What are the effects of Cymbalta on blood pressure. How can potential side effects be managed. What should patients know about Cymbalta’s impact on cardiovascular health. When should you consult a doctor about Cymbalta and blood pressure concerns.

Understanding Cymbalta: Uses and Mechanism of Action

Cymbalta, known generically as duloxetine, is a widely prescribed medication that belongs to the class of drugs called serotonin-norepinephrine reuptake inhibitors (SNRIs). The Food and Drug Administration (FDA) approved Cymbalta in 2004 for treating various conditions in adults and children.

Approved uses for adults include:

• Fibromyalgia
• Chronic musculoskeletal pain
• Diabetic neuropathy pain
• Generalized anxiety disorder
• Major depressive disorder

For children, Cymbalta is approved to treat:

• Generalized anxiety disorder (ages 7 and older)
• Fibromyalgia (ages 13 and older)

Cymbalta works by increasing the levels of serotonin and norepinephrine in the brain, which are neurotransmitters involved in mood regulation and pain perception. This dual action makes it effective for both mental health conditions and certain types of chronic pain.

Cymbalta and Its Impact on Blood Pressure

One of the notable side effects of Cymbalta is its potential impact on blood pressure. While not all patients experience blood pressure changes, it’s an important consideration for healthcare providers and patients alike.

Can Cymbalta cause high blood pressure? Yes, Cymbalta has been associated with increases in blood pressure in some patients. This effect is thought to be related to its action on norepinephrine, which plays a role in regulating blood pressure.

The extent of blood pressure changes can vary among individuals. Some may experience only slight increases, while others might see more significant elevations. It’s important to note that high blood pressure often doesn’t cause noticeable symptoms, which is why regular monitoring is crucial.

Monitoring Blood Pressure While on Cymbalta

Given the potential for blood pressure changes, healthcare providers often recommend regular blood pressure monitoring for patients taking Cymbalta. This may involve:

1. Baseline blood pressure readings before starting the medication
2. Regular check-ups during the initial weeks of treatment
3. Ongoing monitoring throughout the course of therapy
4. Self-monitoring at home for some patients

Are there specific patients who should be more cautious about blood pressure changes with Cymbalta? Individuals with pre-existing hypertension, cardiovascular disease, or other risk factors for high blood pressure should be particularly vigilant. Your healthcare provider may recommend more frequent monitoring or alternative treatment options in such cases.

Managing Blood Pressure Changes on Cymbalta

If you experience blood pressure increases while taking Cymbalta, there are several strategies that your healthcare provider might consider:

• Dose adjustment: Lowering the dose of Cymbalta may help mitigate blood pressure effects in some cases.
• Lifestyle modifications: Implementing or enhancing heart-healthy habits like regular exercise, a balanced diet, and stress reduction techniques can help manage blood pressure.
• Additional medications: In some cases, adding an antihypertensive medication might be necessary to control blood pressure effectively.
• Alternative treatments: If blood pressure changes are significant or difficult to manage, your provider might consider switching to a different medication.

Is it safe to stop taking Cymbalta if you’re concerned about blood pressure changes? It’s crucial never to stop taking Cymbalta abruptly without consulting your healthcare provider. Sudden discontinuation can lead to withdrawal symptoms and potentially dangerous blood pressure fluctuations.

Other Cardiovascular Considerations with Cymbalta

While blood pressure changes are a primary cardiovascular concern with Cymbalta, there are other heart-related effects to be aware of:

Heart Rate Changes

Some patients may experience changes in heart rate while taking Cymbalta. This can manifest as:

• Tachycardia (increased heart rate)
• Palpitations (awareness of heartbeat)
• Irregular heartbeat sensations

Do these heart rate changes always indicate a serious problem? Not necessarily. Many patients experience mild, transient changes that don’t require intervention. However, persistent or severe heart rate abnormalities should be evaluated by a healthcare provider.

Orthostatic Hypotension

Cymbalta can sometimes cause orthostatic hypotension, which is a sudden drop in blood pressure upon standing. Symptoms may include:

• Dizziness or lightheadedness
• Blurred vision
• Fainting or near-fainting episodes

How can patients manage orthostatic hypotension? Strategies include rising slowly from a seated or lying position, staying well-hydrated, and avoiding prolonged standing. In some cases, medication adjustments may be necessary.

Interactions Between Cymbalta and Blood Pressure Medications

For patients with pre-existing hypertension or those who develop high blood pressure while on Cymbalta, understanding potential drug interactions is crucial.

Can Cymbalta be safely taken with blood pressure medications? In many cases, yes, but it requires careful monitoring and potentially dose adjustments. Some considerations include:

• Additive effects: Cymbalta may enhance the blood pressure-lowering effects of some antihypertensive medications.
• Contradictory effects: In some cases, Cymbalta’s tendency to raise blood pressure may counteract the effects of blood pressure medications.
• Increased side effect risk: Combining Cymbalta with certain blood pressure medications may increase the risk of side effects like dizziness or fainting.

What should patients do if they’re prescribed both Cymbalta and blood pressure medications? Always inform all healthcare providers about all medications you’re taking, including over-the-counter drugs and supplements. Your doctor may need to adjust doses or monitor you more closely when combining these medications.

Special Populations and Cymbalta Blood Pressure Effects

Certain groups of patients may be at higher risk for blood pressure-related effects from Cymbalta or may require special considerations:

Elderly Patients

Older adults may be more susceptible to blood pressure changes and orthostatic hypotension when taking Cymbalta. This increased sensitivity is due to age-related changes in cardiovascular function and drug metabolism.

How should Cymbalta be used in elderly patients? Healthcare providers often start with lower doses and increase slowly, monitoring blood pressure and overall cardiovascular health closely.

Patients with Cardiovascular Disease

Individuals with pre-existing heart conditions or risk factors for cardiovascular disease require careful consideration when prescribed Cymbalta. This includes patients with:

• Coronary artery disease
• History of heart attack or stroke
• Congestive heart failure
• Uncontrolled hypertension

Is Cymbalta contraindicated in all patients with cardiovascular disease? Not necessarily, but the benefits must be carefully weighed against the risks. Close monitoring and potential adjustments to cardiovascular management may be necessary.

Pregnant and Breastfeeding Women

The effects of Cymbalta on blood pressure can have implications for pregnant women and their developing fetuses. Additionally, the medication can pass into breast milk.

What should pregnant or breastfeeding women know about Cymbalta and blood pressure? The decision to use Cymbalta during pregnancy or while breastfeeding should be made in consultation with a healthcare provider, weighing the potential benefits against the risks, including those related to blood pressure changes.

Long-Term Cardiovascular Effects of Cymbalta

While the immediate impacts of Cymbalta on blood pressure are well-documented, questions remain about its long-term cardiovascular effects.

Does long-term use of Cymbalta increase cardiovascular risk? Current research doesn’t definitively link long-term Cymbalta use to increased cardiovascular events. However, ongoing studies are exploring this question further.

Some areas of interest in long-term cardiovascular effects include:

• Cumulative impact on blood pressure over years of use
• Potential effects on heart structure and function
• Interaction with age-related cardiovascular changes
• Impact on overall cardiovascular risk profile

What should patients on long-term Cymbalta therapy do to monitor their cardiovascular health? Regular check-ups, including blood pressure measurements and cardiovascular risk assessments, are important. Patients should also be aware of and report any new or changing cardiovascular symptoms to their healthcare provider.

Balancing Benefits and Risks: Cymbalta and Cardiovascular Health

When considering Cymbalta treatment, particularly for patients with cardiovascular concerns, it’s crucial to weigh the potential benefits against the risks.

How do healthcare providers make decisions about Cymbalta use in patients with cardiovascular risks? The decision-making process typically involves:

1. Assessing the severity of the condition Cymbalta is intended to treat
2. Evaluating the patient’s current cardiovascular health and risk factors
3. Considering alternative treatments and their respective risk profiles
4. Discussing the patient’s preferences and concerns
5. Planning for appropriate monitoring and follow-up

Are there situations where the cardiovascular risks of Cymbalta outweigh its benefits? In some cases, yes. For patients with uncontrolled hypertension, recent cardiovascular events, or other significant cardiac risk factors, the potential cardiovascular effects of Cymbalta may be deemed too risky. In such cases, alternative treatments may be preferred.

It’s important to remember that the impact of untreated depression, anxiety, or chronic pain on cardiovascular health can also be significant. Therefore, effective treatment of these conditions, whether with Cymbalta or another option, may have cardiovascular benefits that need to be considered in the overall risk-benefit analysis.

Patients should engage in open discussions with their healthcare providers about their individual risk factors, treatment goals, and concerns regarding Cymbalta and cardiovascular health. This collaborative approach can help ensure that treatment decisions are well-informed and aligned with the patient’s overall health objectives.

What they are and how to manage them

Cymbalta (duloxetine) is a brand-name prescription medication. The Food and Drug Administration (FDA) has approved it to treat the following conditions in adults:

• fibromyalgia
• chronic musculoskeletal pain (pain affecting the bones, joints, muscles, ligament, or tendons)
• pain from diabetic neuropathy
• generalized anxiety disorder
• major depressive disorder (commonly called depression)

The FDA has approved it to treat the following conditions in certain children:

• generalized anxiety disorder in children ages 7 years and older
• fibromyalgia in children ages 13 years and older

Here are some fast facts about Cymbalta:

• Active ingredient: duloxetine
• Drug class: serotonin-norepinephrine reuptake inhibitor (SNRI)
• Drug form: delayed-release capsule
• FDA approval year: 2004

As with other drugs, Cymbalta can cause side effects. Read on to learn about potential common, mild, and serious side effects. For a general overview of Cymbalta, including details about its uses, see this article.

Cymbalta can cause certain side effects, some of which are more common than others. These side effects may be temporary, lasting a few days to weeks. However, if the side effects last longer than that, bother you, or become severe, be sure to talk with your doctor or pharmacist.

These are just a few of the more common side effects reported by people who took Cymbalta in clinical trials:

• loss of appetite
• drowsiness or fatigue
• dry mouth
• constipation*
• nausea*

* For more information about this side effect, see “Side effect specifics” below.

Mild side effects can occur with Cymbalta use. This list doesn’t include all possible mild side effects of the drug. For more information, you can refer to Cymbalta’s prescribing information.

Mild side effects that have been reported with Cymbalta include:

• abdominal pain (stomach pain)
• diarrhea
• dizziness
• dry mouth
• drowsiness or fatigue
• excessive sweating
• insomnia
• heart palpitations
• loss of appetite
• nausea*
• headache*
• sexual side effects*
• constipation*
• mild allergic reaction*

These side effects may be temporary, lasting a few days to weeks. However, if the side effects last longer than that, bother you, or become severe, be sure to talk with your doctor or pharmacist.

Note: After the Food and Drug Administration (FDA) approves a drug, it tracks side effects of the medication. If you develop a side effect while taking Cymbalta and want to tell the FDA about it, visit MedWatch.

* For more information about this side effect, see “Side effect specifics” below.

Cymbalta may cause serious side effects. The list below may not include all possible serious side effects of the drug. For more information, you can refer to Cymbalta’s prescribing information.

If you develop serious side effects while taking Cymbalta, call your doctor right away. If the side effects seem life threatening or you think you’re having a medical emergency, immediately call 911 or your local emergency number.

Serious side effects that have been reported and their symptoms include:

• Angle-closure glaucoma. Symptoms can include:
  • blurred vision
  • eye pain
  • seeing halos or rings around lights
  • severe headache
• Hyponatremia (low blood sodium levels). Symptoms can include:
  • confusion
  • difficulty with memory
  • trouble concentrating
  • muscle weakness
• High blood pressure, which does not typically have symptoms.
• Liver damage. Symptoms can include:
  • dark-colored urine
  • fatigue
  • itchiness
  • jaundice
• Orthostatic hypotension (low blood pressure when you stand up). Symptoms can include:
  • dizziness, which can lead to fainting or falls
  • blurred vision
• Seizure. Symptoms can include:
  • tingling in the hands or feet
  • loss of taste, smell, or hearing
  • convulsions or spasms
• Serotonin syndrome (too much serotonin in the body), which can be life threatening. Symptoms can include:
  • agitation
  • delirium
  • dizziness
  • fast heart rate
  • fever
  • nausea, vomiting, or diarrhea
  • seizure
  • sweating or flushing
  • tremors
• Severe skin reactions, including Stevens-Johnson syndrome. Symptoms can include:
  • blisters
  • hives
  • mouth sores
  • peeling rash
• Difficulty urinating. Symptoms can include:
  • decreased urine flow
  • inability to urinate
• Withdrawal symptoms, especially when stopping the drug suddenly. Symptoms can include:
  • atypical sensations, such as burning or prickling
  • anxiety or irritability
  • excessive sweating
  • nausea, vomiting, or diarrhea
  • drowsiness or fatigue
• Risk of suicidal thoughts and behaviors.*
• Severe allergic reaction. †

* Cymbalta has a boxed warning for this side effect. This is a serious warning from the Food and Drug Administration (FDA). To learn more, see the “Side effect specifics” section below.
† An allergic reaction is possible after taking Cymbalta. However, it’s not clear whether this side effect occurred in clinical trials. To learn more, see the “Side effect specifics” section below.

Cymbalta is approved to treat generalized anxiety disorder in children ages 7 years and older. It’s also approved to treat fibromyalgia in children ages 13 years and older. The list below may not include all possible side effects of Cymbalta in children. For more information, see Cymbalta’s prescribing information.

In clinical trials of Cymbalta, the following side effects were commonly reported in children:

• loss of appetite
• decreased weight
• diarrhea
• fatigue
• vomiting
• nausea*

In addition, Cymbalta has a boxed warning for the risk of suicidal thoughts and behaviors in children. For more information, see the “Side effect specifics” section below.

If you have questions about Cymbalta and its possible side effects in children, speak with your child’s doctor or pharmacist.

* For more information about this side effect, see “Side effect specifics” below.

Cymbalta may cause several side effects. Here are some frequently asked questions about the drug’s side effects and their answers.

Is weight gain a side effect of Cymbalta?

No, weight gain wasn’t reported in Cymbalta’s clinical trials. However, weight gain can result from depression or inactivity due to other chronic medical conditions.

Cymbalta treats depression and other conditions that can result in inactivity due to pain or fatigue, such as fibromyalgia and diabetic neuropathy (nerve pain). So, it’s important to discuss weight changes with your doctor.

If you have concerns about weight gain with Cymbalta, talk with your doctor. They can help determine potential causes and ways to manage it.

If I stop taking Cymbalta, will I experience withdrawal symptoms?

Stopping Cymbalta treatment may cause a group of withdrawal symptoms called discontinuation syndrome.

Discontinuation syndrome can happen any time you stop taking an antidepressant. However, it’s more likely when you stop it suddenly. Due to this risk, doctors typically do not recommend stopping cold turkey. Instead, doctors usually recommend gradually reducing the dose of the drug.

Talk with your doctor if you are interested in stopping treatment with Cymbalta. Do not stop taking the drug before talking with your doctor about how to do it safely. When stopping treatment, report any unusual symptoms to your doctor, such as burning or tingling, dizziness, or brain zaps.

Can Cymbalta cause long-term side effects?

Some serious side effects of Cymbalta, such as liver damage and angle-closure glaucoma, may be long term. Contact your doctor right away if you experience any serious side effects.

Most mild side effects of Cymbalta are temporary, lasting a few days to weeks. However, be sure to talk with your doctor or pharmacist if side effects last longer, bother you, or become severe.

Does Cymbalta cause different side effects in women vs. men?

In clinical trials of Cymbalta, males* and females* reported some differences in side effects.

Certain sexual side effects were reported in both males and females, including a decreased libido (sexual desire) and a delay or lack of orgasm. However, males also reported erectile dysfunction (ED) and delayed ejaculation. Additionally, sexual side effects were more common in males than in females.

For more information about sexual side effects with Cymbalta, view the “Side effects specifics” section below.

If you have questions or concerns about Cymbalta’s side effects, talk with your doctor or pharmacist.

* Sex and gender exist on spectrums. Use of the terms “female” and “male” in this article refers to sex assigned at birth.

Learn more about some of the side effects that Cymbalta may cause. To find out how often side effects occurred in clinical trials, see Cymbalta’s prescribing information.

Risk of suicidal thoughts and behaviors

Cymbalta has a boxed warning for the risk of suicidal thoughts and behaviors. This is a serious warning from the Food and Drug Administration (FDA).

Antidepressants, such as Cymbalta, can increase the risk of suicidal thoughts and behaviors in people with depression and other mental health conditions. Cymbalta may increase this risk in children, adolescents, and young adults up to 24 years old.

In clinical trials, this increased risk was not reported in adults older than 24 years. The risk of suicidal thoughts and behaviors may actually be lower in adults 65 years and older.

What you can do

Due to the boxed warning, doctors typically monitor closely for signs of suicidal thoughts or behaviors. Signs to watch for include changes in thoughts, feelings, mood, or behavior. If you notice any of these symptoms, contact your doctor immediately.

Suicide prevention

If you know someone at immediate risk of self-harm, suicide, or hurting another person:

• Ask the tough question: “Are you considering suicide?”
• Listen to the person without judgment.
• Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
• Stay with the person until professional help arrives.
• Try to remove any weapons, medications, or other potentially harmful objects.

If you or someone you know is having thoughts of suicide, a prevention hotline can help. The 988 Suicide and Crisis Lifeline is available 24 hours a day at 988. During a crisis, people who are hard of hearing can use their preferred relay service or dial 711 then 988.

Click here for more links and local resources.

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Sexual side effects

Cymbalta may cause sexual side effects in some people. These can include erectile dysfunction (ED), delayed ejaculation, a delay or lack of orgasm, and decreased libido (sexual desire).

However, it’s important to know that some of the conditions Cymbalta treats can also cause sexual dysfunction. This can make it hard to tell whether it’s the condition or the drug causing the side effect.

In clinical trials of Cymbalta, males* taking Cymbalta reported more sexual side effects than those taking a placebo. (In these studies, a placebo was a pill without an active ingredient.) In females,* the same sexual side effects occurred with both Cymbalta and the placebo.

What you can do

If you have questions or concerns about sexual side effects, talk with your doctor. Tell your doctor about any changes in sexual function during treatment with Cymbalta. They can suggest ways to manage or treat these concerns.

* Sex and gender exist on spectrums. Use of the terms “female” and “male” in this article refers to sex assigned at birth.

Nausea

Nausea was the most common side effect reported in clinical trials of Cymbalta. It was also the most common reason people stopped taking the drug.

It’s important to let your doctor know about any nausea you experience. This can be a symptom of other serious side effects, such as serotonin syndrome (too much serotonin in the body) and withdrawal symptoms.

What you can do

Contact your doctor if you have nausea that persists or becomes severe. They can help you find ways to manage this side effect.

Tips to help relieve nausea include:

• avoiding fatty, fried, greasy, spicy, or heavily seasoned foods
• consuming several small snacks during the day instead of three large meals
• avoiding from strong aromas and smells
• taking sips of liquid or sucking on ice chips often during the day

Headache

Headache was another common side effect reported in clinical trials of Cymbalta. However, this side effect occurred only slightly more in people taking Cymbalta. So, it’s difficult to tell whether or not Cymbalta caused these headaches.

That said, headache can be a symptom of other serious side effects, such as angle-closure glaucoma and discontinuation syndrome.

What you can do

Contact your doctor if you have headaches that persist or become severe. They can suggest ways to manage this problem, such as taking over-the-counter (OTC) pain relievers. These pain relievers can include Advil (ibuprofen) or Aleve (naproxen). For a severe headache with other symptoms that concern you, seek medical care right away.

Constipation

Constipation was also a common side effect reported in Cymbalta’s clinical trials. However, it wasn’t one of the reported reasons that people stopped taking the drug.

What you can do

Contact your doctor if constipation becomes long lasting or severe. They can recommend ways to manage this side effect, including certain OTC remedies. They may suggest a stool softener, such as Colace (docusate), or a laxative, such as Dulcolax (bisacodyl).

Tips to help relieve and prevent constipation include:

• drinking more water
• increasing the amount of fiber in your diet
• staying physically active
• taking a probiotic supplement or eating probiotic foods

Allergic reaction

As with most drugs, Cymbalta can cause an allergic reaction in some people. However, it’s not clear whether this side effect occurred in clinical trials.

Symptoms can be mild or serious and can include:

• skin rash
• itching
• flushing
• swelling under your skin, typically in your eyelids, lips, hands, or feet
• swelling of your mouth, tongue, or throat, which can make it hard to breathe

What you can do

For mild symptoms of an allergic reaction, call your doctor right away. They may recommend ways to ease your symptoms and determine whether you should keep taking Cymbalta. However, if your symptoms are serious and you think you’re having a medical emergency, immediately call 911 or your local emergency number.

Cymbalta comes with several warnings, including a boxed warning.

Boxed warning: Risk of suicidal thoughts and behaviors

This drug has a boxed warning for the risk of suicidal thoughts and behaviors. This is a serious warning from the Food and Drug Administration (FDA). For details, see the “Side effect specifics” section above.

Other precautions

Be sure to talk with your doctor about your health history before you take Cymbalta. This drug may not be the right treatment for you if you have certain medical conditions or other factors that affect your health. These are considered drug-condition or drug-factor interactions. The conditions and factors to consider include:

Activation of mania. Cymbalta may trigger a manic or hypomanic episode in people with depression. Symptoms of these episodes may include euphoria, irritability, or racing thoughts. The risk may be higher if you have bipolar disorder or risk factors for the condition. Tell your doctor if you have a history of bipolar disorder before starting Cymbalta. They can advise whether this medication is safe for your condition.

Bleeding problems. Cymbalta can increase the risk of bleeding. This risk may be higher if you take other drugs that affect bleeding, such as aspirin, warfarin, or other anticoagulants. Certain clotting disorders can also increase your risk of this side effect. These disorders can include hemophilia, von Willebrand’s disease, or a low platelet count. If you take any of these drugs or have a history of clotting disorders, talk with your doctor before starting Cymbalta. They can advise whether this medication is safe for your condition.

Diabetes. In people with diabetes, Cymbalta can make it harder to manage blood sugar levels. If you have diabetes, tell your doctor before starting Cymbalta. They can suggest any necessary changes in how you monitor your blood sugar or manage your diabetes.

High blood pressure. Cymbalta may cause increases in blood pressure. Your doctor will check your blood pressure before prescribing the drug and during treatment. If you already have high blood pressure, taking Cymbalta may worsen this condition. In this case, your doctor will likely want to treat your high blood pressure before prescribing Cymbalta.

Your doctor may also recommend that you check your blood pressure at home between appointments. If you develop high blood pressure while taking Cymbalta, let your doctor know. They can advise whether this treatment is still safe for your condition.

Liver or kidney problems. Cymbalta isn’t recommended for people with severe liver or kidney problems, such as liver disease or kidney disease. Taking this drug may worsen these conditions. If you have liver or kidney problems, talk with your doctor before starting Cymbalta. They may recommend other treatment options for your condition.

Seizure. Cymbalta may cause seizure, but it hasn’t been studied in people with seizure disorders. Because of this, it’s not known if the drug is safe for people with these conditions to take. If you have a seizure disorder or history of seizures, tell your doctor before starting Cymbalta. They may recommend other treatment options for your condition.

Slow stomach emptying. Cymbalta has a coating that protects it from stomach acid. When the stomach empties slowly, the stomach acid can break down this coating. This may cause Cymbalta to be less effective. If you have diabetes or another condition that could affect stomach emptying, tell your doctor before starting Cymbalta.

Allergic reaction. If you’ve had an allergic reaction to Cymbalta or any of its ingredients, your doctor will likely not prescribe Cymbalta. Ask your doctor what other medications may be better options for you.

Alcohol with Cymbalta

Cymbalta and heavy alcohol consumption may interact and cause severe liver damage. Your doctor will likely recommend avoiding heavy alcohol consumption while taking Cymbalta.

Ask your doctor how much alcohol, if any, is safe to consume while taking Cymbalta.

Pregnancy and breastfeeding while taking Cymbalta

Cymbalta may cause harm to a developing fetus. However, more research is necessary to determine if there is a clear risk of congenital anomalies (commonly known as birth defects). Clinical trials of Cymbalta reported an increased risk of postpartum hemorrhage (severe bleeding after childbirth).

Tell your doctor if you become pregnant or become pregnant while taking Cymbalta. Together, you can discuss the risks and benefits of taking the drug during pregnancy. They can also help you explore other treatment options.

Cymbalta passes into human breast milk and can affect a child who is breastfeeding. However, it isn’t known to cause serious side effects. Side effects reported in infants who were breastfeeding included drowsiness, limited feeding, and trouble gaining weight.

Talk with your doctor if you’re breastfeeding or plan to breastfeed. Together, you can discuss the risks and benefits of breastfeeding while taking Cymbalta. They can also help you explore other treatment options.

Cymbalta has some common side effects that are usually mild and temporary. However, serious side effects are possible. If you’d like to learn more about Cymbalta, talk with your doctor or pharmacist. They can help answer any questions you have about side effects from taking the drug.

Besides talking with your doctor, you can do some research on your own. These articles might help:

• More information about Cymbalta. For details about other aspects of Cymbalta, refer to this article.
• Drug comparison. Learn how Cymbalta compares with Lexapro and Effexor XR.
• Dosage. For information about the dosage of Cymbalta, view this article.
• Interactions. To find out about Cymbalta’s interactions, see this article.
• A look at Cymbalta’s uses. To learn more about your condition, see our:
  • anxiety hub
  • diabetes hub
  • mental health hub
  • list of fibromyalgia articles

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

What They Are and How to Manage Them

Cymbalta (duloxetine) is a prescription drug that’s used to treat certain conditions, including depression. The drug can cause side effects that range from mild to serious, including some sexual side effects.

Cymbalta is used as a long-term treatment for several different conditions in adults, including:

• major depressive disorder
• generalized anxiety disorder (GAD)
• pain caused by diabetic neuropathy (nerve damage caused by diabetes)
• fibromyalgia (a condition that causes pain throughout the body)
• long-term musculoskeletal pain (pain in the bones, muscles, tendons, ligaments, and nerves)

Cymbalta is also approved to treat GAD and fibromyalgia in certain children.

The active ingredient in Cymbalta is duloxetine. (An active ingredient is what makes a drug work.) The drug comes as capsules that you swallow.

Keep reading to learn about the common, mild, and serious side effects that Cymbalta can cause. For a general overview of the drug, including details about its uses, see this article.

Some people may experience mild or serious side effects during Cymbalta treatment. Some side effects are more common than others.

Cymbalta’s more common side effects include:

• fatigue (lack of energy)
• nausea
• constipation
• reduced appetite
• sweating more than usual*
• dizziness

* To learn more about this side effect, see “Side effects explained” below.

Mild side effects have been reported with Cymbalta, many of which are also more common side effects of the drug. Cymbalta’s mild side effects include:

• sleepiness
• fatigue (lack of energy)
• nausea
• dry mouth
• constipation
• reduced appetite
• dizziness
• headache
• sexual side effects in females and males*
• sweating more than usual†
• trouble sleeping†
• headache
• belly pain

* In this article, we use the terms “female” and “male” to refer to someone’s sex assigned at birth. For information about the difference between sex and gender, see this article. For details on sexual side effects Cymbalta may cause, see “Sexual side effects in women and men” below.
† To learn more about this side effect, see “Side effects explained” below.

In most cases, these side effects should be temporary. Some may be easily managed, too. But if you have any symptoms that are ongoing or that bother you, talk with your doctor or pharmacist. And don’t stop using Cymbalta unless your doctor recommends it.

Cymbalta may cause mild side effects other than the ones listed above. See the Cymbalta medication guide for details.

Note: After the Food and Drug Administration (FDA) approves a drug, it tracks side effects of the medication. If you’d like to notify the FDA about a side effect you’ve had with Cymbalta, visit MedWatch.

Serious side effects from Cymbalta aren’t common, but they can happen. Serious side effects that have been reported with Cymbalta include:

• suicidal behaviors and thoughts*
• liver damage†
• eye problems†
• allergic reaction†‡
• fainting or dizziness when standing up
• blood pressure changes
• serotonin syndrome, a rare side effect of drugs that affect serotonin, a brain chemical
• low sodium levels
• urination problems
• severe skin reaction, such as Stevens-Johnson syndrome
• unusual bleeding or bruising

* Cymbalta has a boxed warning for this side effect. This is the most serious warning from the Food and Drug Administration (FDA). To learn more, see “Side effects explained” below.
† To learn more about this side effect, see “Side effects explained” below.
‡ An allergic reaction is possible after using Cymbalta. But this side effect wasn’t reported in studies.

If you develop serious side effects while taking Cymbalta, call your doctor right away. If the side effects seem life threatening or if you think you’re having a medical emergency, immediately call 911 or your local emergency number.

The most common side effects of Cymbalta in children may include:

• weight loss
• reduced appetite
• fatigue (lack of energy)
• nausea or vomiting
• diarrhea

Sexual side effects from taking Cymbalta are possible and may be more common in males than females.* In studies, sexual side effects were reported in a small percentage of males and females during Cymbalta treatment. Some of these side effects, such as erectile dysfunction, may be more likely to occur when taking a higher dosage of Cymbalta.

Males who took Cymbalta reported significantly more sexual side effects compared with those who took a placebo (a treatment that contains no active drug). The sexual side effects reported in males included:

• decrease in or loss of libido (sex drive)
• trouble becoming aroused
• erectile dysfunction
• difficulty reaching orgasm
• delayed ejaculation or being unable to ejaculate

Females who took Cymbalta also reported sexual side effects. But these side effects were similar to those experienced by females who received a placebo. Sexual side effects included:

• decreased libido (sex drive)
• trouble becoming aroused
• reduced vaginal lubrication
• difficulty reaching orgasm

Note that some males and females in this study reported improvements in sexual desire, performance, and satisfaction with Cymbalta treatment. This may be because the medication helped to reduce the symptoms of their condition. As a result, their sexual health may have also improved.

* In this article, we use the terms “female” and “male” to refer to someone’s sex assigned at birth. For information about the difference between sex and gender, see this article.

Some side effects of Cymbalta can affect your long-term health, but this isn’t common.

For example, liver failure is a rare but serious side effect of Cymbalta. Heavy alcohol use may increase the risk of liver failure. The liver damage that develops from this side effect doesn’t go away once a person stops taking Cymbalta.

You may be wondering if it’s safe to take Cymbalta long term. Studies have tested the drug’s safety for up to 6 months. A 2009 study has shown Cymbalta to be safe to use when taken for 12 months. Your doctor can tell you about their understanding of long-term Cymbalta use.

It’s a good idea to go over all of your medications with your doctor every so often. Together, you can discuss your condition and consider whether you should continue Cymbalta long term.

Keep reading to get answers to some frequently asked questions about Cymbalta’s side effects.

How long do Cymbalta’s side effects last?

How long side effects from Cymbalta last can vary. Some of the more common side effects are usually temporary, such as sleepiness, dizziness, and reduced appetite. These side effects typically ease within a few days or weeks after starting treatment.

Common side effects may get worse after your doctor increases your dosage, but this is usually temporary.

Other side effects are more likely to continue for as long as you’re taking the drug. Examples include sweating more than usual and sexual side effects. These side effects usually aren’t severe.

Cymbalta side effects can affect each person differently. For example, nausea may be a mild, temporary side effect for some people. For others it can be bothersome. In studies, a small percentage of people had to stop taking the drug due to nausea.

If you’re experiencing troublesome side effects, you shouldn’t suddenly stop taking Cymbalta. It’s best to talk with your doctor first. If you and your doctor decide that you should stop the drug, they’ll guide you on how best to do so.

Do seniors have a higher risk for side effects from Cymbalta?

No, this doesn’t seem to be the case. In general, older adults (ages 65 years and older) have a higher risk for medication side effects compared with younger adults. But in studies of Cymbalta, older adults had similar side effects to those of younger adults.

Can Cymbalta cause weight gain?

Cymbalta doesn’t typically cause weight gain. In studies, weight gain wasn’t reported as a side effect.

In fact, weight loss is more likely than weight gain with Cymbalta. This is because the drug commonly causes reduced appetite and nausea.

These side effects may lead to weight loss, especially in children. Because of this, if your child is taking Cymbalta, their doctor will monitor your child’s weight and height during Cymbalta treatment.

If you have questions about weight changes with Cymbalta, talk with your doctor.

Will Cymbalta side effects differ depending on the strength I use (20 mg, 30 mg, or 60 mg)?

Some side effects of Cymbalta may be dependent on dose. Cymbalta comes in the following strengths: 20 milligrams (mg), 30 mg, and 60 mg. A higher strength of the drug might come with a higher risk of certain side effects.

Common dose-dependent side effects of Cymbalta include nausea, fatigue (lack of energy), constipation, dizziness, reduced appetite, and sweating more than usual.

Learn more about some of the side effects Cymbalta may cause.

Sweating more than usual

Sweating more than usual is a common side effect of Cymbalta. This side effect may be worse with higher doses of the drug. In addition, hot flashes (also called hot flushes) are a possible side effect of this medication.

Some people may notice increased sweating only in certain situations, such as when they’re active or during humid weather. Others may have increased sweating more often, including while trying to sleep.

What might help

Increased sweating isn’t a harmful side effect, but it may be uncomfortable. Here are a few tips that may help ease this side effect:

• Use a strong deodorant.
• Shower more often.
• Wear light fabrics
• Use a fan at night.

If this side effect continues to bother you, your doctor may suggest adjusting your dosage or switching to a different drug.

But if Cymbalta is particularly effective for your condition, you may not want to switch to a different drug. In this case, your doctor may suggest treatments for your sweating. Examples of drugs sometimes used to treat this side effect include:

• benztropine (Cogentin)
• cyproheptadine
• terazosin

If you have concerns about sweating more than usual with Cymbalta, talk with your doctor.

Eye problems

Eye problems aren’t a common side effect of Cymbalta. But this drug may increase the risk of serious eye problems, such as glaucoma (a buildup of pressure within the eye).

Cymbalta can cause a person’s pupils to dilate. This can trigger a serious eye problem, including vision loss, especially for someone who has closed-angle glaucoma. Symptoms can include:

• sudden vision changes
• eye pain
• eye redness
• swelling in or around your eye

What might help

If you have closed-angle glaucoma, you shouldn’t take Cymbalta. If you’re not sure whether you have this condition, consider visiting an eye doctor. The results of an eye exam can help you and your doctor decide if it’s safe for you to take Cymbalta.

If you develop any of the above symptoms while taking Cymbalta, you should seek medical attention. Urgent treatment is needed to help prevent permanent vision loss.

If you have questions about eye problems that Cymbalta may cause, talk with your doctor.

Liver damage

Although rare, Cymbalta can cause serious liver damage that could be fatal. The risk of this side effect may be higher with alcohol use. It could also be higher in people who already had liver problems before starting Cymbalta.

The following may indicate that there’s a problem with your liver:

• pain in the upper right part of your belly
• itching
• dark urine
• yellowing of your skin or whites of your eyes
• increased liver enzyme levels

What might help

To help prevent this side effect, talk with your doctor about any liver problems you’ve had. It’s also important to be honest about your alcohol consumption. Talk with your doctor about whether you’ve had problems with your liver or alcohol in the past.

If you develop any of the above symptoms, get emergency medical care right away.

Trouble sleeping

Insomnia (trouble falling asleep or staying asleep) can occur with Cymbalta. In studies, this side effect was more commonly reported in people taking the drug for long-term musculoskeletal pain. (This is pain in the bones, muscles, tendons, ligaments, and nerves. ) Waking up earlier than desired was also reported with Cymbalta.

Insomnia is also a common side effect reported in children taking Cymbalta.

What might help

Here are a few tips that may help to improve your sleep:

• Try to exercise regularly.
• Avoid caffeine after lunch.
• Practice good sleep hygiene.

If you’re having insomnia since starting Cymbalta, talk with your doctor. They may suggest the temporary use of a sleep aid, such as melatonin. Or they may adjust your dosage or discuss other treatment options with you.

Suicidal behaviors and thoughts

Cymbalta has a boxed warning for suicidal behaviors and thoughts. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). It alerts doctors and patients about drug effects that may be dangerous.

Antidepressants such as Cymbalta may increase the risk of suicidal behaviors and thoughts in children and young adults ages 24 years or younger. This is a rare side effect. Studies show that the risk is higher after a person first starts treatment or increases their dose.

What might help

While taking Cymbalta, you should watch for any new behaviors, feelings, or thoughts. This is especially important in the first few weeks after starting Cymbalta or after your dose is adjusted.

Consider using a journal or app to make notes about your mood. You may want to ask your loved ones to let you know if they notice that you’re acting differently. Tell your doctor right away if you or someone else notices any changes in your behavior or moods.

Suicide prevention

If you think someone is at immediate risk of self-harm or hurting another person:

• Call 911 or your local emergency number.
• Stay with the person until help arrives.
• Remove any guns, knives, medications, or other things that may cause harm.
• Listen, but don’t judge, argue, threaten, or yell.

If you or someone you know is considering suicide, get help from a crisis or suicide prevention hotline. Try the National Suicide Prevention Lifeline at 800-273-8255.

Allergic reaction

Like most drugs, Cymbalta can cause an allergic reaction in some people. But this side effect wasn’t reported in studies.

Symptoms can be mild or serious and can include:

• skin rash
• itchiness
• flushing (temporary warmth, redness, or deepening of skin color)
• swelling under your skin, typically in your eyelids, lips, hands, or feet
• swelling of your mouth, tongue, or throat, which can make it hard to breathe

What might help

If you have mild symptoms of an allergic reaction, such as a mild rash, call your doctor right away. To manage symptoms, they may suggest an over-the-counter antihistamine you take by mouth, such as Benadryl (diphenhydramine). Or they may recommend a product you apply to your skin, such as hydrocortisone cream.

If your doctor confirms you had a mild allergic reaction to Cymbalta, they’ll decide if you should continue using it.

If you have symptoms of a severe allergic reaction, such as swelling or trouble breathing, call 911 or your local emergency number right away. These symptoms could be life threatening and require immediate medical care.

If your doctor confirms you had a serious allergic reaction to Cymbalta, they may have you switch to a different treatment.

Keeping track of side effects

During Cymbalta treatment, consider keeping notes on any side effects you’re having. You can then share this information with your doctor. This is especially helpful to do when you first start taking new drugs or using a combination of treatments.

Your side effect notes can include things such as:

• what dose of drug you were taking when you had the side effect
• how soon after starting that dose you had the side effect
• what your symptoms were from the side effect
• how it affected your daily activities
• what other medications you were also taking
• any other information you feel is important

Keeping notes and sharing them with your doctor will help your doctor learn more about how Cymbalta affects you. Your doctor can use this information to adjust your treatment plan if needed.

Cymbalta has several warnings that may affect whether you can safely use this drug to treat your condition.

Boxed warning: Suicidal behaviors and thoughts

Cymbalta has a boxed warning for suicidal behaviors and thoughts. A boxed warning is the most serious warning from the Food and Drug Administration (FDA).

Antidepressants such as Cymbalta may increase the risk of suicidal behaviors and thoughts in children and young adults ages 24 years or younger. After starting Cymbalta, you should watch for any new behaviors, feelings, or thoughts. Tell your doctor right away if you or your loved ones notice any changes in your behavior or moods.

To learn more, see “Side effects explained” above.

Other warnings

Cymbalta may not be right for you if you have certain medical conditions or other factors that affect your health. Talk with your doctor about your health history before you take Cymbalta. The list below includes factors to consider.

Liver or kidney problems. The liver and kidneys help clear Cymbalta from the body. In a person who has liver or kidney problems, Cymbalta levels could become too high in their body. This can worsen the drug’s side effects. In rare cases, Cymbalta may cause liver failure. People who already have liver problems may be at higher risk for this side effect. Before taking Cymbalta, tell your doctor about any liver or kidney problems you have.

Closed-angle glaucoma. Cymbalta can cause the pupils to dilate, which may worsen certain eye problems. If you have closed-angle glaucoma, vision loss could occur with Cymbalta. Talk with your doctor about other treatment options.

Heart or blood pressure conditions. Cymbalta may increase your blood pressure. If you already have high blood pressure or heart problems, taking Cymbalta could worsen your condition. Before starting this drug, tell your doctor about any heart or blood pressure problems you may have.

Slow stomach emptying. Cymbalta capsules are delayed-release. As such, they have a special coating that helps protect the drug against the acid in your stomach. If you have a condition that can slow stomach emptying, such as diabetes, the special coating may get destroyed. This could make Cymbalta less effective for treating your condition. Before taking Cymbalta, talk with your doctor about any medical conditions that you have.

Diabetes. If you have diabetes, Cymbalta may make it more difficult to manage your blood sugar levels. Before taking Cymbalta, talk with your doctor about a plan for managing your blood sugar levels.

Seizures. Cymbalta may increase the risk of seizures. But the drug hasn’t been studied in people with epilepsy (a seizure disorder). If you have a seizure disorder, your doctor may suggest another treatment option for your condition.

Bipolar disorder or mania. Cymbalta may bring on or worsen certain symptoms of bipolar disorder or mania. If you have bipolar disorder or mania, talk with your doctor about the risks involved in taking Cymbalta. If you aren’t sure whether you have either condition, your doctor may screen you for them before you take Cymbalta.

Low sodium levels. Cymbalta can cause low sodium levels. If you have problems with your sodium levels, talk with your doctor before you take Cymbalta.

Bleeding problems. Cymbalta may raise your risk for bruising or bleeding problems. If you have a condition that causes bleeding problems, taking this drug may worsen your condition. Before starting Cymbalta, tell your doctor about any current or past bleeding problems.

Allergic reaction. If you’ve had an allergic reaction to Cymbalta or any of its ingredients, you shouldn’t take Cymbalta. Ask your doctor what other medications are better options for you.

Alcohol and Cymbalta

Drinking alcohol isn’t recommended with Cymbalta, especially heavy alcohol consumption.

Alcohol may worsen some of Cymbalta’s common side effects, such as:

• nausea
• sleepiness
• dizziness

Heavy alcohol consumption while taking Cymbalta can increase your risk for serious liver problems and liver failure. This can be life threatening.

If you drink alcohol, talk with your doctor about whether it’s safe for you to do so while taking Cymbalta. You can also ask them how much alcohol is safe for you to drink.

Pregnancy and breastfeeding while taking Cymbalta

Cymbalta use isn’t recommended during pregnancy because its effects aren’t fully known. The drug may cause harm to a developing fetus.

If you’re pregnant or you’re considering a pregnancy, talk with your doctor. They’ll tell you about treatment options that may be safer during this time.

Cymbalta passes into breast milk, and the drug may affect a child who is breastfed. There have been reports of drowsiness and feeding problems in children breastfed by people taking Cymbalta.

If you’re breastfeeding or have plans to breastfeed, talk with your doctor. They can help you weigh the pros and cons of breastfeeding while taking this drug.

Many people find that Cymbalta is an effective treatment for their condition. When you’re considering Cymbalta as a treatment option, it’s a good idea to talk with your doctor about your risk for side effects. Here are some questions that you may want to ask:

• Do my medical conditions increase my risk for side effects with Cymbalta?
• Are there other ways to help me manage side effects from Cymbalta?
• Are there any lifestyle changes I can make that may help to reduce my need to take Cymbalta in the future?

To learn more about Cymbalta, see these articles:

• Cymbalta (duloxetine)
• Cymbalta Interactions: Alcohol, Medications, and Others
• Dosage Details for Cymbalta

To get information on different conditions and tips for improving your health, subscribe to any of Healthline’s newsletters. You may also want to check out the online communities at Bezzy. It’s a place where people with certain conditions can find support and connect with others.

Q:

My child has generalized anxiety disorder, and their doctor suggested Cymbalta treatment. I’m concerned about the drug’s suicide warning. How common or rare is this side effect, and how can it be avoided?

Anonymous patient

A:

The risk of suicidal behaviors and thoughts with Cymbalta use is rare. But Cymbalta does have a boxed warning for this side effect. A boxed warning is the most serious warning from the Food and Drug Administration (FDA).

When compared with a placebo (a treatment with no active drug), antidepressants such as Cymbalta were associated with increased suicidal behaviors and thoughts. This risk affected children and young adults ages 24 years and younger.

For more about this FDA boxed warning, see “Side effects explained” above.

If your child’s doctor prescribes Cymbalta, make sure to monitor your child for any changes in their behavior or mood. This is especially important when treatment with Cymbalta begins or the dosage is changed. Contact your child’s doctor right away if you notice any changes in your child’s behavior or mood.

The Healthline Pharmacist TeamAnswers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.

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Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

Medical therapy | Clinic of Urogynecology and Neurourology

Drug therapy for chronic pelvic pain syndrome has certain characteristics, depending on the type of pelvic pain (neuropathic, myofascial), but certain general principles are followed when prescribing drugs.

Topicals: Topicals have the advantage of local action without systemic toxicity. Capsaicin cream, which contains chili pepper extract, is sometimes used to treat neuropathic pain. This cream affects the so-called. vanilloid receptors on the nerve endings of the C-fibers, which are responsible for the transmission of pain. The most common side effect is burning, which decreases with consistent use.

Lidocaine can be used topically. It comes in two forms, cream and patch. There are also combined topical agents such as a cream of gabapentin, amitriptyline, lidocaine, and ketoprofen.

Antidepressants: tricyclic antidepressants and serotonin reuptake inhibitors are used to treat pudendal neuropathy. Numerous clinical studies demonstrate the safety and efficacy of TCAs. Amitriptyline was the first tricyclic antidepressant used to treat neuropathy and is still included in all European guidelines for the treatment of chronic pelvic pain syndrome. Amitriptyline also has a high incidence of anticholinergic side effects. It may lead to delirium in the elderly and should be avoided in this population. Desipramine and nortriptyline, which have the least anticholinergic activity, are equally effective substitutes. The analgesic properties of TCAs occur independently of their antidepressant properties.

Some of the TCAs have proarrhythmic side effects. Therefore, it is necessary to perform a baseline ECG with repetition after reaching the therapeutic dose. The greatest risk for the development of arrhythmia occurs at the maximum therapeutic dose. Other risk factors include congestive heart failure, coronary artery disease, and bundle branch block. TCAs should also be avoided in people with angle-closure glaucoma, benign prostatic hyperplasia, and bipolar disorders.

Specific serotonin reuptake inhibitors (SSRIs) are less effective in treating pudendal neuropathy, although some have shown some clinical benefit. Some of the typical SSRIs are: sertraline, paroxetine, fluoxetine.

Serotonin and norepinephrine reuptake inhibitors include drugs such as Cymbalta (duloxetine), venlafaxine are widely used to treat symptoms of pudendal neuralgia. Serotonin and norepinephrine reuptake inhibitors appear to have a better effect on pudendal neuropathy. Cymbalta is currently approved by the FDA for the treatment of neuropathic pain. Side effects may include high blood pressure and/or hypertension, irritability, insomnia, nausea, vomiting, and constipation.

Anticonvulsants: Anticonvulsants are considered second line therapy. Carbamazepine (Tegretol), phenytoin (Dilantin), gabapentin (Tebantin), lamotrigine (Lamictal), and pregabalin (Lyrica) are all used to treat neuropathic pain. The ones most widely used for pudendal neuralgia are Lyrica and Tebantine.

Lyrica is currently used to treat pudendal neuropathy. This drug is FDA approved for the treatment of neuropathic pain. There are some studies showing that the combination of Lyric and Cymbalt is more effective for treating pudendal neuropathy than using either one.

Carbamazepine: Carbamazepine is considered first-line therapy for trigeminal neuralgia. Clinical trials show its effectiveness for treating diabetic neuropathy, but results are mixed for postherpetic neuralgia.

The most common side effects of carbamazepine are dizziness and upset stomach. These are dose-dependent symptoms and can be minimized by starting treatment with low doses.

Gabapentin: Gabapentin is more effective than placebo in the treatment of diabetic neuropathy and postherpetic neuralgia. The most common side effects associated with gabapentin are asthenia, headache, dizziness and drowsiness. Surprisingly, gabapentin has been reported to cause polyneuropathy.

Lamotrigine has been shown to reduce pain associated with trigeminal neuralgia. However, there is no difference from placebo when used to treat other types of neuropathic pain. Of the side effects, rashes on the skin, including Stevens-Johnson syndrome, are of greatest concern. To avoid this, treatment should be started at low doses and slowly titrated to a therapeutic dose.

Analgesics : Abroad, opiates and other narcotic analgesics are actively used to treat chronic pelvic pain. In Russia, this is impossible due to the peculiarities of legislation and law enforcement.

Benzodiazepines : Patients with myofascial pelvic floor pain syndromes due to pudendal neuralgia may benefit from diazepam (Relanium), lorazepam, or clonazepam, which act as muscle relaxants. Their mechanism of action is not fully known, but they act on the neurotransmitter gamma-aminobutyric acid (GABA), a substance that reduces neural activity in the center of descending modulation of pain sensitivity.

Zolpidem is not a classic benzodiazepine, however it is a hypnotic with some of the same pharmacological characteristics as benzodiazepines. Many patients with pudendal neuropathy who have trouble sleeping can use Zolpidem to fall asleep.

Flexeril (cyclobenzaprine) is a muscle relaxant that may be useful in the treatment of myofascial pain syndromes. Baclofen is used in the Russian Federation, however, when it reaches an effective dosage (50-75 mg / day), pronounced side effects often occur.

Vaginal or rectal suppositories: Diazepam or belladonna extract suppositories are used to relieve pelvic floor muscle spasm in chronic pelvic pain syndrome.

Botulinum toxin (Xeomin) : Botulinum toxin injections to relieve spasm of the pelvic floor muscles are very effective in the treatment of myofascial pain syndromes. The disadvantage is the relatively high price of the drug.

Non-steroidal anti-inflammatory drugs are widely used to treat chronic pelvic pain syndrome, but rarely show serious efficacy in pudendal neuropathy, because. in this case there is no inflammation. One of the promising drugs is katadolon.

Opiates, tramadol, ketamine are actively used abroad. However, as mentioned above, in the Russian Federation, the prescription of these drugs is extremely difficult even for cancer patients, not to mention patients with pelvic pain.

The selection of drugs for the treatment of neuropathic and myofascial pain is a complex clinical task and requires the selection of a drug or their combination, in fact, by “trial and error”. And this, in turn, requires patience from the doctor and the patient.

Depression increases the risk of uncontrolled hypertension. New evidence

PUBLICATIONS

Depression is a universal disease

Depression is a relatively common disease affecting all segments of the population, regardless of social status. This is a mental disorder characterized by a decrease in mood and the loss of the ability to experience joy, impaired thinking, and motor retardation. Many different methods have been developed for the treatment of depression, including psychotherapy and pharmacotherapy. The latest guidelines for the treatment of this disease recommend the use of antidepressants from the group of serotonin reuptake inhibitors or a short psychotherapy focused on the patient’s most pressing problems as first-line agents. In addition to these agents, tricyclic antidepressants, serotonin and epinephrine reuptake inhibitors, and monoamine oxidase inhibitors may be used in the treatment of patients with depression. However, their use is limited by the combination of side effects and concomitant pathology of organs and systems. Many psychotherapeutic methods have also been developed, among them cognitive, interpersonal, behavioral therapy, self-control therapy. There is information about the use of herbal preparations, but the effect seems to be unproven. Currently, given the concern of patients with the multitude of drugs they receive and the availability of information on the side effects of therapy, including in the public domain, the impact of the ability of patients with depression to discuss with a doctor and take part in the selection of the therapy they receive on improving their condition is being discussed.

Depression and cardiovascular disease

Depression is often associated with a negative impact not only on the mood and well-being of the patient, but also the damage to his organs and systems, which has been confirmed by many studies. An important place among depression-mediated pathologies is occupied by arterial hypertension, which leads to the development of an increased risk of developing cardiovascular pathology in patients. Recent data on the relationship between depression and hypertension indicate involvement in both processes of the biotransformation of amines in the body, there is evidence of a decrease in the production or relative lack of monoamines (serotonin, norepinephrine and dopamine) in the central nervous system. This is supported by the effect of antidepressants on monoamine-associated neurotransmitters. Both in patients with depression and with hypertension, there is an increase in the tone of the sympathetic nervous system, an increase in the secretion of adrenocorticotropic hormones and cortisol, which may indicate a relationship between these two pathologies.

Dopamine and other neurotransmitters released by special cells have an antihypertensive effect. The lack of dopamine in certain areas of the brain, on the contrary, leads to an increase in blood pressure and may be a trigger for the development of depression. The feedback is also discussed, when in patients with cardiovascular pathology, due to ischemic changes in the brain, the predisposition to the development of depressive states may increase.

Despite the above, and given the high prevalence of depression among patients with chronic diseases, primary care physicians rarely recognize this disease in a timely manner, and therefore, patients with depression and hypertension rarely receive adequate treatment. In the UK, the United States Preventive Services Task Forces recommended “screening adult patients for depression to increase the accuracy of diagnosis, selection of adequate treatment and further management measures.”

Researchers from Mexico City conducted a study to determine the effect of depression on blood pressure levels in hypertensive patients and confirm the validity of such screening.

Methods

The study included 40 patients diagnosed with hypertension, for which they received antihypertensive therapy for at least 6 months. The exclusion criteria were the presence of secondary hypertension, hypothyroidism, mental illness, the use of centrally acting antihypertensive drugs, a history of alcohol or psychotropic substance abuse, and the use of antidepressants for any reason. The subjects were trained to measure blood pressure using an automatic blood pressure monitor (OMRON HEM713C, OMRON Healthcare Inc, USA) for a week. Using a cuff of the right diameter, they measured blood pressure three times a day: in the morning after waking up, before dinner, and before bed. Each time, the pressure was determined after 5 minutes in a sitting position, three times in a row with an interval of 3 minutes. To assess adherence to antihypertensive therapy, both the study participants themselves and their relatives were interviewed. All patients were tested for depression using the Self-Assessment Scale developed by Zung et al. It has a maximum of 80 points, the diagnosis of depression is established when patients score more than 50 points. After receiving the results, a statistical analysis was performed with an estimate of the Spearman correlation coefficient.

Results

In 23 patients (57.5%), according to testing, depression was revealed. In 21 of them, blood pressure was not controlled by antihypertensive therapy, and in only 1 person, hypertension was controlled. Among the remaining 17 people without depression, the results were the opposite. In total, in 1 patient, arterial pressure was difficult to control, in the remaining 16, classical antihypertensive therapy had a positive effect.