How to take Duloxetine (Cymbalta)?
Ensure to read and understand the Patient Information Leaflet provided by your pharmacist before you start using Duloxetine. If there are any doubts ask your doctor or pharmacist.

Take Duloxetine (Cymbalta) tablet with a glass of water with or without food as per your doctor's advice. Usually it is recommended to take once or twice a day. If you have nausea, take this medicine with food. Swallow the capsule as a whole. Do not chew, crush,split or mix the contents with liquid or food.

Your dosage will be decided upon your medical condition, age, laboratory tests, your response to the medication and other medications that you are taking. Take Duloxetineexactly as it was prescribed for you. Do not take in doses which are either larger or for longer than what is recommended by your doctor.Inform your doctor about any medications that you are taking including prescription medications, over the counter medications, vitamins, supplements and herbal remedies.In order to reduce the side effects your doctor may start Duloxetine at a low dosage and gradually will increase the dosage over time. Take Duloxetineexactly as it was prescribed for you. Do not take in doses which are either larger or for longer than what is recommended by your doctor. Make sure to take Duloxetine regularly to get the most benefit from it.

Duloxetine (Cymbalta) needs to be continued even if you feel well. It should not be discontinued without consulting your doctor. Sometimes your condition may get worse when you stop the medication is stopped abruptly. It may also cause mood swings, tiredness, headache, sleep changes, brief feelings similar to that of electric shock. In order to stop this medication your doctor may decrease your dosage gradually. If you develop any new symptoms keep your doctor well informed.

Precaution
Prior to taking Duloxetine (Cymbalta) inform your doctor if you have

• any allergies to Duloxetine  or any other allergies
• personal or family history of bipolar/manic depressive disorder
• seizures
• liver disease
• kidney disease
• low sodium in the blood
• personal or family history of suicide attempts
• peptic ulcer disease
• bleeding problems
• stomach problems (slow emptying of the stomach)
• personal or family history of glaucoma
• use / abuse of alcohol

Duloxetine may make you dizzy, confused or disoriented. Consumption of alcohol or marijuana can increase the risk of drowsiness. Do not operate machinery, drive a car or do anything that require alertness until you can do it safely.  Understand how this medication affects you.  Do not take any alcoholic beverages.

Check your blood sugar regularly if you are diabetic as instructed by your doctor and share the results with your doctor as Duloxetine can increase your blood sugar. Your doctor will need to adjust your diabetes medication, exercise program, or diet.
If you are having surgery prior to your surgery, inform your doctor or the dentist of all the products (prescription, non- prescription medications, herbal products, vitamin and supplements) you are taking.

Older adult patients may be more sensitive to the side effects of this drug. They may experience

• dizziness
• bleeding
• lightheadedness
• loss of coordination

Older adults have a higher risk of falling due to dizziness and loss of coordination

Loss of appetite and weight loss often seen in children as a side effect among those who are taking Duloxetine. Children may be more sensitive to side effects of this medication. Need to monitor weight and height in children who are taking Duloxetine.

If you are pregnant you must take Duloxetine only if it's absolutely. Unborn baby may be harmed by Duloxetine. If the mother has been taking Duloxetine during the last 3 months of the pregnancy the babies may rarely develop withdrawal symptoms such as breathing or feeding difficulties, muscle stiffness, seizures or constant crying. Consult your doctor immediately If you notice these symptoms in your new born.  If you are planning a pregnancy, become pregnant or think you may be pregnant discuss with your doctor the risks and the benefits involved.

Nursing mothers must discuss with the doctor if it is safe to feed the baby while taking Duloxetine as it passes into breast milk and may have undesirable effects on a nursing infant.

Side Effects
Your doctor prescribed this medicine after carefully analyzing the benefits over the risks involved. Most people do not experience any serious side effects.

• dry mouth
• loss of appetite
• nausea
• drowsiness
• tiredness
• sweating
• blurred vision

Check your blood pressure regularly as Duloxetine may raise your blood pressure.  Inform the doctor if the readings are high.
Inform your doctor immediately if you experience any of the serious side effects mentioned below.

• low libido
• shaking (tremor)
• easy bruising / bleeding
• changes in sexual ability

A serious allergy reaction is extremely rare with Duloxetine. In case you show the following symptoms get to the emergency clinic

• itching
• fainting
• black stools
• swelling in the face, throat, tongue, throat
• rash  - itching
• vomit that looks like coffee grounds
• irregular / fast heartbeat
• eye pain / swelling/ vision changes/ widened pupils

Interaction
Inform your doctor about any medications that you are taking including prescription medications, over the counter medications, vitamins, supplements and herbal remedies.  Do not start, stop and change the dosage of any medicine without your doctor's permission.

Some of the medications which cause drowsiness may interact with Duloxetine is

• blood thinners (warfarin)
• antiplatelet drugs (clopidogrel)
• NSAIDS (ibruprofen)

The removal of other medications from your body can be slowed down by Duloxetine, which may affect how this medication works. Some of the medications are certain quinolone antibiotics, cimetidine etc.

Duloxetine (Cymbalta) when taken with aspirin the risk of bleeding is increased. If your doctor has prescribed a low dosage aspirin in order to prevent a heart attack or a stroke you should continue taking it unless your doctor advices you otherwise.

Duloxetine (Cymbalta) taken together with MAO inhibitors can cause serious drug interaction. You need to avoid MAO inhibitors (linezolid, rasagiline, phenelzine, procabazine, methylene blue, isocarboxazid,  safinamide, tranylcypromine) during the time of treatment.  

Most MAO shouldn't be taken for two weeks before and after treatment with Duloxetine.