Amlodipine; Valsartan: (Moderate) Orthostatic hypotension and syncope have been reported during duloxetine administration. Dextromethorphan: (Moderate) Because of the potential risk and severity of serotonin syndrome, caution should be observed when administering dextromethorphan with duloxetine. Serious rash and other severe cutaneous reactions, including erythema multiforme and Stevens-Johnson Syndrome (SJS), can occur with duloxetine. At least 14 days should elapse between discontinuation of an MAOI intended to treat psychiatric disorders and initiation of therapy with CYMBALTA. The concomitant use of opioids with other drugs that affect the serotonergic neurotransmitter system has resulted in serotonin syndrome. (Moderate) Monitor for increased duloxetine-related adverse effects if coadministered with bupropion. Monitor blood pressure if the combination is necessary. Prasugrel: (Moderate) Platelet aggregation may be impaired by serotonin norepinephrine reuptake inhibitors (SNRIs) due to platelet serotonin depletion, possibly increasing the risk of a bleeding complication (e.g., gastrointestinal bleeding, ecchymoses, epistaxis, hematomas, petechiae, hemorrhage) in patients receiving platelet inhibitors (e.g., cilostazol, clopidogrel, dipyridamole, ticlopidine, platelet glycoprotein IIb/IIIa inhibitors). Orthostatic hypotension and syncope have been reported during duloxetine administration. Concomitant use of hydrocodone with duloxetine may increase hydrocodone plasma concentrations and prolong opioid adverse reactions, including hypotension, respiratory depression, profound sedation, coma, and death. If a patient becomes cyanotic or if elevated methemoglobin concentrations are suspected, immediately institute treatment to counteract methemoglobinemia (such as administration of methylene blue) as oxygen delivery is ineffective throughout the body until the condition is reversed. Concomitant use may increase the exposure of nebivolol. The concurrent administration of antihypertensive agents and duloxetine may increase the risk of hypotension. antihemophilic factor (factor VIII, recombinant), Fc fusion prote antihemophilic factor (factor VIII, recombinant), glycopegylated, antihemophilic factor (factor VIII, recombinant), pegylated, antihemophilic factor (factor VIII, recombinant), porcine, antihemophilic factor (factor VIII, recombinant), single chain, antihemophilic factor (recombinant), Fc-VWF-XTEN fusion protein, asparaginase erwinia chrysanthemi (recombinant), Aspercreme Lidocaine Pain Relieving Creme, aspirin/chlorpheniramine/dextromethorphan/phenylephrine, aspirin/doxylamine/dextromethorphan/phenylephrine, Aveeno Baby Eczema Therapy Moisturizing Cream, Aveeno Baby Eczema Therapy Nighttime Balm, Aveeno Baby Eczema Therapy Soothing Bath Treatment, Aveeno Baby Soothing Hydration Creamy Oil, Aveeno Baby Soothing Multi-Purpose Ointment, Aveeno Restorative Skin Therapy Itch Relief Balm. Concomitant use increases the risk for hypotension, including orthostatic hypotension and syncope. The concurrent administration of antihypertensive agents and duloxetine may increase the risk of hypotension. Discontinue hydrocodone if serotonin syndrome is suspected. Discontinuation of duloxetine could decrease hydrocodone plasma concentrations, decrease opioid efficacy, and potentially lead to a withdrawal syndrome in those with physical dependence to hydrocodone. Dextromethorphan; Quinidine: (Moderate) Because of the potential risk and severity of serotonin syndrome, caution should be observed when administering dextromethorphan with duloxetine. Paroxetine: (Moderate) Monitor patients for an increase in paroxetine-related adverse reactions and signs and symptoms of serotonin syndrome during concomitant use of paroxetine and duloxetine, particularly during treatment initiation and dosage increases. In vivo data suggest that teriflunomide is a weak inducer of CYP1A2. If duloxetine is discontinued, monitor the patient carefully and consider increasing the opioid dosage if appropriate. The toxic effects of local anesthetics are additive. The concomitant use of serotonergic drugs increases the risk of serotonin syndrome. Dextromethorphan; Guaifenesin; Pseudoephedrine: (Moderate) Because of the potential risk and severity of serotonin syndrome, caution should be observed when administering dextromethorphan with duloxetine. Geriatric patients are more likely than younger adults to have a regimen of multiple medications, concomitant illnesses, and gait disturbances that may increase the underlying risk of falls. Diazoxide: (Moderate) Orthostatic hypotension and syncope have been reported during duloxetine administration. Patients should be instructed to monitor for signs and symptoms of bleeding while taking an SNRI with medications which impair platelet function and to promptly report any bleeding events to the practitioner. Discontinue all serotonergic agents and initiate symptomatic treatment if serotonin syndrome occurs. Patients should be instructed to monitor for signs and symptoms of bleeding while taking an SNRI with a platelet inhibitor and to promptly report any bleeding events to the practitioner. Calcium-channel blockers: (Moderate) Orthostatic hypotension and syncope have been reported during duloxetine administration. If combination treatment is required, patients should be carefully observed, particularly during treatment initiation and during dose adjustments of the serotonergic drug; discontinue buprenorphine if serotonin syndrome is suspected. Theophylline, Aminophylline: (Moderate) Close monitoring of theophylline levels is advisable during concurrent use of duloxetine and theophylline. Sacubitril; Valsartan: (Moderate) Orthostatic hypotension and syncope have been reported during duloxetine administration. Enalapril, Enalaprilat: (Moderate) Orthostatic hypotension and syncope have been reported during duloxetine administration. If duloxetine is discontinued, monitor the patient carefully and consider reducing the opioid dosage if appropriate. Methylene Blue: (Contraindicated) Concurrent use of methylene blue and serotonin norepinephrine reuptake inhibitors (SNRIs) (e.g., venlafaxine, duloxetine, desvenlafaxine, milnacipran) should generally be avoided due to the potential for serotonin syndrome. Brompheniramine; Pseudoephedrine; Dextromethorphan: (Moderate) Because of the potential risk and severity of serotonin syndrome, caution should be observed when administering dextromethorphan with duloxetine. Serotonin release by platelets plays an important role in hemostasis. Sodium levels should be closely monitored when starting or changing dosages in older adults. The concurrent administration of antihypertensive agents and duloxetine may increase the risk of hypotension. There is no evidence that doses higher than 60 mg once daily confer additional significant benefit and the higher dosage is clearly less well tolerated. Codeine; Guaifenesin; Pseudoephedrine: (Moderate) Careful monitoring, particularly during treatment initiation and dose adjustment, is recommended during coadministration of codeine and duloxetine because of the potential risk of serotonin syndrome, reduced codeine efficacy, and potential for opioid withdrawal symptoms. If serotonin syndrome is suspected, discontinue dolasetron and concurrent serotonergic agents and initiate appropriate medical treatment. Sexual side effects from these drugs are common - they can cause problems related to ejaculation (it's delayed or impossible) and weak libido. Then, the dosage may be increased to 60 mg once daily based on response and tolerability. Can I take Cymbalta (duloxetine) and Trintellix (vortioxetine) together? Monitor blood pressure if the combination is necessary. Patients receiving this combination should be monitored for the emergence of serotonin syndrome or neuroleptic malignant syndrome-like reactions. In terms of maternal risk, exposure to SNRIs in mid to late pregnancy may increase the risk of eclampsia and use near obstetric delivery may increase the risk for postpartum hemorrhage. aspirin, prednisone, ibuprofen, sertraline, trazodone, tramadol, meloxicam, escitalopram, duloxetine, alprazolam. While a 120mg once daily dose was shown to be effective, there is no evidence that doses greater than 60mg/day confer additional benefit. Patients with residual disability, pneumothorax with arterial and venous thrombo- sis. It is not intended to be a substitute for the exercise of professional judgment. The drug undergoes extensive hepatic oxidation to numerous inactive metabolites with only 3% of the parent drug remaining in the plasma. The concurrent administration of antihypertensive agents and duloxetine may increase the risk of hypotension. It is not known if patients receiving other serotonergic psychiatric agents with intravenous methylene blue are at a comparable risk or if methylene blue administered by other routes (e.g., orally, local injection) or in doses less than 1 mg/kg IV can produce a similar outcome. Duloxetine is not recommended for use in pediatric patients less than 7 years of age; safety and efficacy have not been established. Monitor patients closely at frequent intervals and consider a dosage reduction of hydrocodone until stable drug effects are achieved. Data are inadequate to determine whether the chronic use of SNRIs causes long-term growth inhibition; however, decreased weight gain has been observed in children and adolescents receiving duloxetine. Acetaminophen; Pentazocine: (Major) Because of the potential risk and severity of serotonin syndrome or neuroleptic malignant syndrome-like reactions, caution should be observed when administering serotonin norepinephrine reuptake inhibitors (SNRIs) with other drugs that have serotonergic properties such as pentazocine. Monitor blood pressure if the combination is necessary. Serotonin syndrome is characterized by rapid development of hyperthermia, hypertension, myoclonus, rigidity, autonomic instability, mental status changes (e.g., delirium or coma), and in rare cases, death. The concurrent administration of antihypertensive agents and duloxetine may increase the risk of hypotension. Side Effects. Nitroglycerin: (Minor) Nitroglycerin can cause hypotension. Clinicians should closely monitor patients for the development of methemoglobinemia when a combination local anesthetic is used during a procedure. Serotonin release by platelets plays an important role in hemostasis. It is unclear if the reaction was the result of a drug interaction. Serotonin release by platelets plays an important role in hemostasis. Nicardipine: (Moderate) Orthostatic hypotension and syncope have been reported during duloxetine administration. Duloxetine has not been studied in patients with cardiac disease, including those with a recent history of myocardial infarction or unstable coronary artery disease. Clevidipine: (Moderate) Orthostatic hypotension and syncope have been reported during duloxetine administration. Monoamine oxidase inhibitors: (Contraindicated) Due to the risk of serotonin syndrome, monoamine oxidase inhibitors (MAOIs) intended to treat psychiatric disorders are contraindicated for use with serotonin norepinephrine reuptake inhibitors (SNRIs). While a 120 mg/day dose was shown to be effective, there is no evidence that doses more than 60 mg/day confer any additional benefits. Eprosartan: (Moderate) Orthostatic hypotension and syncope have been reported during duloxetine administration. Periodically reassess the need for continued treatment. Sildenafil: (Moderate) Orthostatic hypotension and syncope have been reported during duloxetine administration. Results from an in vitro study indicate that methylene blue is a potent, reversible inhibitor of the monoamine oxidase type A enzyme (MAO-A). Buprenorphine: (Moderate) Concurrent use of opioids, such as buprenorphine, with other drugs that modulate serotonergic function, such as duloxetine, has resulted in serotonin syndrome in some cases. Epidemiological studies have demonstrated an association between use of psychotropic drugs that interfere with serotonin reuptake and the occurrence of upper gastrointestinal bleeding. In addition, coadministration of eliglustat with CYP2D6 substrates (e.g., duloxetine) may result in increased concentrations of the concomitant drug; monitor patients closely for adverse events, and consider reducing the dosage of duloxetine and titrating to clinical effect. A postmarketing study showed a higher incidence of postpartum hemorrhage in individuals taking duloxetine. Eptifibatide: (Moderate) Platelet aggregation may be impaired by serotonin norepinephrine reuptake inhibitors (SNRIs) due to platelet serotonin depletion, possibly increasing the risk of a bleeding complication (e.g., gastrointestinal bleeding, ecchymoses, epistaxis, hematomas, petechiae, hemorrhage) in patients receiving platelet inhibitors. Inform the patient of the increased risk and monitor for the emergence of serotonin syndrome, particularly at treatment initiation or with dose increases. Inform patients taking this combination of the possible increased risk and monitor for the emergence of serotonin syndrome particularly during treatment initiation and dose adjustment. In addition, the A1c increased by 0.5% in those treated with duloxetine and 0.2% in those receiving routine care. In the treatment of stress urinary incontinence, inhibition of 5-HT and NE reuptake by duloxetine increases the activity of the bladder detrusor muscle and the urethral sphincter thereby promoting continence. It is recommended that the skin area that is to be topically anesthetized have no previous treatment with benzoyl peroxide or that the skin is thoroughly washed prior to the application of the anesthetic. Tamsulosin: (Moderate) Use caution if coadministration of duloxetine with tamsulosin is necessary, especially at a tamsulosin dose higher than 0.4 mg, as the systemic exposure of tamsulosin may be increased resulting in increased treatment-related adverse reactions including hypotension, dizziness, and vertigo. Published interaction reports between intravenously administered methylene blue and serotonergic psychiatric agents have documented symptoms including lethargy, confusion, delirium, agitation, aggression, obtundation, myoclonus, expressive aphasia, hypertonia, pyrexia, elevated blood pressure, seizures, and/or coma. It works by relaxing blood vessels . Valsartan; Hydrochlorothiazide, HCTZ: (Moderate) Orthostatic hypotension and syncope have been reported during duloxetine administration. Caution is recommended when prescribing duloxetine to patients with controlled closed-angle glaucoma. CYMBALTA (Duloxetine Delayed-Release Capsules) for Oral Use. Theophylline is a substrate for CYP1A2 and duloxetine is a CYP1A2 inhibitor. Consider reducing the duloxetine dose or discontinuing duloxetine if symptomatic orthostatic hypotension, falls, or syncope occur during treatment. Investigators attributed the decreased anesthetic effect to a breakdown of the benzocaine molecule by either or both benzoyl peroxide or benzoyl peroxide-derived free radicals. Patients who are receiving other drugs that can cause methemoglobin formation, such as prilocaine, are at greater risk for developing methemoglobinemia. (Moderate) Monitor for an increase in tricyclic antidepressant-related adverse reactions and signs and symptoms of serotonin syndrome if coadministration with duloxetine is necessary, particularly during treatment initiation and dosage increases; a dose reduction of the tricyclic antidepressant may be necessary. Serotonin-Receptor Agonists: (Moderate) Monitor for signs and symptoms of serotonin syndrome, particularly during treatment initiation and dosage increase, during concomitant duloxetine and serotonin-receptor agonists use. Fluoxetine: (Major) Due to similarity of pharmacology and the potential for additive adverse effects, including serotonin syndrome, selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine should generally not be administered with serotonin norepinephrine reuptake inhibitors (SNRIs) such as duloxetine. It is not known if patients receiving other serotonergic psychiatric agents with intravenous methylene blue are at a comparable risk or if methylene blue administered by other routes (e.g., orally, local injection) or in doses less than 1 mg/kg IV can produce a similar outcome. Duloxetine is a sensitive CYP1A2 substrate. Inform patients taking this combination of the possible increased risk and monitor for the emergence of serotonin syndrome particularly during treatment initiation and dose adjustment. The concurrent administration of antihypertensive agents and duloxetine may increase the risk of hypotension. It is not known if patients receiving other serotonergic psychiatric agents with intravenous methylene blue are at a comparable risk or if methylene blue administered by other routes (e.g., orally, local injection) or in doses less than 1 mg/kg IV can produce a similar outcome. Meperidine: (Moderate) If concomitant use of meperidine and serotonin norepinephrine reuptake inhibitors is warranted, monitor patients for the emergence of serotonin syndrome. A pooled analysis found that maternal use of sertraline, along with nortriptyline and paroxetine, usually produced undetectable or low drug concentrations in infant serum and, therefore, may be the preferred antidepressants in breast-feeding mothers. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. Discontinuation of duloxetine could decrease hydrocodone plasma concentrations, decrease opioid efficacy, and potentially lead to a withdrawal syndrome in those with physical dependence to hydrocodone. Clinicians should closely monitor patients for the development of methemoglobinemia when a combination local anesthetic is used during a procedure. Coadministration with another strong CYP2D6 inhibitor increased the duloxetine AUC by about 60%. Falls resulting in bone fractures and hospitalizations have occurred during treatment with duloxetine. Serotonin syndrome, in its most severe form, can resemble neuroleptic malignant syndrome. Naproxen; Esomeprazole: (Moderate) Monitor for signs and symptoms of bleeding during concomitant duloxetine and nonsteroidal antiinflammatory drug (NSAID) use due to increased risk for bleeding. The potential for growth inhibition in pediatric patients should be monitored during duloxetine therapy. Cymbalta is used to treat major depressive disorder in adults. Aspirin, ASA; Dipyridamole: (Moderate) Platelet aggregation may be impaired by serotonin norepinephrine reuptake inhibitors (SNRIs) due to platelet serotonin depletion, possibly increasing the risk of a bleeding complication (e.g., gastrointestinal bleeding, ecchymoses, epistaxis, hematomas, petechiae, hemorrhage) in patients receiving aspirin, ASA or other salicylates which affect hemostasis. Monitor blood pressure if the combination is necessary. St. John's Wort, Hypericum perforatum: (Moderate) Because of the potential risk and severity of serotonin syndrome, caution should be observed when coadministering St. John's wort and serotonin norepinephrine reuptake inhibitors (SNRIs). Some geriatric patients may experience increased sensitivity to other adverse effects of antidepressants, including duloxetine. Serotonin release by platelets plays an important role in hemostasis. The National Pregnancy Registry for Antidepressants is dedicated to evaluating the safety of antidepressant medications that may be taken during pregnancy to treat a wide range of mood, anxiety, or psychiatric disorders. Treatment with clozapine has been associated with QT prolongation, torsade de pointes (TdP), cardiac arrest, and sudden death. Epidemiological studies have demonstrated an association between use of psychotropic drugs that interfere with serotonin reuptake and the occurrence of upper gastrointestinal bleeding. Monitor patients closely at frequent intervals and consider a dosage reduction of hydrocodone until stable drug effects are achieved. Based on in vitro data, gefitinib is metabolized to O-desmethyl gefitinib by CYP2D6 and duloxetine is a CYP2D6 inhibitor. In addition, when fluvoxamine, a potent CYP1A2 inhibitor, was coadministered with duloxetine to male subjects (n=14) the duloxetine AUC was increased approximately 6-fold, the Cmax was increased about 2.5-fold, and duloxetine half-life was increased approximately 3-fold. Duloxetine is a CYP2D6 substrate/inhibitor. Calamine; Pramoxine: (Moderate) Caution is advised if combining local anesthetics. Aspirin, ASA; Caffeine: (Moderate) Platelet aggregation may be impaired by serotonin norepinephrine reuptake inhibitors (SNRIs) due to platelet serotonin depletion, possibly increasing the risk of a bleeding complication (e.g., gastrointestinal bleeding, ecchymoses, epistaxis, hematomas, petechiae, hemorrhage) in patients receiving aspirin, ASA or other salicylates which affect hemostasis. Inform patients taking this combination of the possible increased risk and monitor for the emergence of serotonin syndrome particularly during treatment initiation and dose adjustment. Monitor blood pressure if the combination is necessary. Monitor patients for serotonin syndrome if concomitant use is necessary. Phenothiazines are CYP2D6 substrates and duloxetine is a CYP2D6 inhibitor. Case reports and epidemiological studies have demonstrated an association between use of drugs that interfere with serotonin reuptake and gastrointestinal bleeding. Diltiazem: (Moderate) Orthostatic hypotension and syncope have been reported during duloxetine administration. Inform patients taking this combination of the possible increased risk and monitor for the emergence of serotonin syndrome particularly during treatment initiation and dose adjustment. Epidemiological studies have demonstrated an association between use of psychotropic drugs that interfere with serotonin reuptake and the occurrence of upper gastrointestinal bleeding. Discontinue all serotonergic agents and initiate symptomatic treatment if serotonin syndrome occurs. Phentermine is related to the amphetamines, and there has been historical concern that phentermine might exhibit potential to cause serotonin syndrome when combined with serotonergic agents. One case report suggests that serotonin toxicity may have occurred post-operatively following administration of standard infusions of methylene blue in a patient receiving duloxetine. Clopidogrel: (Moderate) Carefully monitor patients for signs and symptoms of bleeding during coadministration of duloxetine and clopidogrel. Important Administration Instructions Administer CYMBALTA orally (with or without meals) and swallow whole. The pregnancy registry monitors pregnancy outcomes; information about the registry can be obtained at https://womensmentalhealth.org/research/pregnancyregistry/antidepressants or by calling 1-866-961-2388. Discontinuation of duloxetine could decrease hydrocodone plasma concentrations, decrease opioid efficacy, and potentially lead to a withdrawal syndrome in those with physical dependence to hydrocodone. Concurrent use may increase exposure of the tricyclic antidepressant. If serotonin syndrome occurs, duloxetine and the concomitant serotonergic agent should be discontinued and symptomatic treatment should be initiated. The concurrent administration of esmolol and duloxetine may increase the risk of hypotension. Codeine; Phenylephrine; Promethazine: (Moderate) Careful monitoring, particularly during treatment initiation and dose adjustment, is recommended during coadministration of codeine and duloxetine because of the potential risk of serotonin syndrome, reduced codeine efficacy, and potential for opioid withdrawal symptoms. Since M1 is a more potent mu-opioid agonist, decreased M1 exposure could result in decreased therapeutic effects, and may result in signs and symptoms of opioid withdrawal in patients who have developed physical dependence to tramadol. Aliskiren: (Moderate) Orthostatic hypotension and syncope have been reported during duloxetine administration. Duloxetine is a CYP1A2 and CYP2D6 substrate and amiodarone is a CYP1A2 and CYP2D6 inhibitor. The concomitant use of opioids with other drugs that affect the serotonergic neurotransmitter system has resulted in serotonin syndrome. Granisetron: (Major) Because of the potential risk and severity of serotonin syndrome, use caution when administering granisetron with other drugs that have serotonergic properties such as duloxetine. Guanfacine: (Moderate) Monitor blood pressure during concomitant duloxetine and central-acting adrenergic agent use. Stiripentol: (Moderate) Consider a dose adjustment of duloxetine when coadministered with stiripentol. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. It is advisable to monitor blood pressure if the combination is necessary. Epidemiological studies have demonstrated an association between use of psychotropic drugs that interfere with serotonin reuptake and the occurrence of upper gastrointestinal bleeding. 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