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Duloxetine: Cymbalta

Duloxetine is a serotonin-norepinephrine reuptake inhibitor used to treat mood disorders, fibromyalgia, and neuropathic and chronic pain.

Duloxetine, an antidepressant and more: a debrief for patients

Duloxetine is an SNRI (serotonin-norepinephrine reuptake inhibitor), first patented in 1990.

Under the trade name Cymbalta, it was FDA-approved in 2004 to treat:

In 2013, patent protection for Cymbalta expired, which meant that Eli Lilly (Cymbalta manufacturer) was now not the only company that could produce duloxetine.

Nowadays, the medication is available under various other trade names, such as:

However, research suggests that duloxetine can be effective for the treatment of other mental health issues, including mood spectrum disorders, panic disorder, several symptom clusters of borderline personality, and as an add-on drug in schizophrenia.

Further investigation of the drug’s potential in support for mental health requires placebo-controlled, randomized trials with large sample sizes and prolonged duration.

Duloxetine is also used off-label (without specific FDA indication) to alleviate pain caused by chemotherapy-induced peripheral neuropathy and mitigate stress urinary incontinence.

The drug is not scheduled as a controlled substance, but it is available only via a prescription from a licensed medical professional.

How it works

As the name of its class suggests, duloxetine inhibits the reuptake of serotonin and norepinephrine—two neurotransmitters that have an important role in mood regulation.

By inhibition of norepinephrine transporters, the drug also increases dopamine levels within the prefrontal cortex.

The analgetic effect of duloxetine lies in its ability to affect certain neurons which results in the prevention of excess neural input reaching the brain and being perceived as pain.

Administration and dosage

Generally, the medication should be taken once per day, through the mouth, with no regard to meals. It is important to remember that duloxetine capsules should not be chewed, crushed, or opened.

Available dosage strengths are 20 mg, 30 mg, and 60 mg. The initial dose varies from 30 to 60 mg daily and can be adjusted depending on the patient’s response to treatment.

While the maximum daily dose of duloxetine is 120 mg, there is no convincing evidence that the dosage over 60 mg provides additional benefits.

If the drug is discontinued, it is recommended to gradually reduce the dose rather than drop the treatment abruptly.

Side effects

Common adverse reactions to duloxetine include:

Severe side effects of the medication include:

If the patient experiences any side effects presumably caused by treatment with duloxetine, they should consult their healthcare provider.

Who should not take duloxetine
Drug interactions and alcohol

Duloxetine interacts with many drugs, including the aforementioned MAO inhibitors, linezolid, NSAIDs, blood thinners, etc.

If the patient takes any medication, either prescription or OTC, they should notify their doctor and clarify the compatibility of duloxetine with the drug.

It is recommended to avoid drinking alcohol during duloxetine therapy to prevent liver injury.


Duloxetine, also well-known under the brand name Cymbalta, is a prescription-only drug that belongs to second-generation antidepressants and is used to treat chronic pain and mental health disorders.

The drug is prescription-only, and patients on treatment should be monitored to avoid dangerous side effects.