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Duloxetine (generic Cymbalta)


Duloxetine (Generic Cymbalta) is used to treat depression and generalized anxiety disorder, ongoing bone or muscle pain such as lower back pain, and osteoarthritis. Cymbalta is also used to treat pain and tingling caused by diabetic neuropathy (damage to nerves that can develop in people who have diabetes), and fibromyalgia (a long-lasting condition that may cause pain, muscle stiffness and tenderness, tiredness, and difficulty falling asleep or staying asleep). Off-label uses for duloxetine include treatment for stress urinary incontinence in women (leakage of urine during physical activity such as coughing, sneezing, laughing, and exercise).

Quantity/Dose Price Medical Services Fee Shipping Total
10  20mg Capsule$ 50.00$ 39.95$ 4.99$ 94.94
20  20mg Capsule$ 70.00$ 39.95$ 4.99$ 114.94
30  20mg Capsule$ 90.00$ 39.95$ 4.99$ 134.94
10  60mg Capsule$ 55.00$ 39.95$ 4.99$ 99.94
20  60mg Capsule$ 75.00$ 39.95$ 4.99$ 119.94
30  60mg Capsule$ 95.00$ 39.95$ 4.99$ 139.94

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IMPORTANT NOTE: This information is intended to supplement, not substitute for, the expertise and judgment of your physician, pharmacist or other health care provider. It should not be construed to indicate that the use of the medication(s) shown are safe, appropriate, or effective for you. The information shown is general and does not cover all directions, possible drug integrations, or precautions. Information on this site cannot be used for self-treatment and/or self-diagnosis. Any specific instructions for a particular patient should be agreed with your health care provider. We disclaim reliability of this information and mistakes it could contain. We are not responsible for any direct, indirect, special or other indirect damage as a result of any use of the information on this site nor will we be held responsible for consequences of self-treatment. Consult your health care provider before using any drug.

Drug Facts for Cymbalta (Duloxetine)

Alternate Names:
Cymbalta, Ariclaim, Xeristar, Yentreve, Duzela, Dulane

Uses:
Duloxetine is used to treat depression and generalized anxiety disorder (GAD) (excessive worry and tension that disrupts daily life and lasts for 6 months or longer). Duloxetine is also used to treat pain and tingling caused by diabetic neuropathy (damage to nerves that can develop in people who have diabetes) and fibromyalgia (a long-lasting condition that may cause pain, muscle stiffness and tenderness, tiredness, and difficulty falling asleep or staying asleep). Duloxetine is also used to treat ongoing bone or muscle pain such as lower back pain or osteoarthritis (joint pain or stiffness that may worsen over time). Duloxetine is in a class of medications called selective serotonin and norepinephrine reuptake inhibitors (SNRIs). It works by increasing the amounts of serotonin and norepinephrine, natural substances in the brain that help maintain mental balance and stop the movement of pain signals in the brain. Off-label uses for duloxetine include treatment for stress urinary incontinence in women (leakage of urine during physical activity such as coughing, sneezing, laughing, and exercise). Talk to your doctor about using this medication to treat your condition. This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

IMPORTANT WARNING:
A small number of children, teenagers, and young adults (up to 24 years of age) who took antidepressants (''mood elevators'') such as duloxetine during clinical studies became suicidal (thinking about harming or killing oneself or planning or trying to do so). Children, teenagers, and young adults who take antidepressants to treat depression or other mental illnesses may be more likely to become suicidal than children, teenagers, and young adults who do not take antidepressants to treat these conditions. However, experts are not sure about how great this risk is and how much it should be considered in deciding whether a child or teenager should take an antidepressant. Children younger than 18 years of age should not normally take duloxetine, but in some cases, a doctor may decide that duloxetine is the best medication to treat a child's condition. You should know that your mental health may change in unexpected ways when you take duloxetine or other antidepressants even if you are an adult over 24 years of age. These changes may occur even if you do not have a mental illness and you are taking duloxetine to treat a different type of condition. You may become suicidal, especially at the beginning of your treatment and any time that your dose is increased or decreased. You, your family, or caregiver should call your doctor right away if you experience any of the following symptoms: new or worsening depression; thinking about harming or killing yourself, or planning or trying to do so; extreme worry; agitation; panic attacks; difficulty falling asleep or staying asleep; aggressive or hostile behavior; irritability; acting without thinking; severe restlessness; frenzied abnormal excitement; or any other unusual changes in behavior. Be sure that your family or caregiver checks on you daily and knows which symptoms may be serious so they can call the doctor if you are unable to seek treatment on your own. Your healthcare provider will want to see you often while you are taking duloxetine, especially at the beginning of your treatment. Be sure to keep all appointments for office visits with your doctor. The doctor or pharmacist will give you the manufacturer's patient information sheet (Medication Guide) when you begin treatment with duloxetine. Read the information carefully and ask your doctor or pharmacist if you have any questions. You also can obtain the Medication Guide from the FDA website: http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/UCM096273. No matter your age, before you take an antidepressant, you, your parent, or your caregiver should talk to your doctor about the risks and benefits of treating your condition with an antidepressant or with other treatments. You should also talk about the risks and benefits of not treating your condition. You should know that having depression or another mental illness greatly increases the risk that you will become suicidal. This risk is higher if you or anyone in your family has or has ever had bipolar disorder (mood that changes from depressed to abnormally excited) or mania (frenzied, abnormally excited mood), depression, or has thought about or attempted suicide. Talk to your doctor about your condition, symptoms, and personal and family medical history. You and your doctor will decide what type of treatment is right for you.

What should I tell my health care provider before I take this medicine?
Tell your health care provider if you are allergic to duloxetine, any other medications, or any of the ingredients in duloxetine delayed-release capsules. Also ask for a list of the ingredients.

Your health care provider needs to know:
  • if you have if you have or have ever had glaucoma (an eye condition)
  • if you drink or have ever drunk large amounts of alcohol or if you use or have ever used street drugs
  • or have ever overused prescription medications
  • if you have or have ever had a heart attack, high blood pressure, seizures, coronary artery disease (blockage or narrowing of the blood vessels that lead to the heart) or heart, liver, or kidney disease
  • if you have diabetes
  • if you are pregnant (duloxetine may cause problems in newborns following delivery if it is taken during the last months of pregnancy), or if you plan to become pregnant
  • if you are breast-feeding
  • if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking duloxetine
Tell your health care provider if you are taking thioridazine or a monoamine oxidase inhibitor (MAO), such as:
  • isocarboxazid (Marplan)
  • linezolid (Zyvox)
  • methylene blue
  • phenelzine (Nardil)
  • selegiline (Eldepryl, Emsam, Zelapar)
  • tranylcypromine (Parnate)
Also tell your health care provider if you have stopped taking an MAO inhibitor within the past 14 days. If you stop taking duloxetine, you should wait at least 5 days before you start to take an MAO inhibitor. Your healthcare provider needs to know what other prescription and nonprescription medications and vitamins you are taking or plan to take. Be sure to mention any of the following:
  • anticoagulants (blood thinners) such as warfarin (Coumadin, Jantoven)
  • antidepressants such as:
    • amitriptyline (Elavil)
    • amoxapine (Asendin)
    • clomipramine (Anafranil)
    • desipramine (Norpramin)
    • doxepin (Adapin, Sinequan)
    • imipramine (Tofranil)
    • nortriptyline (Aventyl, Pamelor)
    • protriptyline (Vivactil)
    • trimipramine (Surmontil)
  • antihistamines
  • aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn)
  • buspirone
  • cimetidine (Tagamet)
  • diuretics (water pills)
  • fentanyl (Abstral, Actiq, Fentora, Onsolis, and others)
  • medications for irregular heartbeat such as:
    • amiodarone (Cordarone)
    • flecainide (Tambocor)
    • moricizine (Ethmozine)
    • propafenone (Rythmol)
    • quinidine (Quinidex)
  • propranolol (Inderal)
  • medications for migraine headaches such as:
    • almotriptan (Axert)
    • eletriptan (Relpax)
    • frovatriptan (Frova)
    • naratriptan (Amerge)
    • rizatriptan (Maxalt)
    • sumatriptan (Imitrex)
    • zolmitriptan (Zomig)
  • lithium (Eskalith, Lithobid)
  • proton pump inhibitors such as:
    • lansoprazole (Prevacid)
    • omeprazole (Prilosec)
    • pantoprazole (Protonix)
    • rabeprazole (Aciphex)
  • quinolone antibiotics such as ciprofloxacin (Cipro) or enoxacin (Penetrex)
  • sedatives
  • certain selective serotonin reuptake inhibitors (SSRIs) such as:
    • fluoxetine (Prozac, Sarafem)
    • fluvoxamine (Luvox) and paroxetine (Paxil)
    • sibutramine (Meridia)
  • sleeping pills
  • theophylline (Theochron, Theolair)
  • tramadol (Ultram)
  • tranquilizers
  • other medications for anxiety,high blood pressure, mental illness, pain, and nausea
Tell your health care provider what nutritional supplements and herbal products you are taking, especially products containing St. John's wort or tryptophan.

How to Use:
Duloxetine comes as a delayed-release capsule (releases the medication in the intestine to prevent break-down of the medication by stomach acids) to take by mouth. When duloxetine is used to treat generalized anxiety disorder, the pain of diabetic neuropathy, fibromyalgia, or ongoing bone or muscle pain, it is usually taken once a day with or without food. When duloxetine is used to treat depression, it is usually taken once or twice a day with or without food. Take duloxetine at around the same time(s) every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take duloxetine exactly as directed. Do not take more or less of it, take it more often, or take it for a longer time than prescribed by your doctor. Swallow the delayed-release capsules whole; do not split, chew, or crush them. Do not open the delayed-release capsules and mix the contents with liquids or sprinkle the contents on food. Your doctor may start you on a low dose of medication and increase your dose after one week. Duloxetine may help control your symptoms but will not cure your condition. It may take 1 to 4 weeks or longer before you feel the full benefit of duloxetine. Continue to take duloxetine even if you feel well. Do not stop taking duloxetine without talking to your doctor. Your doctor will probably decrease your dose gradually.

Side Effects:
Duloxetine may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
  • nausea
  • vomiting
  • constipation
  • diarrhea
  • heartburn
  • stomach pain
  • decreased appetite
  • dry mouth
  • increased urination
  • difficulty urinating
  • sweating or night sweats
  • dizziness
  • headache
  • tiredness
  • weakness
  • drowsiness
  • muscle pain or cramps
  • changes in sexual desire or ability
  • uncontrollable shaking of a part of the body
Some side effects can be serious. If you experience any of the following side effects, or those mentioned in the IMPORTANT WARNING section, call your doctor immediately or get emergency medical treatment:
  • unusual bruising or bleeding
  • pain in the upper right part of the stomach
  • swelling of the abdomen
  • itching
  • yellowing of the skin or eyes
  • dark colored urine
  • loss of appetite
  • extreme tiredness or weakness
  • confusion
  • flu-like symptoms
  • fever, sweating, confusion, fast or irregular heartbeat, and severe muscle stiffness
  • blurred vision
  • fever
  • blisters or peeling skin
  • rash
  • hives
  • difficulty breathing or swallowing
  • swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs
  • hoarseness
If you suddenly stop taking duloxetine, you may experience withdrawal symptoms such as:
  • nausea
  • vomiting
  • diarrhea
  • anxiety
  • dizziness
  • tiredness
  • headache
  • pain, burning, numbness, or tingling in the hands or feet
  • irritability
  • difficulty falling asleep or staying asleep
  • sweating
  • nightmares
Tell your doctor if you experience any of these symptoms when your dose of duloxetine is decreased.
Duloxetine may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

Precautions:
Duloxetine may make you drowsy, dizzy, lightheaded, or may affect your judgment, thinking or coordination. Do not drive a car or operate machinery until you know how this medication affects you. Ask your health care provider about the safe use of alcoholic beverages while you are taking duloxetine. Alcohol can increase the risk of serious side effects from duloxetine.
Duloxetine may cause fainting when you get up too quickly from a lying position. This is more common when you first start taking duloxetine or with an increase in dose. To avoid this problem, get out of bed slowly, resting your feet on the floor for a few minutes before standing up.
Duloxetine may cause high blood pressure. You should have your blood pressure checked before starting treatment and regularly while you are taking this medication.

Medical Interactions:
Many other medications may interact with duloxetine, so be sure to tell your doctor about all the medications you are taking, even those that do not appear on this list. Your doctor may need to change the doses of your medications or monitor you carefully for side effects. Especially tell your health care provider if you take:
  • blood thinners (such as warfarin or Coumadin)
  • buspirone
  • cimetidine
  • diuretics (water pills)
  • fentanyl
  • lithium
  • St. John's wort
  • tramadol
  • tryptophan (sometimes called L-tryptophan)
  • antibiotics such as ciprofloxacin
  • almotriptan, frovatriptan, sumatriptan, naratriptan, rizatriptan, or zolmitriptan
  • any other antidepressant such as desipramine, fluoxetine, fluvoxamine, paroxetine, and others
Overdose Information:
Contact 1-800-222-1222 (the American Association of Poison Control Centers) or your local poison control center, or call 911. Overdose symptoms may include:
  • agitation
  • hallucinating (seeing things or hearing voices that do not exist)
  • fast heartbeat
  • fever
  • loss of coordination
  • nausea
  • vomiting
  • diarrhea
  • drowsiness
  • seizures
  • dizziness
  • lightheadedness
  • fainting
  • unresponsiveness
Missed Dose:
Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

Storage:
Store at 25C (77F); excursions permitted to 15-30C (59-86F).

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