual uptake inhibitor -- or an uptake inhibitor, for that matter?

The way a neurotransmitter works is, it is passed along from one nerve to another. A bit of it is sent out at a time from one nerve to the next. After a bit is sent out and received by the next nerve, any of the neurotransmitter remaining between the nerves is taken back by the first nerve, a process called reuptake.

A reuptake inhibitor prevents this reuptake process from occurring, which means that, when Cymbalta is active, certain neurotransmitters are transmitted in steady streams from one nerve ending to the next, instead of being sent in bits periodically, which they normally are. The neurotransmitters affected by Cymbalta are known as serotonin and norepinephrine. And now we can explain what "dual uptake inhibitor" means -- it simply means a drug that affects the reuptake of two neurotransmitters instead of one.
Back to top of page

Does Cymbalta cure depression?

Good question. If depression has never been proven to be caused by neurotransmitters (or the lack of them), that question cannot obviously be answered conclusively.

Apparently, Eli Lilly and Company knows this. According to a recent news release from Eli Lilly regarding Cymbalta: "Many experts believe treating the complete spectrum of depression symptoms is intrinsic to a lasting recovery. As well, combined action through two key neurotransmitters - serotonin and norepinephrine - may provide a more rapid and sustained clinical effect."

Note the subtle uncertainties in these statements, for there is absolutely no scientific proof behind them. "Many experts believe treating the complete spectrum of depression symptoms..." "...combined action through two key neurotransmitters - serotonin and norepinephrine - may provide..."

Translation: They don't know how, why, or if their drug works. This is evident in the numerous -- and serious -- side effects provided by other antidepressants. Lilly's press release did not even address side effects, but another of their releases regarding Cymbalta's clinical trials revealed three of the exact same side effects as other antidepressants: Dizziness, anxiety, and nausea.

In that Cymbalta has the exact same action as Wyeth's drug Effexor, one could assume the same side effects. (See "Precautions" section on Effexor page). (Opens new browser)
Back to top of page

What is Depression?

Depression is defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association, this way:

The essential feature of a Major Depressive Episode is a period of at least 2 weeks during which there is either depressed mood or the loss of interest or pleasure in nearly all activities. In children and adolescents, the mood may be irritable rather than sad. The individual must also experience at least four additional symptoms drawn from a list that includes major changes in appetite or weight, sleep, and psychomotor [of or relating to movement or muscular activity associated with mental processes] activity; decreased energy; feelings of worthlessness or guilt; difficulty thinking, concentrating, or making decisions; or recurrent thoughts of death or suicidal ideation, plans, or attempts."

While these elements can certainly be seen to exist and have been experienced by many, labeling "depression" as an illness has been criticized by many as simply labeling part of life itself as a physical "disease" which must be "cured".

This could be debated endlessly, however, and whole long texts have been written on the subject. Depression as a state of mind certainly does exist, and can be painful. The question to be addressed here, though, is, does depression truly have a physical cause that can be addressed with medication?

For the answer, let's go back to the DSM. The only information given there as to physical causes of depression is:

Neurotransmitters implicated in the pathophysiology [study of the physical effects of a disease] of a Major Depressive Episode include norepinephrine, serotonin, acetylcholine
, dopamine, and gamma-aminobutryric acid. Back to top of page

All right, what does all that mean? Here's a simple explanation. A neurotransmitter is a chemical that helps transmit nerve impulses through the nervous system. There are many different neurotransmitters used by the body. What the DSM definition is saying is that, by some method, the neurotransmitter chemicals known as norepinephrine, serotonin, acetylcholine
, dopamine, and gamma-aminobutryric acid seemed to be lower in some depressed people, or higher in non-depressed people.

Note carefully the use of the word implicated in the DSM definition, however. And therein is the first clue, for it has never been clinically proven that depression is based in neurotransmitters. We repeat: Never. And believe it or not, there is not a doctor on Earth that will disagree with that statement.

Which leads to the conclusion that a physical cause for depression has never been isolated. Why, then, is Eli Lilly and Company, Cymbalta's manufacturer, so insistent that Cymbalta is a great treatment for depression?

For the answer to this, let's turn to Eli Lilly and find out exactly what Cymbalta is, and how it works.

Should You Take Cymbalta? Back to top of page

The answer is, of course, up to you. Before you do, however, become fully informed of the dangers from the manufacturer. As yet the full list of side effects have not been published.

You should also be aware of a dangerous metabolism issue that may affect you, and for which you should be tested before you take such a drug.

CYMBALTA

(duloxetine hydrochloride)

Pharmacokinetics

CYMBALTA has an elimination half-life of about 12 hours (range 8 to 17 hours) and its pharmacokinetics are dose proportional over the therapeutic range. Steady-state plasma concentrations are typically achieved after 3 days of dosing. Elimination of CYMBALTA is mainly through hepatic metabolism involving two P450 isozymes, CYP2D6 and CYP1A2.

Absorption and Distribution – Orally administered CYMBALTA is well absorbed. There is a median 2-hour lag until absorption begins (T lag), with maximal plasma concentrations C max) of CYMBALTA occurring 6 hours post dose. Food does not affect the Cmax of CYMBALTA, but delays the time to reach peak concentration from 6 to 10 hours and it marginally decreases the extent of absorption (AUC) by about 10%. There is a 3-hour delay in absorption and a one-third increase in apparent clearance of CYMBALTA after an evening dose as compared to a morning dose.

The apparent volume of distribution averages about 1640 L. CYMBALTA is highly bound (>90%) to proteins in human plasma, binding primarily to albumin and ą1-acid glycoptrotein. Plasma protein binding of CYMBALTA is not affected by renal or hepatic impairment.

Metabolism and Elimination – Biotransformation and disposition of CYMBALTA in humans have been determined following oral administration of 14C-labeled CYMBALTA. CYMBALTA comprises about 3% of the total radiolabeled material in the plasma, indication that it undergoes extensive metabolism to numerous metabolites. The major biotransformation pathways for CYMBALTA involve oxidation of the naphthyl ring followed by conjugation and further oxidation. Both CYP2D6 and CYP1A2 catalyze the oxidation of the naphthyl ring in vitro. Metabolites found in plasma include 4 –hydroxy duloxetine glucuronide and 5-hydroxy, 6-methoxy duloxetine sulfate. Many additional metabolites have been identified in urine, some representing only minor pathways of elimination. Only trace (1% of the dose) amounts of unchanged CYMBALTA are present in the urine. Most (about 70%) of the CYMBALTA dose appears I the urine as metabolites of CYMBALTA; about 20% is excreted in the feces.

Smoking Status – CYMBALTA bioavailability (AUC) appears to be reduced by about one-third in smokers. Dosage modifications are not recommended for smokers. Back to top of page

Race – No specific pharmacokinetic study was conducted to investigate the effects of race.

Renal Insufficiency – Limited data are available on the effects of CYMBALTA in patients with end stage renal disease (ESRD). After a single 60-mg dose of CYMBALTA, Cmax and AUC values were approximately 100% greater inpatients with end stage renal disease receiving chronic intermittent hemodialysis than in subjects with normal renal fuction. The elimination half-life, however, was similar in both groups. The AUC’s of the major circulation metabolites, 4-hydroxy duloxetine glucuronide and 5-hydroxy, 6-methoxy duloxetine sulfate, largely excreted in urine, were approximately 7 – to 9 – fold higher and would be expected to increase further with multiple dosing. For this reason, CYMBALTA is not recommended for patients with ESRD (see DOSAGE AND ADMINISTATION). Studies have not been conducted in patients with a moderate degree of renal dysfunction, but population PK analyses suggest that mild renal dysfunction has no significant effect on CYMBALTA apparent clearance.

Hepatic Insufficiency – Patients with clinically evident hepatic insufficiency have decreased CYMBALTA metabolism and elimination. After a single 20-mg dose of CYMBALTA 6 cirrhotic patients with moderate liver impairment (Child-Pugh Class B) had a mean plasma CYMBALTA clearance about 15% that of age- and gender-matched healthy subjects, with a 5-fold increase in mean exposure (AUC). Although Cmax was similar to normals in the cirrhotic patients, the half-life was about 3 times longer (see PRECAUTIONS). It is recommended that CYMBALTA no be administered to patients with any hepatic insufficiency (see DOSAGE AND ADMINISTRATION). Back to top of page

Drug-Drug Interactions (also see PRECAUTIONS, Drug Interactions)

Potential for Other Drugs to Affect CYMBALTA.

Both CYP1A2 and CYP2D6 are responsible for CYMBALTA metabolism.

INDICATIONS AND USAGE

CYMBALTA is indicated for the treatment of major depressive disorder (MDD).

CONTRAINDICATIONS

Hypersensitivity

CYMBALTA is contraindicated in patients with a known hypersensitivity to the product.

WARNINGS Back to top of page

Clinical Worsening and Suicide Risk – Patients with major depressive disorder, both adult and pediatric, may experience worsening of their depression and/or the emergence of suicidal ideation and behavior (suicidality), whether or not they are taking antidepressant medications, and this risk may persist until significant remission occurs. Although there was been a long-standing concern that antidepressants may have a role in inducing worsening of depression and the emergence of suicidality in certain patients, a causal role for antidepressants in inducing such behaviors has not been established. Nevertheless, patients being treated with antidepressants should be observed closely for clinical worsening and suicidality, especially at the beginning of a course of drug therapy, or at the time of dose changes, either increases of decreases. Consideration should be given to changing the therapeutic regimen, including possibly discontinuing the medication, in patients whose depression is persistently worse or whose emergent suicidality is severe, abrupt in onset, or was not part of the patient’s presenting symptoms.

Because of the possibility of co-morbidity between major depressive disorder and other psychiatric and nonpsychiatric disorders, the same precautions observed when treating patients with major depressive disorder should be observed when treating patients with other psychiatric and nonpsychiatric disorders.

The following symptoms – anxiety, agitation, panic attacks, insomnia, irritability, hostility (aggressiveness), impulsivity, akathisia (psychomotor restlessness), hypomania, and mania – have been reported in adult and pediatric patients being treated with antidepressants for major depressive disorder as well as for other indications, both psychiatric and nonpsychiatric. Although a causal link between the emergence of such symptoms and either the worsening of depression and/or the emergence of suicidal impulses has not been established, consideration should be given to changing the therapeutic regimen, including possibly discontinuing the medications, in patients for whom such symptoms are severe, abrupt in onset, or were not part of the patient’s presenting symptoms.

Families and caregivers of patients being treated with antidepressants for major depressive disorder or other indications, both psychiatric and nonpsychiatric, should be alerted about the need to monitor patients for the emergence of suicidality, and to report such symptoms immediately to health care providers. Prescriptions for CYMBALTA should be written for the smallest quantity of capsules consistent with good patient management, in order to reduce the risk of overdose.

If the decision has been made to discontinue treatment, medication should be tapered, as rapidly as is feasible, but with recognition that abrupt discontinuation can be associated with certain symptoms (see PRECAUTIONS and DOSAGE AND ADMINISTRATION, Discontinuing CYMBALTA (duloxetine hydrochloride), for a description of the risks of discontinuation of CYMBALTA).

Information of Patients Back to top of page

Physicians are advised to discuss the following issues with patients for whom they prescribe CYMBALTA.

Patients and their families should be encouraged to be alert to the emergence of anxiety, agitation, panic attacks, insomnia, irritability, hostility, impulsivity, akathisia, hypomania, mania, worsening of depression, and suicidal ideation, especially early during antidepressant treatment. Such symptoms should be reported to the patient’s physician, especially if they are severe, abrupt in onset, or were not part of the patient’s presenting symptoms.

Any psychoactive drug may impair judgment, thinking, or motor skills.

Drug Interactions (also see CLINICAL PHARMACOLOGY, Drug – Drug

Interactions)

Inhibitors of CYP2D6 – Because CYP2D6 is involved in CYMBALTA metabolism, concomitant use of CYMBALTA with potent inhibitors of CYP2D6 may result in higher concentrations of CYMBALTA. Paroxetine (20 mg QD) increased the concentration of CYMBALTA (40 mg QD) by about 60%, and greater degrees of inhibition are expected with higher doses of Paroxetine. Similar effect would be expected with other potent CYP2D6 inhibitors (e.g., fluoxetine, quinidine).

ADVERSE REACTIONS Back to top of page

CYMBALTA has been evaluated for safety in 2418 patients diagnosed with major depressive disorder who participated in multiple-dose premarketing trials, representing 1099 patient-years of exposure. Among these 2418 CYMBALTA treated patients, 1139 patients participated in eight 8- or 9- week, placebo-controlled trials at doses ranging from 40 to 120 mg/day, while the remaining 1279 patients were followed for up to 1 year in an open-label safety study using flexible doses from 80 to 120 mg/day. Two placebo-controlled studies with doses of 80 to 120 mg/day had 6- month maintenance extensions. Of these 2418 patients, 993 CYMBALTA-treated patients were exposed for at least 180 days and 445 CYMBALTA-treated patients were exposed for at least 1 year. Adverse reactions were assessed by collecting adverse events, results of physical examinations, vital signs, weights, laboratory analyses, and ECGs.

Clinical investigators recorded adverse events using descriptive terminology of their own choosing. To provide a meaningful estimate of the proportion of individuals experiencing adverse events, grouping similar types of events into a smaller number of standardized event categories is necessary. In the tables and tabulations that follow, MedDRA terminology has been used to classify reported adverse events.

The stated frequencies of adverse events represent the proportion of individuals who experienced, at least once, a treatment-emergent adverse event of the type listed. An event was considered treatment-emergent if it occurred for the first time or worsened while receiving therapy following baseline evaluation. Events reported during the studies were not necessarily caused by the therapy, and the frequencies do not reflect investigator impression (assessment) of causality.

The cited figures provide the prescriber with some basis for estimating the relative contribution of drug and non-drug factors to the adverse event incidence rate in the population studied. The prescriber should be aware that the figures in the tables and tabulations cannot be used to predict the incidence of adverse events in the course of usual medical practice where patient characteristics and other factors differ from those that prevailed in the clinical trials. Similarly, the cited frequencies cannot be compared with figures obtained from other clinical investigations involving different treatments, uses, and investigators.

Adverse Events Reported as Reasons for Discontinuation of Treatment in Placebo-Controlled Trials

Approximately 10% of the 1139 patients who received CYMBALTA in the placebo-controlled trials discontinued treatment due to an adverse event, compared with 4% of the 777 patients receiving placebo. Nausea (CYMBALTA 1.4%, placebo 0.1%) was the only common adverse event reported as reason for discontinuation and considered to be drug-related (i.e., discontinuation occurring in at least 1% of the CYMBALTA-treated patients and at a rate of at least twice that of placebo).

Adverse Events Occurring at an Incidence of 2% or More Among CYMBALTA-Treated Patients in Placebo-Controlled Trials Back to top of page

Table 1 gives the incidence of treatment-emergent adverse events that occurred in 2% or more of patients treated with CYMBALTA in the acute phase of MDD placebo-controlled trials and with an incidence greater than placebo. The most commonly observed adverse events in CYMBALTA-treated MDD patients (incidence of 5% or greater and at least twice the incidence in placebo patients) were nausea; dry mouth; constipation; decreased appetite; fatigue; somnolence; and increased sweating.

Effects on Male and Female Sexual Function

Although changes in sexual desire, sexual performance and sexual satisfaction often occur as manifestations of a psychiatric disorder, they may also be a consequence of pharmacologic treatment. Reliable estimates of the incidence and severity of untoward experiences involving sexual desire, performance and satisfaction are difficult to obtain, however, in part because patients and physicians may be reluctant to discuss them. Accordingly, estimates of the incidence of untoward sexual experience and performance cited in product labeling are likely to underestimate their actual incidence.

Other Adverse Events Observed During the Premarketing Evaluation of CYMBALTA

Following is a list of modified MedDRA terms that reflect treatment-emergent adverse events as defined in the introduction to the ADVERSE REACTIONS section reported by patients treated with CYMBALTA at multiple doses throughout the dose range studied during any phase of a trial within the premarketing database. The events included are those not already listed elsewhere in ADVERSE REACTIONS and not considered in the WARNINGS and PRECAUTIONS sections, that were reported with an incidence of greater than or equal to 0.05%, are not common as background events and were considered possibly drug related (e.g., because of the drug’s pharmacology) or potentially important. Back to top of page

It is important to emphasize that, although the events reported occurred during treatment with CYMBALTA, they were not necessarily caused by it. Events are further categorized by body system and listed in order of decreasing frequency according to the following definitions: frequent adverse events are those occurring in at least 1/100 patients (only those not already listed in the tabulated results from placebo-controlled trials appear in this listing); infrequent adverse events are those occurring in 1/100 to 1/1000 patients; rare events are those occurring in fewer than 1/1000 patients.

Blood and Lymphatic System Disorders – Infrequent: anemia, leukopenia, increased whit blood cell count, lymphadenopathy, and thrombocytopenia.

Gastrointestinal Disorders – Frequent: gastritis: Infrequent: blood in stool, colitis, dysphagia, esophageal stenosis acquired, gastric ulcer, gingivitis, irritable bowel syndrome, and lower abdominal pain.

Psychiatric Disorders – Frequent: initial insomnia, irritability, lethargy, nervousness, nightmare, restlessness, and sleep disorder; Infrequent: completed suicide, mania, mood swings, pressure of speech, sluggishness, and suicide attempt.

Renal and Urinary Disorders – Frequent: dysuria; infrequent: micturition urgency, urinary hesitation, urinary incontinence, urinary retention, and urine flow decreased.

Skin and Subcutaneous Tissue Disorders – Frequent: night swats, pruritus, and rash; Infrequent: acne, alopecia, cold sweat, ecchymosis, eczema, erythema, face edema, increased tendency to bruise, and photosensitivity reaction.

Vascular Disorders – Infrequent: peripheral edema and phlebitis.

Discontinuing CYMBALTA (duloxetine hydrochloride) Back to top of page

Symptoms associated with discontinuation of CYMBALTA and other SSRIs and SNRIs have been reported (see PRECAUTIONS). Patients should be monitored for these symptoms when discontinuing treatment. A gradual reduction in the dose rather than abrupt cessation is recommended whenever possible. If intolerable symptoms occur following a decrease in the dose or upon discontinuation of treatment, then resuming the previously prescribed dose may be considered. Subsequently, the physician may continue decreasing the dose but at a more gradual rate.

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