Duloxetine (By mouth)

Introduction:

Duloxetine (doo-LOX-e-teen)

Treats depression, generalized anxiety disorder, nerve pain caused by diabetes, or fibromyalgia (muscle pain and stiffness). This medicine is a selective serotonin and norepinephrine reuptake inhibitor (SSNRI).

Brand Name(s):

Cymbalta

When This Medicine Should Not Be Used:

How to Use This Medicine:

Delayed Release Capsule

• Your doctor will tell you how much of this medicine to use and how often. Your dose may need to be changed several times in order to find out what works best for you. Do not use more medicine or use it more often than your doctor tells you to.
• You may take this medicine with or without food.
• Swallow the delayed-release capsule whole. Do not sprinkle contents of the capsule on food or mix it with liquids before you take it. Do not crush, break, open, or chew the capsule.
• You may need to use this medicine for several weeks before you begin to feel better. Keep using the medicine even if you feel you are not improving, and talk to your doctor.
• This medicine should come with a Medication Guide. Read and follow these instructions carefully. Ask your doctor or pharmacist if you have any questions. Ask your pharmacist for the Medication Guide if you do not have one. Your doctor might ask you to sign some forms to show that you understand this information.

If a dose is missed:

• If you miss a dose or forget to use your medicine, use it as soon as you can. If it is almost time for your next dose, wait until then to use the medicine and skip the missed dose. Do not use extra medicine to make up for a missed dose.

How to Store and Dispose of This Medicine:

• Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light.
• Ask your pharmacist, doctor, or health caregiver about the best way to dispose of any leftover medicine after you have finished your treatment. You will also need to throw away old medicine after the expiration date has passed.
• Keep all medicine away from children and never share your medicine with anyone.

Drugs and Foods to Avoid:

Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products.

• Do not take cimetidine (Tagamet®), thioridazine (Mellaril®), or medicine to treat an infection (such as ciprofloxacin, enoxacin Ciloxan®, Cipro®, Penetrex®) while you are being treated with this medicine, unless your doctor says it is okay.
• Make sure your doctor knows if you are using St. John's Wort, lithium (Lithane®, Lithobid®, Eskalith®), tramadol (Ultram®), other medicines to treat depression (such as amitriptyline, desipramine, fluoxetine, fluvoxamine, imipramine, nortriptyline, paroxetine, Celexa®, Effexor®, Lexapro?, Luvox®, Norpramin®, Paxil®, Zoloft®), medicine to treat headaches (such as eletriptan, sumatriptan, Imitrex®, Relpax®), medicine to treat an infection (such as linezolid, Levaquin®, Tequin®, Zyvox®), a phenothiazine medicine (such as prochlorperazine, Compazine®, Phenergan®, Thorazine®, Trilafon®), medicine for heart rhythm problems (such as flecainide, propafenone, quinidine, Rythmol®, Tambocor®), pain or arthritis medicine, also called "NSAIDs" (such as aspirin, ibuprofen, Aleve®, Celebrex®, Vioxx®), or a blood thinner (such as warfarin, Coumadin®).
• Tell your doctor if you are using any medicines that make you sleepy. These include sleeping pills, cold and allergy medicine, narcotic pain relievers, and sedatives.
• Do not drink alcohol while you are using this medicine. Drinking alcohol while using this medicine may increase your risk of liver damage. If you regularly drink 3 or more alcoholic drinks every day, tell your doctor.

Warnings While Using This Medicine:

• Make sure your doctor knows if you are pregnant, trying to become pregnant, or breastfeeding. Tell your doctor if you have heart disease, high blood pressure, narrow-angle glaucoma, diabetes, any digestion problems, or mineral imbalance (such as low sodium in the blood). Also tell your doctor if you have a history of seizures or mania.
• For some children, teenagers, and young adults, this medicine can increase thoughts of suicide. Tell your doctor or your child's doctor right away if you or your child start to feel more depressed and have thoughts about hurting yourselves. Report any unusual thoughts or behaviors that trouble you or your child, especially if they are new or get worse quickly. Make sure the doctor knows if you or your child have trouble sleeping, get upset easily, have a big increase in energy, or start to act reckless. Also tell the doctor if you or your child have sudden or strong feelings, such as feeling nervous, angry, restless, violent, or scared. Let the doctor know if you, your child, or anyone in your family has bipolar disorder (manic-depressive) or has tried to commit suicide.
• Make sure your doctor knows if you have ever abused drugs or alcohol.
• This medicine may make you dizzy or drowsy. Avoid driving, using machines, or doing anything else that could be dangerous if you are not alert. You may also feel lightheaded when getting up from a lying or sitting position suddenly, so get up slowly. If these symptoms are bothering you or keeping you from doing your daily activities, tell your doctor right away.
• Your doctor will need to check your progress at regular visits while you are using this medicine. Be sure to keep all appointments.
• Do not stop using this medicine suddenly without asking your doctor. You may need to slowly decrease your dose before stopping it completely.
• After you stop using the medicine, call your doctor if you have mood or behavior changes, confusion, headache, nausea, vomiting, seizures, tingling pain, or ringing in your ears.

Possible Side Effects While Using This Medicine:

Call your doctor right away if you notice any of these side effects:

• Allergic reaction: Itching or hives, swelling in your face or hands, swelling or tingling in your mouth or throat, chest tightness, trouble breathing.
• Aggression, anxiety, anger, or hostility.
• Dark-colored urine or pale stools.
• Extreme sleepiness or drowsiness.
• Fast or uneven heartbeat, or dizziness.
• Feeling confused, nervous, restless, or clumsy.
• Lightheadedness or fainting.
• Muscle spasms, twitching, or stiffness.
• Nausea, vomiting, loss of appetite, or pain in your stomach.
• Panic attacks, tremors, or feeling irritable.
• Severe nausea or diarrhea.
• Unexplained fever, sweating, or shivering.
• Unusual behavior, or thoughts about hurting yourself.
• Unusual bleeding or bruising.
• Unusual tiredness or weakness.
• Yellowing of your skin or the whites of your eyes.

If you notice these less serious side effects, talk with your doctor:

• Blurred vision.
• Cough, sore throat, or runny or stuffy nose.
• Dry mouth, constipation, upset stomach, or mild nausea or diarrhea.
• Feeling tired, or having trouble sleeping.
• Headache.
• Increased sweating.
• Problems with sex, or loss of interest in sex.
• Problems with urination.
• Skin rash.
• Weight loss.

If you notice other side effects that you think are caused by this medicine, tell your doctor: