Instructions for the drug Cymbalta
Duloxetine Cymbalta is a medication that has the effect of an antidepressant. The active ingredient is Duloxetine, which inhibits the process of serotonin and norepinephrine reuptake.
The drug is used in the treatment of depression and generalized anxiety episodes. The drug has also found its application in polyneuropathy resulting from diabetes mellitus, which is accompanied by severe pain.
How much Cymbalta can you take a day?
Cymbalta Duloxetine is taken per os (orally) regardless of meals and with plenty of water. When taking the drug, pay attention to the integrity of the capsule.
The dosage depends primarily on the severity of the illness. In the case of a depressive episode, this drug (in a dosage of 60 mg) is prescribed at a rate of 1 capsule/per day. In certain situations, it is allowed to take 2 capsules/per day.
The maximum allowable dosage is 120 mg/day. Human use beyond this dose has yet to be studied.
Patients with polyneuropathy resulting from diabetes mellitus at the start of treatment take Cymbalta in a dosage of 60 mg on the scheme of 1 capsule/day. In certain situations, under the control of the attending doctor, it is allowed to increase up to 2 capsules/per day.
Patients suffering from presence of anxiety disorders initially take the drug in a dosage of 30 mg at a rate of 1 capsule/day. In the absence of the desired effect it is allowed to increase to 60 mg/day, at the discretion of the doctor the dosage is increased to 90-120 mg/per day.
The drug has a cumulative effect, so the first results of the application occur within 14 to 28 days of admission. Withdrawal of the drug is carried out gradually, over a period of about two weeks, in order to prevent the occurrence of ricochet syndrome due to the instant withdrawal of this drug.
Cymbalta has no adverse effect on the urinary system, so there is no need to reduce the dosage for people with moderate or reduced renal function.
If the patient suffers from renal failure, has been diagnosed with liver disease or has problems with the biliary tract, it is strictly forbidden to prescribe Cymbalta.
How Cymbalta works?
The mechanism of action is based on the process of inhibition of dopamine uptake and lack of affinity with address- and cholinergic, histamine and dopamine receptors. It is effective in treating patients suffering from depressive episodes due to its ability to inhibit serotonin and norepinephrine reuptake. This enhances noradrenergic and serotonergic neurotransmission in the CNS.
The drug Cymbalta has been proven to have a pain-killing effect to some extent, which significantly reduces the speed of transmission of pain impulses in the CNS.
Is Duloxetine the same as Cymbalta?
Duloxetine is the active ingredient in such drugs as Cymbalta, Intriv, and Duloxenta. That is, all these drugs are antidepressants and the mechanism of action is their ability to reverse the hormone serotonin and, consequently, inhibit the hormone dopamine.
While taking Duloxetine, the following side effects are likely to occur:
- CNS side effects: insomnia; increased anxiety and excitability; delirium; impairment of consciousness; spasm of masticatory muscles; ataxia; loss of strength; suicidal thoughts; unmotivated aggression; hallucinatory syndrome; mania; trembling of the extremities; the occurrence of paresthesias; impaired concentration and memory impairment; impairment of taste perception; dyskinesia; lethargic sleep; seizure syndrome; increased serotonergic activity of the CNS; extrapyramidal syndromes.
- Sensory organs: dilated pupils; decreased visual acuity; dryness of mucous membranes of the eyes; optical neuropathy; tinnitus and tinnitus pain.
- Cardiovascular system: increased heart rate; abnormal heart rhythm; atrial fibrillation; impaired consciousness due to orthostatic hypotension; fluctuations in blood pressure; increase in blood pressure up to the point of a crisis; hypothermia of the extremities.
- Respiratory system: nasal bleeding; sore throat; lumpy feeling in the airways.
- Gastrointestinal tract: increased glucose levels; abnormal weight loss; disorder of stools; dyspepsia; abdominal pain; gastrointestinal bleeding; inflammation of the mucous membrane of the stomach; belching; inflammation of the mucous membrane of the stomach, small and large intestine; foul odor from the oral cavity; ulceration of the mucous membrane of the oral cavity; melena.
- Hepatobiliary system: reactive hepatitis; elevated levels of transaminases; acute liver failure; Jaundice of the skin and mucous membranes.
- Urinary system: impaired urine outflow; acute urinary retention; increased urination; increased frequency of urination at night; decreased outflow of urine; change in urine odor.
- Reproductive system disorders: disruption of the menstrual cycle; decreased erectile function; delayed ejaculation; uterine bleeding; excretion of milk; early menopause; increased prolactin levels.
- Allergic reactions: rashes; increased sweating; Quincke's edema; dermatitis; urticaria; skin hyper reaction to sunlight; Stevens-Jones syndrome; anaphylaxis.
- Others: inflammation of the larynx; decreased thyroid function; decreased vasopressin levels; decreased sodium levels; tendency to bruise; musculoskeletal and muscle soreness; spasms and muscle twitching; trismus; chest discomfort; hot flashes; thirst; weakness; gait disturbance; feeling of crawling goosebumps; weight fluctuations; increased CPK and cholesterol levels.
If the drug is stopped abruptly, it may lead to nausea, vomiting, headache, dizziness, increased sweating, irritability, impaired stools, shaking limbs, sensory disturbances, insomnia.
Contraindications to the use of the drug
Administration of Cymbalta is contraindicated in the case of:
Impaired renal function (filtration less than 30 ml/min).
Presence of liver disease.
Duloxetine and non-selective MAO inhibitors are categorically contraindicated. It is allowed no earlier than two weeks from the date of termination of treatment with such drugs, and therapy with MAOI inhibitors can be started after at least five days from the date of termination of Duloxetine use.
If patients have suicidal tendencies, Cymbalta should be prescribed with extreme caution with constant patient monitoring to prevent possible suicide attempts.
Caution should be exercised while taking Cymbalta in patients with:
Bipolar disorders, mania, sufferers of electrical seizures.
Elevated intraocular pressure, who are highly likely to have glaucoma.
Hypertension and other diseases of the cardiovascular system.
Risk of hyponatremia.
Duloxetine and medications with hepatoxic effects are not recommended and should not be taken while operating dangerous machinery.
It is not recommended that Cymbalta be taken during pregnancy, as the effects of Duloxetine on women during this period have not been studied. Like other serotonergic drugs, Cymbalta is very likely to cause neonatal tremor and hypotension, increased neuroreflex excitability, to cause impaired reflex function, to provoke withdrawal syndrome and epileptic seizures.
It is mandatory to consult a doctor when planning a pregnancy or if pregnancy occurs while taking Duloxetine.
The approximate amount of Duloxetine that may end up in breast milk while taking the drug is 0.14% of the dosage consumed by the mother. Therefore, it is recommended to refrain from taking Cymbalta during lactation.
Before taking the drug, it is necessary to notify the doctor about the use of other drugs and allergic reactions. It is recommended to avoid combinations of the following medicines:
1. Duloxetine, sedatives, and other drugs that depress the CNS. Caution is required when combined with medications such as tramadol, tryptophan, peptidin, and tricyclic antidepressants.
2. Co-administration of Duloxetine and drugs that inhibit MAO is categorically contraindicated (and not earlier than four weeks after completion of treatment with MAO inhibitors).
3. In therapy with anticoagulants and thrombolytics, the probability of bleeding in case of concomitant administration of Cymbalta increases.
Cymbalta and the original package should be stored in a dark, dry place out of the reach of children.
There are limited data to indicate cases of intoxication with the substance Duloxetine. There are episodes when a single dose of the drug was 1400 mg in combination with other drugs without adverse effects. Cymbalta overdose can cause drowsiness, tachycardia, epileptic seizures, serotonin syndrome, and vomiting.
What drugs to use as an antidote to Duloxetine is unknown. If serotonin syndrome develops, specific therapy is recommended. In case of overdose, cardiac function, temperature, and respiratory tract condition must be monitored.
In the case of a single large dose of Duloxetine, gastric lavage should be performed immediately, and with the help of enterosorbent can significantly reduce the absorption of the drug.
And such procedures as hemodialysis and forced diuresis are ineffective in case of Duloxetine overdose.read more