Cymbalta - Comprehensive Usage Guide: instructions, indications, composition, side effects

• Active Ingredient: Duloxetine hydrochloride
• Excipients: May include microcrystalline cellulose, hypromellose, croscarmellose sodium, magnesium stearate, titanium dioxide, and other inactive ingredients depending on the formulation.

• Delayed-Release Capsules: Available in various strengths, including 20 mg, 30 mg, and 60 mg capsules.

Cymbalta belongs to the pharmacological group of serotonin-norepinephrine reuptake inhibitors (SNRIs) (ATC code: N06AX21).

• Pharmacodynamics: Duloxetine inhibits the reuptake of serotonin and norepinephrine in the central nervous system, enhancing neurotransmission. It also has weak inhibitory effects on dopamine reuptake.
• Pharmacokinetics: Duloxetine is well-absorbed after oral administration, with peak plasma concentrations reached within 6 hours. It undergoes extensive hepatic metabolism via the cytochrome P450 enzyme system (CYP1A2 and CYP2D6) and is primarily excreted in the urine.

Cymbalta is indicated for the treatment of:

• Major depressive disorder (MDD)
• Generalized anxiety disorder (GAD)
• Diabetic peripheral neuropathic pain (DPNP)
• Fibromyalgia
• Chronic musculoskeletal pain (e.g., chronic osteoarthritis pain, chronic low back pain)

Cymbalta is contraindicated in individuals with:

• Hypersensitivity to duloxetine or any component of the formulation
• Concomitant use of monoamine oxidase inhibitors (MAOIs) or within 14 days of discontinuing MAOI therapy
• Uncontrolled narrow-angle glaucoma
• Severe hepatic impairment
• End-stage renal disease requiring dialysis

Duloxetine may interact with other medications, including:

• MAOIs, SSRIs, SNRIs, and other serotonergic drugs, increasing the risk of serotonin syndrome
• Drugs that inhibit CYP1A2 and CYP2D6 enzymes, potentially altering duloxetine metabolism and efficacy
• CNS depressants, alcohol, and drugs that impair cognitive or motor function, potentiating sedation and impairment

• Cymbalta capsules should be taken orally once daily, with or without food, preferably at the same time each day.
• The initial dosage for depression and anxiety disorders is typically 60 mg/day, with adjustments based on patient response and tolerability.
• For pain conditions, the initial dosage may be lower (30 mg/day), with gradual titration as needed.

• Cymbalta should be used with caution during pregnancy, especially during the third trimester, and only if the potential benefits outweigh the potential risks to the fetus.
• Duloxetine is excreted in breast milk, and breastfeeding is not recommended during Cymbalta treatment due to the potential risk to the infant.

• Dosage adjustments may be necessary in patients with hepatic impairment or renal impairment to prevent drug accumulation and minimize the risk of adverse effects.
• Elderly patients may require lower initial doses and slower titration due to age-related changes in drug metabolism.

In case of overdose, supportive measures should be initiated, and medical attention should be sought immediately. Symptoms of duloxetine overdose may include nausea, vomiting, tachycardia, and seizures.

Common side effects of Cymbalta may include:

• Nausea
• Dry mouth
• Fatigue
• Headache
• Insomnia
• Constipation

Cymbalta capsules should be stored at controlled room temperature (20-25°C) in a dry place, protected from light and moisture. The expiration date should be checked before use.

These comprehensive instructions provide essential information on the composition, pharmacological properties, indications, contraindications, interactions, administration, side effects, and storage of Cymbalta, aiding healthcare professionals and patients in safe and effective medication use. Always consult a healthcare provider for personalized medical advice.