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Loss of Sex Drive Can Occur With Most Antidepressants: Many antidepressants have detrimental effects on sexual function and cymbalta Cymbalta is no exception. Food does not affect the Cmax of duloxetine, but delays the time to reach peak concentration from 6 to 10 hours and it marginally decreases the extent of absorption (AUC) by about. During marketing of other ssris and snris (serotonin and norepinephrine reuptake inhibitors there have been spontaneous reports of adverse events occurring upon discontinuation of these drugs, particularly when abrupt, including the following: dysphoric mood, irritability, agitation, dizziness, sensory disturbances (e.g., paresthesias. Stopping Cymbalta too quickly or changing from another antidepressant too quickly may result in serious symptoms including: anxiety irritability feeling tired or problems sleeping headache sweating dizziness electric shock-like delivery sensations vomiting or nausea diarrhea. Serotonin syndrome symptoms may include mental status changes (e.g., agitation, hallucinations, delirium, and coma autonomic instability (e.g., tachycardia, labile blood pressure, dizziness, diaphoresis, flushing, hyperthermia neuromuscular symptoms (e.g., tremor, rigidity, myoclonus, hyperreflexia, incoordination seizures, and/or gastrointestinal symptoms (e.g., nausea, vomiting, diarrhea). Symptoms may include: headache weakness or feeling unsteady confusion, problems concentrating or thinking or memory problems problems with urination. Adverse Reactions Occurring delivery at an Incidence of 5 or More Among Cymbalta -Treated Patients in Adult Placebo-Controlled Trials Table 2 gives the incidence day of treatment-emergent adverse reactions in placebo-controlled trials for approved indications that occurred in 5 or more. The women were given 40 mg day of cymbalta twice daily for.5 days. Additionally, cymbalta the benefit of up-titration in non-responders to Cymbalta at 60 mg/ day was evaluated in a separate study. Generalized Anxiety Disorder ( GAD 3 short-term trials in adults, 1 maintenance trial in adults, and 1 short-term trial in children and adolescents see Generalized Anxiety Disorder. After delivery 13 weeks of treatment, patients taking Cymbalta had significantly greater pain reduction. Do not open the capsule and sprinkle on food or mix with liquids. Liver transaminase elevations resulted in the discontinuation.3 (92/34,756) of cymbalta -treated patients. A gradual reduction in the dose rather than abrupt cessation is recommended whenever possible. Additional data come from the overall total of 822 pediatric patients (age 7 to 17 years of age) cymbalta with.7 children age 7 to 11 years of age and.8 female exposed one to cymbalta in MDD and GAD. Nervous System Disorders Frequent: dysgeusia, lethargy, and paraesthesia/hypoesthesia; Infrequent: disturbance in attention, dyskinesia, myoclonus, and poor quality sleep; Rare: dysarthria. 2, gelatin, hypromellose, hydroxypropyl methylcellulose acetate succinate, sodium lauryl sulfate, sucrose, sugar spheres, talc, titanium dioxide, and triethyl citrate. Drugs Metabolized by CYP2C19 Results of in vitro studies demonstrate that duloxetine does not inhibit CYP2C19 activity at therapeutic concentrations. Do not start Cymbalta if you stopped day taking an maoi in the last 14 days unless directed to do so by your healthcare provider. Cases with serum sodium lower than 110 mmol/L have been reported and appeared to be reversible when cymbalta was discontinued. Hyponatremia Advise patients that hyponatremia has been reported as one a result of treatment with snris and ssris, including Cymbalta. Seizures or convulsions low salt (sodium) levels in the blood. Callyour healthcare provider right away or get emergency help if you have skin blisters, peelingrash, sores in the mouth, hives or any other allergic reactions. Potential for Other Drugs to Affect Cymbalta CYP1A2 Inhibitors Co-administration of Cymbalta with potent CYP1A2 inhibitors should be avoided see Drug Interactions (.1 ). Steady-state plasma concentrations are typically achieved after 3 days of dosing. Other Clinically Important Drug Interactions Alcohol Use of cymbalta concomitantly with heavy alcohol intake may be associated with severe one liver injury. CNS Acting Drugs Given the primary CNS effects of Cymbalta, it should be used with caution when it is taken in combination with or substituted for other centrally acting drugs, including those with a similar mechanism of action. Bleeding events related to ssris and snris use have ranged from ecchymoses, hematomas, epistaxis, and petechiae to life-threatening hemorrhages. for additional information on the treatment of any overdose. Laboratory Changes In Adults cymbalta treatment in placebo-controlled clinical trials across approved indications, was associated with small mean increases from baseline to endpoint in ALT, AST, CPK, and alkaline phosphatase; infrequent, modest, transient, abnormal values were observed for these analytes. Treatment with cymbalta 60 mg or 120 mg daily statistically significantly improved the endpoint mean pain scores from baseline and increased the proportion of patients with at least a 50 reduction in pain score from baseline. Switching A Patient To Or From A Monoamine Oxidase Inhibitor (maoi) Intended To Treat Psychiatric Disorders At least 14 days should elapse between discontinuation of an maoi intended to treat psychiatric disorders delivery and initiation of therapy with cymbalta. In all 4 studies, Cymbalta demonstrated superiority over placebo as measured by improvement in the 17-item Hamilton Depression Rating Scale (hamd-17) total score (Studies 1-4 in Table 7 ). Patients should be cautioned about the risk of bleeding one associated with the concomitant use of cymbalta and nsaids, aspirin, or other drugs that affect coagulation. The following symptoms, anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia (psychomotor restlessness hypomania, and mania, have been reported in adult and pediatric patients being treated with antidepressants for major depressive disorder as well as for other indications, both psychiatric and nonpsychiatric.


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