Fibromyalgia is a perplexing and often disabling disorder that affects millions of Americans. However, new treatments are offering hope to those living with the pain of fibromyalgia. Cymbalta is a medication approved to manage the unique symptoms of fibromyalgia. Here is what you need to know, from the pros and cons to who should -- and should not -- take this drug. Cymbalta (duloxetine) is an antidepressant used for the treatment of fibromyalgia. Fibromyalgia is a chronic disorder that causes widespread muscle pain and tenderness, trouble sleeping, and overwhelming tiredness. Cymbalta belongs to a class of medications called serotonin and norepinephrine reuptake inhibitors (SNRIs). The FDA previously approved Cymbalta for the treatment of depression, generalized anxiety disorder, and diabetic peripheral neuropathic pain. does metoprolol lower heart rate Duloxetine was approved for the treatment of major depression in 2004. While duloxetine has demonstrated improvement in depression-related symptoms compared to placebo, comparisons of duloxetine to other antidepressant medications have been less successful. A 2012 Cochrane Review did not find greater efficacy of duloxetine compared to SSRIs and newer antidepressants. Additionally, the review found evidence that duloxetine has increased side effects and reduced tolerability compared to other antidepressants. It thus did not recommend duloxetine as a first line treatment for major depressive disorder, given the (then) high cost of duloxetine compared to inexpensive off-patent antidepressants and lack of increased efficacy. do not list duloxetine among the recommended treatment options. A review from the Annals of Internal Medicine lists duloxetine among the first line drug treatments, however, along with citalopram, escitalopram, sertraline, paroxetine, and venlafaxine. Cialis product monograph Prednisone for purchase Duloxetine Cymbalta is a drug used to treat fibromyalgia and nerve pain. Learn about side effects, drug interactions, dosages, warnings, and more. if increased beyond 60 mg/day, use increments of 30 mg/day. Maximum dose studied was 120 mg/day; safety of doses greater than 120 mg order cialis with mastercard May 3, 2004. Increasing the dose of Cymbalta from 60 mg once a day to 120 mg 60 mg twice daily was a benefit for the majority of the smaller group of. Mg once daily, discontinue if inadequate response after 2 months; review treatment at least every 3 months, maximum dose to be given in divided doses; maximum 120 mg per day. Moderate to severe stress urinary incontinence. Duloxetine ; Side-effects. Common or very common. 40-60 mg/day PO initially (in single daily dose or divided q12hr for 1 week if patient needs to adjust to therapy) Titrate dose in increments of 30 mg/day over 1 week as tolerated Target dosage: 60 mg/day PO (in single daily dose or divided q12hr); not to exceed 120 mg/day (safety of dosages Treatment of chronic musculoskeletal pain, including discomfort from osteoarthritis and chronic lower back pain 30 mg/day PO initially for 1 week to allow for therapy adjustment Target dosage: 60 mg/day PO; not to exceed 60 mg/day Dosages ≥60 mg/day have not been shown to offer additional benefits Major depressive disorder and generalized anxiety disorder: Acute episodes often necessitate several months of sustained therapy Diabetic peripheral neuropathic pain: Efficacy for 12 weeks has not been studied; if diabetes is complicated by renal disease, consider lower starting dosage with gradual increase to effective dosage Fibromyalgia: Efficacy for ≥12 weeks has not been studied; continue treatment on basis of individual patient response Chronic musculoskeletal pain: Efficacy for ≥13 weeks has not been studied Uncontrolled narrow-angle glaucoma: Use not recommended due to increased risk of mydriasis Constipation (10%) Dizziness (10%) Insomnia (10%) Diarrhea (9-10%) Anorexia (8%) Decreased appetite (7-8%) Abdominal pain (6%) Hyperhidrosis (6%) Increased sweating (6%) Agitation (5%) Nasopharyngitis (5%) Vomiting (3-5%) Male sexual dysfunction (2-5%) Abdominal pain (4%) Decreased libido (4%) Musculoskeletal pain (4%) Upper respiratory tract infection (URTI) (4%) Abnormal orgasm (3%) Agitation (3%) Anxiety (3%) Blurred vision (3%) Cough (3%) Influenza (3%) Muscle spasms (3%) Tremor (3%) Abnormal dreams (2%) Dyspepsia (2%) Hot flushes (2%) Nausea (2%) Oropharyngeal pain (2%) Palpitations (2%) Paresthesia (2%) Weight loss (2%) Yawning (2%) Dysuria ( General: Anaphylactic reaction, angioneurotic edema, hypersensitivity Cardiovascular: Hypertensive crisis, supraventricular arrhythmia, myocardial infarction, tachycardia, Takotsubo cardiomyopathy Endocrine: Galactorrhea, gynecologic bleeding, hyperglycemia, hyperprolactinemia Neurologic: Restless legs syndrome, seizures upon treatment discontinuance, extrapyramidal disorders Ophthalmic: Glaucoma Otic: Tinnitus (upon treatment discontinuance) Psychiatric: Aggression and anger (particularly early in treatment or after treatment discontinuance), hallucinations Musculoskeletal: Trismus, muscle spasm Skin: Serious skin reactions (eg, erythema multiforme and Stevens-Johnson syndrome) necessitating drug discontinuance or hospitalization, urticaria, rash Gastrointestinal: Colitis (microscopic or unspecified),cutaneous vasculitis (sometimes associated with systemic involvement), acute pancreatitis Antidepressants increased the risk of suicidal thoughts and behavior in children, adolescents, and young adults in short-term studies These studies did not show an increase in the risk of suicidal thoughts and behavior with antidepressant use in patients 24 yr There was a reduction in risk with antidepressant use in patients ≥65 yr In patients of all ages who are started on antidepressant therapy, monitor closely for worsening, and for emergence of suicidal thoughts and behaviors Advise families and caregivers of the need for close observation and communication with the prescriber CYP1A2 inhibitors or thioridazine should not be coadministered Use caution in severe renal impairment, ESRD Heavy alcohol use Suicidality; monitor for clinical worsening and suicide risk, especially in children, adolescents and young adults (18-24 years) during early phases of treatment and alterations in dosage Serotonin syndrome or neuroleptic malignant syndrome-like reactions may occur; discontinue and initiate supportive therapy; closely monitor patients concomitantly receiving triptans, antipsychotics and serotonin precursors Neonates exposed to serotonin-noreponephrine reuptake inhibitors (SNRIs) or selective serotonin reuptake inhibitors (SSRIs) late in 3rd trimester of pregnancy have developed complications necessitating prolonged hospitalization, respiratory support, and tube feeding Screen patients for bipolar disorder; risk of mixed/manic episodes is increased in patients treated with antidepressants May cause activation of mania or hypomania Increased risk of hepatotoxicity, sometimes fatal; monitor for abdominal pain, hepatomegaly, elevations in hepatic transaminases exceeding 20 times upper limit of normal; jaundice; cholestatic jaundice with minimal elevations of hepatic transaminases have also been reported; use not recommended in patients with substantial alcohol use or chronic liver disease SSRIs and SNRIs may impair platelet aggregation and increase the risk of bleeding events, ranging from ecchymoses, hematomas, epistaxis, petechiae, and GI hemorrhage to life-threatening hemorrhage; concomitant use of aspirin, NSAIDs, warfarin, other anticoagulants, or other drugs known to affect platelet function may add to this risk Severe skin reactions (eg, erythema multiforme and Stevens-Johnson syndrome); discontinue at first appearance of blisters, peeling rash, mucosal erosions, or any other sign of hypersensitivity if no other etiology can be identified Orthostatic hypotension and syncope, especially during week 1 of therapy; monitor patients taking drugs that increase risk of orthostatic hypotension; consider dose reduction or discontinue therapy in patients who experience symptomatic orthostatic hypotension, falls and/or syncope Hyponatremia due to syndrome of inappropriate antidiuretic hormone (SIADH); cases of serum sodium Exact mechanism of action unknown; inhibits reuptake of serotonin and norepinephrine; weakly inhibits reuptake of dopamine; has no MAOI activity; has no significant activity for histaminergic H1 receptor or alpha2-adrenergic receptor The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information. If memory serves me correct 90Mgs a day of Cymbalta is the maximum effective dosage. This basicaly means that in clinical trials any more than 90Mgs of Cymbalta was not shown to produce any further impact on the symptoms of the subjects depression. In my case I found Cymbalta to be the least effective of the SNRI group of SNRI drugs. the dopiness mentioned was more of a drugged out stupor for me and only occurred at dosage changes. Tingling in the fingers or toes lessens over time; occasionally have bad days. I do tend to have numbness in the tips of my fingers most of the time. What I've finally discovered from reading here, is the cause of the hair loss which was extreme over the last six months. Begin with 500 mg (one capsule) two times daily, on an empty stomach with juice. Duloxetine maximum dose Duloxetine Australian Prescriber - NPS MedicineWise, Cymbalta helped patients with depression feel better Zoloft risks Where to buy diflucan Liquid tadalafil dosage Initial dose 30 mg orally once a day for 2 weeks, after which an increase to 60 mg orally once a day may be considered Maintenance dose 30 to 60 mg orally once a day Maximum dose 120 mg Duloxetine Dosage Guide with Precautions - DULOXETINE Drug BNF content published by NICE Cymbalta Duloxetine Hcl Side Effects, Jan 3, 2014. The usual dose of duloxetine is 60 mg. At this dose, there was moderate quality evidence that duloxetine reduced pain in both painful diabetic. clomid for women Mg/day PO qDay initially; after 2 weeks, consider increasing to target dose of 60 mg/day. Some patients may benefit from doses 60 mg/day; if increased beyond 60 mg/day, use increments of 30 mg/day. Maximum dose studied was 120 mg/day; safety of doses 120 mg/day has not been evaluated Feb 13, 2018. Cymbalta is a capsule that you take by mouth once a day. The recommended dose is 60 milligrams a day. However, your doctor will likely tell.