What is Fibromyalgia and Can Cymbalta Help?
Fibromyalgia is a chronic medical condition characterized by widespread pain, tenderness, and sensitivity in various parts of the body. It is considered a central nervous system disorder, and its exact cause is still not fully understood. In addition to pain, individuals with fibromyalgia often experience a range of other symptoms, which may include fatigue, sleep disturbances, cognitive difficulties (often referred to as “fibro fog“), headaches, and mood disorders like depression and anxiety.(1,2)
Treatment for fibromyalgia usually involves a multidisciplinary approach, which may include a combination of medications, physical therapy, exercise, relaxation techniques, and cognitive behavioral therapy. Lifestyle modifications, including stress management, regular exercise, and maintaining a balanced diet, can also be beneficial in managing the condition.
Meanwhile, Cymbalta is a brand name for the medication duloxetine. It belongs to a class of drugs known as serotonin-norepinephrine reuptake inhibitors (SNRIs). Cymbalta is primarily used to treat major depressive disorder, generalized anxiety disorder, and certain types of chronic pain conditions.(3)
In the context of fibromyalgia, Cymbalta has been approved by regulatory agencies in some countries for its use. It is believed to help with fibromyalgia by increasing the levels of serotonin and norepinephrine in the brain, which are neurotransmitters that play a role in pain perception and mood regulation.
Studies have shown that Cymbalta can be beneficial for some individuals with fibromyalgia. It may help reduce pain, improve mood, and enhance overall functioning. However, like any medication, it may not work for everyone and can have side effects.(4)
Read on to find out more about using Cymbalta for fibromyalgia, the treatment options and its efficacy.
How Does Cymbalta Work For People With Fibromyalgia?
Cymbalta, or duloxetine, works for people with fibromyalgia by affecting certain neurotransmitters in the brain. It is classified as a serotonin-norepinephrine reuptake inhibitor (SNRI), which means it primarily affects two neurotransmitters: serotonin and norepinephrine.
- Serotonin: This neurotransmitter plays a role in regulating mood, emotion, and sleep. Increasing serotonin levels can help improve mood and reduce feelings of anxiety or depression, which are commonly associated with fibromyalgia.(5)
- Norepinephrine: This neurotransmitter is involved in the body’s stress response and can also modulate pain signals. By increasing norepinephrine levels, Cymbalta may help in reducing the perception of pain.(6)
By inhibiting the reuptake (reabsorption) of these neurotransmitters in the brain, Cymbalta allows them to remain in the synaptic gap between nerve cells for a longer period. This extended presence of serotonin and norepinephrine can lead to improved mood and a potential reduction in the perception of pain.(7)
It is important to note that the exact mechanisms of how Cymbalta works for fibromyalgia are not completely understood. Additionally, individual responses to medications can vary, so what works for one person may not work for another. Always consult a healthcare professional for personalized advice and treatment options.
Are There Any Side Effects to Using Cymbalta for Fibromyalgia?
- Nausea or upset stomach: This is one of the most frequently reported side effects. It may be helpful to take Cymbalta with food to minimize this.
- Dry mouth: This can be managed with regular dental hygiene and staying hydrated.
- Constipation: Maintaining a balanced diet with fiber and fluids can help alleviate this side effect.
- Drowsiness or fatigue: It is important to be cautious when engaging in activities that require alertness, especially when starting the medication.
- Insomnia or sleep disturbances: Some individuals may experience difficulty falling asleep or staying asleep.
- Dizziness or lightheadedness: This can occur, particularly when standing up quickly. It is important to stand up slowly.
- Sweating more than usual: Some people may experience increased sweating.
- Sexual side effects: These can include decreased libido, difficulty achieving orgasm, or other sexual dysfunction.
- Weight changes: Some individuals may experience weight gain or weight loss while taking Cymbalta.
- Headache: This is a less common side effect, but it can occur.
- Increased blood pressure: In some cases, Cymbalta may lead to a slight increase in blood pressure.
Serious side effects are less common, but may include:
- Allergic reactions (difficulty breathing, rash, swelling of the face, lips, tongue, or throat).
- Liver problems (jaundice, upper stomach pain, dark urine, loss of appetite).
- Bleeding (unusual bleeding or bruising).
- Serotonin syndrome (agitation, hallucinations, rapid heartbeat, fever, muscle stiffness).
Cymbalta can also lead to sexual side effects, including decreased libido, difficulty achieving orgasm, delayed ejaculation (in men), erectile dysfunction (in men), and vaginal dryness (in women). These effects can vary in severity and not everyone experiences them. If you have concerns, discuss them with your healthcare provider.
It is crucial to discuss any concerns or potential side effects with a healthcare professional. They can provide guidance on how to manage side effects or adjust the dosage if necessary. Additionally, sudden discontinuation of Cymbalta can lead to withdrawal symptoms, so any changes in medication should be made under the guidance of a healthcare provider.
Issue of Drug Interactions with Cymbalta for Fibromyalgia Patients
Cymbalta can interact with several medications, potentially leading to adverse effects or changes in how the drugs work. Here are some categories of medications and specific examples that may interact with Cymbalta:
- Monoamine Oxidase Inhibitors (MAOIs): According to the National Alliance on Mental Illness (NAMI), it is advised not to take duloxetine (Cymbalta) concurrently with, or within two weeks of using monoamine oxidase inhibitors (MAOIs).(10) Combining Cymbalta with MAOIs can result in severe and potentially life-threatening reactions, such as serotonin syndrome. MAOIs include drugs like phenelzine and tranylcypromine.
- Serotonergic Medications: Combining Cymbalta with other medications that increase serotonin levels, such as selective serotonin reuptake inhibitors (SSRIs) like fluoxetine or sertraline, can increase the risk of serotonin syndrome.
- Blood Thinners: Cymbalta may increase the risk of bleeding when taken with anticoagulant medications like warfarin or antiplatelet drugs like aspirin.
- Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Combining Cymbalta with NSAIDs like ibuprofen or aspirin can increase the risk of bleeding or gastrointestinal problems.
- Certain Pain Medications: Opioid medications can interact with Cymbalta and increase the risk of serotonin syndrome or central nervous system depression. Discuss with your doctor if you are prescribed opioids.
- Certain Antipsychotic Medications: Some antipsychotic drugs may increase the risk of serotonin syndrome when taken with Cymbalta.
- Antidepressants: Combining Cymbalta with other antidepressants, especially tricyclic antidepressants, can increase the risk of side effects and interactions.
- Certain Heart Medications: Medications like quinidine, flecainide, and propafenone used for heart rhythm problems can interact with Cymbalta.
- Certain Antibiotics: Antibiotics like linezolid can increase the risk of serotonin syndrome when combined with Cymbalta.
- Medications Metabolized by CYP2D6: Cymbalta is metabolized by the CYP2D6 enzyme, and medications that inhibit or induce this enzyme may affect Cymbalta’s levels in the body. Examples include certain antidepressants, antipsychotics, and anti-arrhythmics.(11)
Always inform your healthcare provider about all the medications, supplements, and herbal products you are taking before starting Cymbalta or any new medication. Your healthcare provider can assess the potential for drug interactions and adjust your treatment plan accordingly. Do not stop or change any medication without consulting your healthcare provider.
Cymbalta (duloxetine) stands as a viable treatment option for fibromyalgia, offering potential relief from widespread pain and associated symptoms. As an SNRI, it works by affecting neurotransmitters in the brain, influencing both mood and pain perception. While it can be effective for many individuals, it’s important to note that its impact may vary from person to person, and side effects are possible. As with any medication, consultation with a healthcare provider is crucial to determine its suitability and to monitor for any potential interactions with other medications. The decision to incorporate Cymbalta into a fibromyalgia treatment plan should be made in close collaboration between the individual and their healthcare team, ensuring the best possible outcome in managing this chronic condition.
- Häuser, W., Ablin, J., Fitzcharles, M.A., Littlejohn, G., Luciano, J.V., Usui, C. and Walitt, B., 2015. Fibromyalgia. Nature reviews Disease primers, 1(1), pp.1-16.
- Bair, M.J. and Krebs, E.E., 2020. Fibromyalgia. Annals of internal medicine, 172(5), pp.ITC33-ITC48.
- Bymaster, F.P., Beedle, E.E., Findlay, J., Gallagher, P.T., Krushinski, J.H., Mitchell, S., Robertson, D.W., Thompson, D.C., Wallace, L. and Wong, D.T., 2003. Duloxetine (Cymbalta™), a dual inhibitor of serotonin and norepinephrine reuptake. Bioorganic & medicinal chemistry letters, 13(24), pp.4477-4480.
- Brederson, J.D., F Jarvis, M., Honore, P. and S Surowy, C., 2011. Fibromyalgia: mechanisms, current treatment and animal models. Current pharmaceutical biotechnology, 12(10), pp.1613-1626.
- Westanmo, A.D., Gayken, J. and Haight, R., 2005. Duloxetine: a balanced and selective norepinephrine-and serotonin-reuptake inhibitor. American journal of health-system pharmacy, 62(23), pp.2481-2490.
- Lee, S.I. and Keltner, N.L., 2006. Serotonin and norepinephrine reuptake inhibitors (SNRIs): Venlafaxine and Duloxetine. Perspectives in Psychiatric Care, 42(2), p.144.
- Trivedi, M.H., Desaiah, D., Ossanna, M.J., Pritchett, Y.L., Brannan, S.K. and Detke, M.J., 2008. Clinical evidence for serotonin and norepinephrine reuptake inhibition of duloxetine. International clinical psychopharmacology, 23(3), pp.161-169.
- nhs.uk. (2022). Side effects of duloxetine. [online] Available at:
- GoodRx. (n.d.). The 12 Side Effects of Cymbalta You Should Consider. [online] Available at: https://www.goodrx.com/duloxetine/cymbalta-side-effects [Accessed 14 Sep. 2023].
- Nami.org. (2020). Duloxetine (Cymbalta) | NAMI: National Alliance on Mental Illness. [online] Available at(Cymbalta).
- Knadler, M.P., Lobo, E., Chappell, J. and Bergstrom, R., 2011. Duloxetine: clinical pharmacokinetics and drug interactions. Clinical pharmacokinetics, 50, pp.281-294.
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