Fibromyalgia is a complex and often disabling disorder that affects millions of Americans. But 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. Is this medicine right for you? Here is what you need to know, from the pros and cons to who should -- and should not -- take this drug.
What Is Cymbalta?
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. The agency approved Cymbalta for the management of fibromyalgia in adults in 2008.
Two similar medications, called Lyrica (pregabalin) and Savella (milnacipran), are also FDA approved.
How Does Cymbalta Work for Fibromyalgia?
Scientists are not exactly certain how Cymbalta helps make people with fibromyalgia feel better. The condition itself is poorly understood. Many believe the pain is due to changes in the nervous system that cause nerve cells to send too many signals along pain pathways. This makes a person overly sensitive to things that would normally not be painful.
Researchers think that Cymbalta helps calm down these pain signals by increasing the level of two naturally occurring substances called serotonin and norepinephrine. These substances, which are found in the brain and other parts of the nervous system, can affect mood and are believed to help control and suppress feelings of pain. Cymbalta and other SNRIs block serotonin and norepinephrine from reentering cells, so they increase the levels of these substances in your body. This process is thought to improve mood and relieve pain in patients with fibromyalgia.
How Do You Take Cymbalta?
Cymbalta is a capsule that you take by mouth once a day. The recommended dose is 60 milligrams a day. But your doctor will likely tell you to take 30 milligrams a day for the first week, before increasing you to the full dose. It is important to keep in mind that there is no evidence to suggest that taking more than 60 milligrams a day will further reduce your pain. In fact, doing so increases your chances of side effects.
If the medicine upsets your stomach, you can try taking it with a meal or some crackers. You should not drink alcohol when taking Cymbalta. Doing so can increase your risk of liver damage.
If you miss a dose, you should take it as soon as you remember -- unless it is close to the time when you are supposed to take the next one. If so, skip the missed dose and go back to your regular medication schedule. Never double your dose to catch up.
You should not suddenly stop taking this medicine. Doing so may cause unpleasant side effects, including nausea and headache. If you wish or need to stop taking Cymbalta, your doctor will tell you how to reduce your dose gradually.
Benefits of Cymbalta for Fibromyalgia
In clinical trials, Cymbalta significantly and quickly improved pain. More than half of the patients with fibromyalgia said they felt much better within 1 week. Pain relief may be greater in patients who also have depression, although those without depression also can have a significant improvement in symptoms.
Other benefits of Cymbalta:
- Pain relief is proven to be significant for at least 3 months of treatment. But treatment should be based on your individual response.
- Less pain allows you to get back to your daily routine.
- Better sleep leads to improved quality of life.
- More refreshing sleep may allow muscle tissues to heal.
Also, SNRIs often have less bothersome side effects than tricyclic antidepressants (such as amitriptyline), which are sometimes prescribed to those with fibromyalgia.
Side Effects of Cymbalta
The most common side effects of Cymbalta are:
- Constipation
- Dry mouth
- Nausea
Other side effects that may occur include:
- Decreased appetite (may include anorexia)
- Decreased sex drive
- Drowsiness or sleepiness
- Increased sweating
- Jitters, nervousness, or restlessness (agitation)
- Urinary hesitation
In rare cases, taking Cymbalta may cause you to have liver problems. Drinking alcohol when taking Cymbalta may increase your risk of liver damage. Plus, taking alcohol and other commonly abused substances with Cymbalta may make the medicine not work as well as it should and increase your risk of side effects like sleepiness and drowsiness.
Taking opioid medicines or substances at the same time you’re taking Cymbalta could also raise your risk of having a nervous system reaction called serotonin syndrome. This life-threatening reaction occurs when your body has too much serotonin and may cause symptoms like restlessness, sleeplessness, racing heart, sweating, and high fever.
You may feel dizzy upon standing when you start taking Cymbalta or when your dose is increased. This is due to a drop in blood pressure and is known as orthostatic hypotension. Your doctor may want to check your blood pressure from time to time while you are taking Cymbalta.
Cymbalta Risks and Warnings
Cymbalta and other antidepressants may increase the risk for suicidal thoughts and behaviors in people under age 24. After you are prescribed Cymbalta, your doctor will monitor you closely for unusual behavior changes, new or worsening signs of depression, or suicidal thoughts.
Cymbalta may cause a drop in salt (sodium) levels in the blood, a potentially life-threatening condition called hyponatremia. Older adults, particularly those who take diuretics ("water pills"), are more likely to develop this complication. Hyponatremia can cause headaches, confusion, weakness, and in severe cases can lead to fainting, seizures, coma, and death.
Some patients taking Cymbalta have developed liver problems. In rare cases, this has lead to liver failure and death. Contact your health care provider immediately if you develop any of the following symptoms while taking Cymbalta:
Cymbalta Drug Interactions
In rare cases, a life-threatening condition called serotonin syndrome has occurred in patients who have taken Cymbalta. Serotonin syndrome most often results when someone takes two or more medications that increase the body's serotonin levels at the same time. You need serotonin for your brain and nerve cells to function, but too much of it can be dangerous. Serotonin syndrome can lead to rapid changes in blood pressure, muscle rigidity, seizures, and even death.
This is why it is so important that your health care providers know what medications you are taking. Always tell them about all the medicines you take, including over-the-counter drugs and herbs and supplements.
Drugs that may interact with Cymbalta and cause serotonin syndrome include:
- Cough medicines that contain dextromethorphan
- Monoamine oxidase inhibitors (MAOIs)
- Nausea and heartburn medications such as metoclopramide (Reglan) and ondansetron (Zofran)
- Pain medications, including meperidine (Demerol) and tramadol (Ultram)
- St. John's wort
- Triptans, used to treat migraine headaches
Other drugs may also interact with Cymbalta, including:
- Blood thinners, including aspirin, warfarin, and nonsteroidal anti-inflammatory drugs (NSAIDs). Taking Cymbalta with such medications may increase your chances for bleeding events.
Before You Take Cymbalta
Tell your doctor about all other medical conditions you take. Cymbalta should be prescribed with caution in those who have:
- A history of seizures or mania
- Conditions that slow gastric emptying (sometimes occurs in those with diabetes)
- Diabetes (Cymbalta may affect blood sugar levels)
- High blood pressure or heart disease
- Liver disease
- Kidney disease
Before You Discontinue Cymbalta
Don’t suddenly stop taking Cymbalta, even if you feel better or have any side effects. Always speak to your doctor first, telling them about your concerns or side effects. They can explain whether stopping the medicine is right for your case, help you figure out the best way to stop taking it, or suggest other options.
Cymbalta withdrawal symptoms
If you suddenly stop taking your medicines as prescribed or stop altogether, you might have physical and mental symptoms called withdrawal symptoms.
Cymbalta withdrawal symptoms include:
- Nausea
- Vomiting
- Diarrhea
- Anxiety
- Sweating
- Headache
- Pain
- Numbness or tingling in your hands and feet
- Difficulty falling and staying asleep
- Nightmares
- Dizziness
Let your doctor know if you experience any of these symptoms anytime when taking Cymbalta. They can also happen when you return to taking lower doses.
Who Should Not Take Cymbalta?
You should not take Cymbalta if you:
- Are taking a medication called thioridazine
- Are taking a medicine called MAOI or have used one in the last 14 days
- Have uncontrolled narrow-angle glaucoma
In animal studies Cymbalta has demonstrated adverse effects on a developing fetus. No adequate or well-controlled studies of the drug have been performed in pregnant or breastfeeding women. If you're breastfeeding, pregnant, or planning to become pregnant, talk to your doctor about whether Cymbalta is right for you. You should only take Cymbalta if the benefits outweigh the risks.
Alternatives to Cymbalta for Fibromyalgia
Other medicines that can reduce symptoms like pain and difficulty sleeping include:
Gabapentin (Neurontin)
This medicine is used for nerve pain and as part of a treatment plan for seizures in people with epilepsy. This medicine may also be prescribed off-label for treating fibromyalgia. Your doctor may recommend you take between 400 and 800 milligrams by mouth daily at first,and may raise your dose to 2,400 milligrams daily. When taking Gabapentin, you might have side effects like tiredness, dizziness, nausea, vomiting, fever, weight gain, memory loss, and headache.
Milnacipran (Savella)
Savella is an SNRI antidepressant FDA-approved for treating fibromyalgia in adults. You take this medicine by mouth. Your doctor might recommend that you start by taking 12.5 milligrams once a day and gradually increase your dose to 100 milligrams per day. This medicine may cause side effects like nausea, headache, constipation, dizziness, insomnia, dry mouth, and high blood pressure.
Pregabalin (Lyrica)
Lyrica is FDA-approved for treating fibromyalgia symptoms and other conditions like nerve pain from diabetes or spinal cord injury and seizures. Your first dose may start at 300 milligrams a day, and then your doctor may increase it to 450 milligrams daily. Side effects of Lyrica include dizziness, dry mouth, sleepiness, blurred vision, difficulty focusing or concentrating, and weight gain.
Tramadol (Ultram) and other prescription pain relievers
Your doctor might recommend prescription pain relief medicines like tramadol to manage pain symptoms. Tramadol is FDA-approved for treating moderate-to-severe pain. But doctors don’t often recommend this medicine because people have been likely to misuse it or have addiction problems with it. Research is also still looking at how safe this medicine is for treating fibromyalgia pain. You’ll likely start taking Tramadol on a dose of 100 milligrams a day. Side effects of taking this medicine include nausea, dizziness, constipation, vomiting, headache, and sleepiness.
Venlafaxine (Effexor XR)
Although this antidepressant medicine isn’t FDA-approved for fibromyalgia, your doctor may recommend this medicine for you off-label. Your doctor may prescribe this medicine at first on a lower dose of 75 milligrams daily and raise it from there. You take this medicine by mouth with food. Side effects you might have while taking Venlafaxine include drowsiness, dizziness, headache, heartburn, dry mouth, nausea, vomiting, constipation, diarrhea, gas, and weight loss.
Zolpidem (Ambien, Ambien CR, Edluar, Intermezzo)
Zolpidem is recommended for treating insomnia by helping you fall asleep. It may also help relax your muscles, improving your other fibromyalgia symptoms. This medicine is a tablet you take by mouth. Your doctor may prescribe taking 5 or 10 milligrams. You’ll take this medicine at least 7 to 8 hours before you intend to wake up. Side effects you might have with Zolpidem include anxiety, memory loss, dizziness, diarrhea, tiredness, headache, and mood and behavior changes.
OTC pain relievers
Over-the-counter pain relievers may also help manage your pain symptoms. Common pain relievers called nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen are unlikely to work because the pain from fibromyalgia isn’t due to inflammation. Still, they could manage pain from other conditions when you have fibromyalgia.
Selective serotonin reuptake inhibitors (SSRIs)
Unlike SNRIs, this class of antidepressants doesn’t work for fibromyalgia pain. However, your doctor might recommend them if you have mental or emotional symptoms like depression and anxiety symptoms. Side effects you might have while taking them are nausea, weight gain, dry mouth, headache, and sweating.
Takeaways
Fibromyalgia is a chronic and disabling condition that causes symptoms like extreme tiredness, muscle pain, and difficulty sleeping. Cymbalta is an antidepressant that works well for improving your symptoms, possibly by reducing pain signals in your brain. You’ll take 60 milligrams a day by mouth. You might have side effects like dry mouth and nausea, but don’t stop taking it unless your doctor says so and tells you how to. Also, tell your doctor about any health conditions you have or medicines, herbs, or supplements you’re taking if they recommend Cymbalta.
Cymbalta for Fibromyalgia FAQs
What is the best medication for fibromyalgia pain?
The best medicine for fibromyalgia pain depends on your case. But drugs FDA-approved for fibromyalgia pain include milnacipran (Savella) and pregabalin (Lyrica).
What is the best time of day to take Cymbalta for fibromyalgia?
You can take Cymbalta for fibromyalgia at any time of the day. Your doctor might recommend taking it in the morning rather than at night if you have trouble sleeping.
What is the newest treatment for fibromyalgia?
One of the newest treatments for fibromyalgia is FibroLux. It is the first FDA-aproved laser therapy for treating fibromyalgia pain, along with other treatments.
How long does it take Cymbalta to work?
Cymbalta generally works quickly. Most people start feeling better after a week of taking it.
How long can you take Cymbalta for fibromyalgia?
How long you can take Cymbalta for fibromyalgia depends on your symptoms and how long it takes for them to get better. Your doctor will let you know how long you might be taking Cymbalta.
