Around 16 million individuals in the US have experienced atleast one episode of major depressive disorder, accounting for almost 7% of the total US adult population.   Among different age groups there are marked differences with some age groups having higher incidence rates. Considered as one of the world’s main reasons for disability, depression impacts individuals in many different ways, affecting routine actions and social life. Among the medications commonly used to treat depression, Duloxetine is popular and is also used for treating various other conditions, including pain. Here is a close look at the  side effects of Cymbalta, the brand name of Duloxetine, and other important information about the drug.

Overview of Cymbalta

Belonging to the category of dual serotonin and norepinephrine reuptake inhibitor, Cymbalta is used for treating major depressive disorder, and multiple other conditions include generalized anxiety disorder, diabetic peripheral neuropathy, fibromyalgia, chronic musculoskeletal pain, osteoarthritis of the knee, lower back pain and urinary incontinence among women. In addition to the above, the medication is also commonly used for off label purposes including chemotherapy induced peripheral neuropathy, and stress urinary incontinence among men after prostatectomy.

Mechanism of action of Cymbalta

Before we look at the side effects of Cymbalta here is a look at the mechanism of action of the drug to understand how it works and the manner in which it can have undesirable effects on the body. The formulation is an inhibitor of neuronal serotonin and prevents the absorption of norepinephrine. It also inhibits the absorption of dopamine, albeit with lesser intensity. The medication is not known to exercise any affinity for other receptors including opioid, cholinergic and adrenergic.

The medication is also used to manage pain and this is attributed to the increase in the levels of serotonin and norepinephrine which in turn results in the inhibition of pain. By virtue of an activated neuron, the medication prevents the pain stimuli to be transmitted to the brain and this helps in pain suppression.

The medication is known to facilitate an increase in the level of the neurotransmitters, by preventing the absorption. As a consequence, patients experience therapeutic effects. The role of serotonin and norepinephrine in emotions is well known and by ensuring that the balance is maintained through inhibition of reuptake, the medication helps in managing symptoms associated with depression. For instance, there is a clear link between mood disorders and levels of serotonin and norepinephrine, and the medication ensures that the inhibition of reuptake, maintains the desired levels of the neurotransmitters. The medication also facilitates smooth muscle contraction, thereby exerting hypertensive effects.

Frequently reported side effects of Cymbalta

By virtue of the mechanism of action of the medication and the desired outcomes, there is a possibility of different side effects. Some of the side effects are temporary in nature and likely to resolve quickly without the need for medical attention. However, some of the other side effects are serious in nature and require medical intervention to prevent the conditions from manifesting into more adverse conditions. Here is a look at the frequently reported side effects of Cymbalta. Commonly reported side effects include increased drowsy feelings, tiredness, desire to take rest or sleep always, dryness in the mouth, feelings of nausea, abnormal loss of appetite, sudden constipation, dizzy feeling and abnormally heavy sweating. Children are likely to experience additional side effects. For instance, pain in the stomach, diarrhea, sudden loss of weight and feelings of overpowering nausea are likely to be experienced by children in addition to the side effects experienced by adults.

There are possibilities of serious side effects of Cymbalta among a small percentage of users Commonly reported serious side effects include the following – damage to the liver, abnormal change in blood pressure levels, serotonin syndrome, unusual bleeding, manic episodes, difficulty in urinating, problems in vision, seizures and low sodium levels in the body.

#1 Damage to the liver – The drug is likely to cause damage to the liver and the symptoms that are indicative of this include discoloration in urine, sudden pain in the upper right side of the abdomen, heavy itching sensations, and change in the color of the skin or eyes.

#2 Abnormal change in blood pressure levels – Individuals are likely to experience change in blood pressure levels and the condition is considered as serious in nature. Possible symptoms that indicate this change include dizziness when rising from a reclining position. There is also the possibility of fainting when standing up from the bed. The possibility of this occurring is high when patients take Cymbalta for the first time or whenever the dosage of the medication is increased.

#3 Serotonin syndrome – Considered as one of the serious side effects of Cymbalta, serotonin syndrome is a result of increased levels of serotonin that accumulate from medication. The symptoms that are commonly associated with serotonin syndrome include the possibility of experiencing hallucinations, difficulty in coordinated movements, twitching of the muscles, sudden change in blood pressure, agitated behavior, slipping into a coma, sudden seizures or convulsions, shivering, dizzy feelings rigidity in the muscles and nausea or vomiting. Serotonin syndrome is considered as a serious condition in some cases as it can manifest into life threatening complications. Common methods for resolving the problem of increased levels of serotonin, include modification of the dosage, frequency of the medication or the use of serotonin blockers.

#4 Unusual bleeding – Another serious complication or adverse effect of Cymbalta includes the possibility of sudden bleeding. This is most likely to happen when the patient is on medications for other health conditions. For instance, a patient on a treatment regimen that includes non-steroidal anti-inflammatory drugs or blood thinners is likely to experience bleeding. Patients on such medications are expected to intimate the treating specialist of the other medications and conditions to prevent side effects that are attributed to drug interactions.

#5 Manic episodes – Individuals with pre-existing conditions including bipolar disorder are likely to experience manic episodes as a result of treatments using Cymbalta. The commonly reported symptoms associated with manic episodes include extreme difficulty in falling asleep, sudden spike in energy levels, uncontrollable pace of thought processes, irrational behavior, grandiose ideas, extreme mood swings from unusual levels of happiness to abrupt irritability, increased pace of conversation, and indulging in more conversations that usual.

#6 Difficulty in urinating – One of the side effects of Cymbalta is difficulty in urinating. Commonly experienced symptoms include reduced volume of urine, unlike pre-medication levels, and difficulty during actual urination.

#7 Problems in vision – Patients are also likely to experience problems related to vision. For instance, individuals could experience pain, or changed vision or inflammation around the eye. In certain cases, there is a possibility of the area around the eye turning reddish.

#8 Seizures – Convulsions or seizures are side effects of Cymbalta and require medical intervention as this could manifest into serious problems. Individuals experiencing seizures or convulsions are typically advised to reduce the dosage, or frequency, or may sometimes be prescribed alternate medications to prevent seizures.

#9 Low sodium levels – Patients are also likely to experience reduced sodium or salt levels as a result of the medication. As a consequence of low salt levels, patients are likely to end up feeling weak, unsteady, with headache. There is every possibility of patients having difficulty in concentrating or focusing on activities. Memory retention could be affected, in addition to patients having confusion with regard to routine decision-making requirements.

#10 Adverse reactions on skin – Additionally, patients are also likely to experience adverse reactions on the skin. For instance, there is a possibility of blisters breaking out on the skin, along with rashes. Patients are also known to have hives and sores when on Cymbalta.

To conclude, it is necessary to exercise caution while taking the medication, as the side effects of Cymbalta could be serious in nature. The drug is classified with a black box warning, and this level of warning is considered as the highest level of warning by the FDA.


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