Cymbalta for Osteoarthritis - What You Need to Know

Osteoarthritis Added to List of Indications for Duloxetine

Pills in a bottle
Pills in a bottle. David McNew/Getty Images

Cymbalta is emerging as a treatment for chronic musculoskeletal pain, including osteoarthritis and chronic low back pain, since the FDA approved it for those uses in 2010. Cymbalta (duloxetine hydrochloride) is an oral drug manufactured by Lilly. It was first approved by the U.S. FDA in 2004 for major depressive disorder. It has received approval for a variety of mental health conditions, but now it is also prescribed for chronic musculoskeletal pain.

How Does Cymbalta Work for Osteoarthritis and Pain?

Cymbalta is classified as a selective serotonin and norepinephrine reuptake inhibitor (SNRI). It works by increasing natural substances in the brain, serotonin and norepinephrine, which are believed to stop pain signals to the brain.

What Is the Basis of Cymbalta's Approval and Use for Osteoarthritis?

The approval of Cymbalta for musculoskeletal pain, including osteoarthritis and low back pain, was based on the results of double-blind, placebo-controlled, randomized clinical trials -- three studies for low back pain and two for osteoarthritis. Results revealed that patients taking Cymbalta had significantly greater pain reduction than patients taking placebo.

What Are the Available Doses of Cymbalta?

Cymbalta is available by prescription only. The drug is available as a delayed-release capsule in 20, 30, and 60 mg. strengths. Your doctor will prescribe the appropriate dose for your condition and may start you on a lower dose and increase the dose.

Be sure to swallow the capsule whole without crushing, splitting, chewing, or opening the capsule.

Are There Any Other Special Instructions Regarding How to Take Cymbalta?

Take your prescription exactly according to directions on the label. You can take Cymbalta with or without food. If it causes stomach upset, take with food.

Be sure not to stop the drug suddenly or without first discussing discontinuation with your doctor. If you stop suddenly, you may experience unpleasant or adverse side effects.

Is Cymbalta Unsuitable for Certain People?

Your doctor will decide if Cymbalta is an appropriate treatment for you. Be sure to inform your doctor if you have a known allergy to duloxetine, or if you take thioridazine or a MAO inhibitor. Give your doctor a list of all medications and vitamins which you take. Discuss any other medical conditions you have as well as habits such as alcohol use.

What Common Side Effects Are Associated With Cymbalta?

Common side effects may include nausea, dry mouth, constipation, sleepiness, sweating and decreased appetite. Less common side effects include vomiting, diarrhea, stomach pain, changes to urinary habits, dizziness, headache, tiredness, muscle pain, muscle cramps, changes to sexual habits, or shaking. Cymbalta may cause other side effects, some of which may be severe. If you experience severe side effects that seem like an emergency situation, seek immediate medical attention.

What Special Warnings Are Associated With Cymbalta?

Cymbalta has a black box warning as is often seen for antidepressant drugs. It was added in 2014. According to prescribing information for Cymbalta provided by the manufacturer, 

"WARNING: SUICIDAL THOUGHTS AND BEHAVIORS
• Increased risk of suicidal thinking and behavior in children, adolescents, and young adults taking antidepressants
• Monitor for worsening and emergence of suicidal thoughts and behaviors"

Keep in mind that this indication is based on studies of patients with major depressive disorder and other psychiatric disorders rather than those using it for osteoarthritis. But you, your family and caregivers should be alert to monitor you for agitation, irritability, unusual changes in behavior, and suicidality. Report any of these immediately to your health care provider.

A warning was also added in 2014 for orthostatic hypotension, falls and syncope (fainting). This is when your blood pressure drops when you get out of bed or out of a chair. The risk of falls is greater if you are taking an antihypertensive drug in addition to Cymbalta. If you are already at risk of falls from age or other conditions, this may be worse with Cymbalta, especially when you first start taking it.

Are There Drug Interactions Linked With Cymbalta?

Certain drugs taken with Cymbalta may increase or decrease the effect of the drug. Drugs to be especially careful with, which may cause drug interactions, include:

  • quinolones
  • antidepressants
  • antipsychotic medications
  • narcotic pain medications
  • sleep medications
  • tranquilizers

Is Cymbalta Safe for Pregnant or Nursing Women?

Lilly warns that animal studies show Cymbalta may cause fetal harm. They recommend caution for use in breastfeeding women. Consult your doctor but most likely it is ill-advised in most cases.

Sources:

Duloxetine (By mouth), Micromedex Consumer Medication Information, PubMed Health, U.S. National Library of Medicine, Dec. 1, 2015.

Physician Desk Reference. 2011 Edition.

Cymbalta. Prescribing Information. Eli Lilly and Co. Revised 6/2015.
http://pi.lilly.com/us/cymbalta-pi.pdf

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