Duloxetine
An antidepressant that also turns down pain. Useful when low mood, anxiety and chronic pain arrive as a package deal.
Quick answer: Duloxetine (Cymbalta) is an SNRI antidepressant used for depression, generalised anxiety and diabetic nerve pain, and widely used for fibromyalgia, osteoarthritis and chronic musculoskeletal pain. Nausea is the most common side effect; starting low and taking it with food helps. It shouldn’t be stopped suddenly, because withdrawal symptoms are common.
At a glance
- For
- Depression, generalised anxiety, diabetic nerve pain; also fibromyalgia and chronic musculoskeletal pain
- Works
- Similar to other antidepressants for mood; a meaningful pain benefit for about 1 in 4 to 1 in 3 with nerve pain or fibromyalgia
- Cost
- $25 a script on the PBS for depression ($7.70 concession); check the PBS for other uses
- Kicks in
- Pain: 1–2 weeks; mood and anxiety: 2–6 weeks
- Dose
- Often 30 mg for a week, then 60 mg once a day
- Watch for
- Nausea, dry mouth, constipation, sleepiness or insomnia, sweating, sexual side effects, raised blood pressure
Two jobs for one capsule: mood and pain. Start low, and never just stop it.
Brand names
- Cymbalta, Andepra, Coperin, and generic duloxetine brands
How it works
Duloxetine boosts serotonin and noradrenaline. In the brain that helps mood and anxiety; in the spinal cord it strengthens the body’s own “volume down” pathways for pain.
Used for
- Major depression (TGA-approved)
- Generalised anxiety disorder (TGA-approved)
- Diabetic peripheral neuropathic pain (TGA-approved)
- Off label in Australia (approved overseas): fibromyalgia, chronic low back pain and osteoarthritis pain
Side effects
Nausea affects more than 1 in 5 early on and usually settles within 1–2 weeks. Dry mouth, headache, sleepiness or trouble sleeping, dizziness, constipation, sweating, less appetite and sexual side effects are common. It can raise blood pressure a little.
Full side-effect list (from the product information)
How often, from the official product information. Bold = serious.
Very common more than 1 in 10
- Nausea
- Headache
- Dry mouth
- Sleepiness
Common 1 in 10 to 1 in 100
- Dizziness or tiredness
- Trouble sleeping or vivid dreams
- Constipation, diarrhoea or indigestion
- Less appetite or weight change
- Sweating or hot flushes
- Less libido, erection or orgasm problems
- Anxiety or shakiness
- Blurred vision
- Palpitations, raised blood pressure
Uncommon 1 in 100 to 1 in 1,000
- Liver inflammation
- Bruising or bleeding
- Trouble passing urine
- Mood swings
- Suicidal thoughts (young people)
Rare 1 in 1,000 to 1 in 10,000
- Serotonin syndrome
- Low sodium
- Mania
- Seizures
- Severe skin reactions
- Glaucoma attack
Get help urgently if
- Agitation, fever, sweating, shaking and a racing heart (serotonin syndrome), especially after adding another medicine. Call 000
- Thoughts of self-harm. Call 000 or Lifeline 13 11 14
- Yellow skin or eyes, dark urine
- Confusion, severe headache or a seizure
Good to know
- Stopping: taper slowly with your doctor. Stopping suddenly often causes dizziness, “brain zaps”, nausea, irritability and poor sleep.
- Interactions: avoid with other serotonin medicines (e.g. tramadol, triptans in high use, St John’s wort) unless your doctor agrees; ciprofloxacin and fluvoxamine raise levels.
- Bleeding: risk rises with aspirin, anti-inflammatories and blood thinners.
- Avoid in heavy alcohol use or liver disease. Blood pressure is checked.
Common questions
What is duloxetine used for?
Depression, generalised anxiety and diabetic nerve pain. It’s also widely used for fibromyalgia, osteoarthritis and chronic back pain, which are approved uses overseas.
How do I stop duloxetine?
Slowly, with your doctor. Stopping suddenly often causes dizziness, “brain zaps”, nausea and irritability.
Does duloxetine cause nausea?
Yes, it’s the most common side effect at first, affecting more than 1 in 5 people. Starting at 30 mg and taking it with food helps, and it usually settles within 1–2 weeks.
Information only. Not a recommendation or endorsement of any product. Whether a medicine suits you depends on your health and other medicines, so talk to your doctor or pharmacist. In an emergency, call 000 (Australia) or your local emergency number. From a mobile, 112 works in most countries.
More information
- Cymbalta product information (TGA)
- PBS: Duloxetine
- Cochrane: Duloxetine for painful neuropathy, chronic pain or fibromyalgia (2014)
- Healthdirect: Medicines information
maladywise.com/medicines/duloxetine/