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Cymbalta (duloxetine)

An Antidepressant That Also Relieves Nerve Pain

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Updated November 16, 2006

Updated November 16, 2006
Depression is very common among people living with HIV. Peripheral neuropathy (nerve pain) is often a side effect of the medications used to treat HIV. It can also be a primary consequence of HIV infection itself. Cymbalta is an antidepressant that is also approved for the treatment of diabetic peripheral neuropathy. Cymbalta is available to HIV-infected people as an alternative to the drugs commonly prescribed for depression and peripheral neuropathy.

Dealing with Depression

What is Peripheral Neuropathy?

What is Cymbalta?

Cymbalta (duloxetine) is an antidepressant recently approved by the FDA that has also been approved to treat peripheral neuropathy. People who suffer from depression will often experience pain; people with depression are more sensitive to pain, and treating depression improves one’s threshold for pain. Cymbalta not only treats the emotional effects of depression, but the physical pain of depression as well.

How Does Cymbalta Work?

To understand how Cymbalta works, you must first understand the physiology or cause of depression. There are two naturally occurring chemicals in the brain that are responsible for mood and mood stability. Under normal circumstances, these two chemicals, serotonin and norepinephrine, are in a specific balance. However, these chemicals can become out of balance, causing changes in mood, specifically depression. Cymbalta works by re-establishing the balance of these two chemicals, and in turn relieving the symptoms of depression.

The same two chemicals responsible for mood also have an influence on pain perception. Just as an imbalance causes depression, an imbalance of these chemicals causes pain. When Cymbalta re-establish chemical balance, the symptoms of pain are relieved.

Important Note! - While Cymbalta relieves nerve pain, keep in mind it is not a narcotic.

How is Cymbalta Prescribed and Taken?

Cymbalta is available in 20mg, 30mg, and 60mg capsules. The preferred dose is 60mg once daily. Some people may require less than 60mg each day. As is the case in any medication, the prescribed dose should be the lowest does that has therapeutic effect.

One benefit of Cymbalta is the fact it can be taken as one capsule once per day. Adherence to HIV medications is an ongoing problem in the treatment of HIV. Two factors that impact adherence is the number of pills that must be taken each day and how often medicine needs to be taken in a day. Most antidepressants can be taken once per day, however, current peripheral neuropathy medications often have to be taken several times each day. Cymbalta's one capsule, once-a-day treatment does not add significantly to a daily pill burden.

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What Should I Expect When Taking Cymbalta?

Like most antidepressants, it will take some time before you feel the effects of Cymbalta. It takes some time to re-establish a chemical balance in the brain. Some people will feel better after about a week on the drug and most will feel better by four to five weeks after starting. You should not stop the drug until speaking with your physician.

Important Note! - Unlike narcotic pain medications that work an hour after taking a dose, Cymbalta will take a little time to relieve your pain. If you need pain control while serotonin and norepinephrine balance is restored, speak to your doctor for suggestions.

Are There Any Side Effects I Should Be Aware Of?

Like most medications, there are some side effects associated with Cymbalta. Most side effects - if they do occur - will resolve after the body becomes adjusted to the medication, usually in a couple of weeks. In clinical trials, the most commonly reported side effects include:
  • nausea
  • dry mouth
  • constipation
  • decreased appetite
  • fatigue
  • drowsiness or feeling sleepy
  • increased sweating
  • sexual side-effects
  • possible withdrawal symptoms if abruptly discontinued
While not common, there have been reported cases of elevated blood pressure when taking Cymbalta. Your doctor will monitor your blood pressure while taking the drug.

Drug Interactions and Precautions

While Cymbalta has been deemed safe by the FDA, there are people who should not take the drug because of certain drug interactions. Some drugs, when taken together can cause unpredictable and potentially dangerous side effects. For that reason, you should not take Cymbalta if:
  • you have had an allergic reaction to Cymbalta in the past
  • you have taken drugs known as monoamine oxidase inhibitors (MAOI) - consult your doctor or pharmacist if you are taking an MAOI drug
  • you have glaucoma
  • you are taking the drug Mellaril (thioridazine).
Important Note! - Inform your doctor of all prescription and over-the-counter medications you are taking before starting Cymbalta in order to avoid dangerous drug interactions.

In addition to the above precautions, Cymbalta has not been approved for use in people less than 18 years of age.

Talk With Your Doctor

Important Note! - If you feel depressed, think you may want to harm yourself, or have thoughts of suicide, speak to your doctor or a mental health professional immediately.

Source: Physicians Desk Reference Package Insert - Cymbalta; Eli Lilly and Company, September 2006.

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