Does Cymbalta cause constipation. How can you manage Cymbalta side effects. What are the most common side effects of Cymbalta. Are there any serious side effects associated with Cymbalta. How does Cymbalta affect sexual function in males and females.

Understanding Cymbalta: Uses and Applications

Cymbalta, known by its generic name duloxetine, is a versatile prescription medication used to treat various conditions in adults. Its primary applications include:

• Major depressive disorder
• Generalized anxiety disorder (GAD)
• Diabetic neuropathy pain
• Fibromyalgia
• Long-term musculoskeletal pain

Additionally, Cymbalta has been approved for treating GAD and fibromyalgia in certain pediatric patients. The active ingredient, duloxetine, is administered orally in capsule form, making it a convenient long-term treatment option for many individuals.

Common Side Effects of Cymbalta: What to Expect

While Cymbalta can be an effective treatment for various conditions, it’s essential to be aware of potential side effects. Some of the more common side effects include:

• Fatigue
• Nausea
• Constipation
• Reduced appetite
• Increased sweating
• Dizziness

Is constipation a common side effect of Cymbalta. Yes, constipation is indeed listed among the more frequent side effects experienced by Cymbalta users. However, it’s important to note that not everyone will experience these side effects, and their severity can vary from person to person.

Mild Side Effects and Their Management

Many of Cymbalta’s side effects are considered mild and often resolve on their own as your body adjusts to the medication. These mild side effects may include:

• Sleepiness
• Dry mouth
• Headaches
• Belly pain
• Trouble sleeping

How can you manage these mild side effects. Here are some strategies:

1. Stay hydrated to combat dry mouth and constipation
2. Maintain a balanced diet to help with appetite changes
3. Practice good sleep hygiene if experiencing sleep disturbances
4. Use over-the-counter remedies for headaches, as approved by your doctor

If these side effects persist or become bothersome, it’s crucial to consult with your healthcare provider. They may adjust your dosage or suggest additional management techniques.

Serious Side Effects: When to Seek Medical Attention

While less common, Cymbalta can potentially cause serious side effects that require immediate medical attention. These include:

• Suicidal behaviors and thoughts
• Liver damage
• Eye problems
• Allergic reactions
• Serotonin syndrome
• Severe skin reactions

Are there any warning signs of serious side effects to watch for. Yes, be alert for symptoms such as:

• Sudden changes in mood or behavior
• Yellowing of the skin or eyes
• Vision changes
• Severe rash or hives
• Confusion, fever, or muscle stiffness

If you experience any of these symptoms, it’s crucial to seek immediate medical attention or contact emergency services.

Boxed Warning: Suicidal Thoughts and Behaviors

Cymbalta carries a boxed warning, the most serious warning from the FDA, regarding the increased risk of suicidal thoughts and behaviors, particularly in children, adolescents, and young adults. This risk is especially prevalent during the initial months of treatment or when the dosage is adjusted.

Cymbalta and Children: Pediatric Side Effects

While Cymbalta is approved for use in certain pediatric populations, it’s important to be aware of the most common side effects observed in children. These include:

• Weight loss
• Reduced appetite
• Fatigue
• Nausea or vomiting
• Diarrhea

How should parents monitor their children taking Cymbalta. Parents should:

1. Keep track of their child’s weight and eating habits
2. Monitor energy levels and sleep patterns
3. Be alert for any changes in mood or behavior
4. Regularly communicate with their child’s healthcare provider

Sexual Side Effects: Impact on Males and Females

Sexual side effects are a concern for many individuals taking antidepressants like Cymbalta. These effects can vary between males and females:

Sexual Side Effects in Males

Males may experience:

• Decreased libido
• Difficulty becoming aroused
• Erectile dysfunction
• Delayed ejaculation or inability to ejaculate

Sexual Side Effects in Females

Females may experience:

• Decreased libido
• Difficulty becoming aroused
• Reduced vaginal lubrication
• Difficulty reaching orgasm

Do sexual side effects differ between males and females taking Cymbalta. Studies have shown that males reported significantly more sexual side effects compared to those taking a placebo, while females reported similar rates of sexual side effects whether taking Cymbalta or a placebo.

Managing Cymbalta Side Effects: Strategies and Considerations

While side effects can be concerning, there are several strategies to manage them effectively:

1. Open communication with your healthcare provider
2. Adjusting the timing of medication intake
3. Gradual dosage changes under medical supervision
4. Lifestyle modifications to address specific side effects
5. Considering alternative treatments if side effects persist

Can lifestyle changes help mitigate Cymbalta side effects. Yes, certain lifestyle modifications can help manage side effects. For instance:

• Regular exercise may help combat fatigue and improve mood
• A balanced diet rich in fiber can help with constipation
• Staying well-hydrated can alleviate dry mouth
• Stress-reduction techniques may help with sleep disturbances

Long-Term Use of Cymbalta: What to Consider

As Cymbalta is often prescribed for long-term use, it’s important to consider the potential long-term effects and management strategies:

Regular Monitoring

Periodic check-ups with your healthcare provider are crucial to monitor:

• Overall effectiveness of the medication
• Any persistent or new side effects
• Blood pressure and liver function
• Mental health status and suicidal ideation risk

Discontinuation Syndrome

When stopping Cymbalta, some individuals may experience discontinuation syndrome. Symptoms can include:

• Dizziness
• Nausea
• Headaches
• Paresthesia (tingling or prickling sensation)
• Irritability

How can discontinuation syndrome be managed. To minimize the risk of discontinuation syndrome:

1. Never stop taking Cymbalta abruptly without medical supervision
2. Follow your doctor’s guidance on gradually tapering the dosage
3. Report any unusual symptoms during the tapering process
4. Consider a slower tapering schedule if symptoms are severe

Interactions and Precautions: Maximizing Cymbalta’s Safety

To ensure the safe and effective use of Cymbalta, it’s essential to be aware of potential interactions and take necessary precautions:

Drug Interactions

Cymbalta may interact with various medications, including:

• Other antidepressants, particularly MAOIs
• NSAIDs and aspirin
• Certain antibiotics
• Some antipsychotics

Always inform your healthcare provider about all medications, supplements, and herbal products you’re taking to avoid potential interactions.

Special Populations

Certain groups may require special consideration when taking Cymbalta:

• Pregnant women
• Breastfeeding mothers
• Elderly patients
• Individuals with liver or kidney problems
• People with a history of seizures or bipolar disorder

How should these special populations approach Cymbalta use. It’s crucial for these groups to:

1. Discuss the risks and benefits thoroughly with their healthcare provider
2. Undergo more frequent monitoring
3. Be aware of any specific warnings or contraindications
4. Report any unusual symptoms promptly

Alternative Treatments: When Cymbalta Isn’t the Right Fit

While Cymbalta can be effective for many, it’s not suitable for everyone. Alternative treatments may include:

Other Medications

• SSRIs (Selective Serotonin Reuptake Inhibitors)
• TCAs (Tricyclic Antidepressants)
• MAOIs (Monoamine Oxidase Inhibitors)
• Atypical antidepressants

Non-Pharmacological Approaches

• Cognitive Behavioral Therapy (CBT)
• Interpersonal therapy
• Mindfulness-based therapies
• Electroconvulsive Therapy (ECT) for severe cases

Can lifestyle changes be an alternative to Cymbalta. While not always a complete substitute, lifestyle modifications can complement or, in some cases, replace medication:

• Regular exercise
• Balanced nutrition
• Stress management techniques
• Improved sleep hygiene
• Social support and connection

It’s essential to work closely with your healthcare provider to determine the most appropriate treatment approach for your specific situation.

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

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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.

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.

Duloxetine for the treatment of painful neuropathy, chronic pain or fibromyalgia

Review question

Does duloxetine work to treat pain generated by nerves when damaged by disease or pain caused by fibromyalgia?

Relevance

Duloxetine is a medicine used to treat depression and urinary incontinence (urinary leakage), and may also be useful for certain types of pain. Pain can occur spontaneously when there is damage to the nerves that carry pain information to the brain (neuropathic pain). When nerve damage occurs outside of the spinal cord, it is called peripheral neuropathy. Another type of pain, nociceptive pain, occurs when nerves sense damage to another tissue (such as a prick in the skin). Some types of pain of unknown origin occur without visible nerve or tissue damage. This type of pain occurs, for example, with fibromyalgia. The purpose of this review was to evaluate the benefits and harms of duloxetine for the treatment of neuropathic pain and chronic pain of all types.

Study profile

We reviewed all published scientific literature and found 18 trials with a total of 6407 participants that were of sufficient quality to include in this review. Eight clinical trials examined the effect of duloxetine in painful diabetic neuropathy and six in pain associated with fibromyalgia. Three trials looked at painful physical symptoms associated with depression, and one small study looked at duloxetine for stroke pain or spinal cord disease (central pain).

Main findings and quality of evidence

The usual dose of duloxetine is 60 mg. There was moderate-quality evidence that duloxetine at this dose reduced pain in painful diabetic peripheral neuropathy and fibromyalgia. In diabetic peripheral neuropathic pain, 50% or slightly more had an improvement on duloxetine 60 mg per day more than one and a half times more often than in the placebo group. In other words, five people with diabetic peripheral neuropathy must receive duloxetine in order for one of them to achieve an effect of 50% or more. The effect on fibromyalgia was similar, but the number of patients needed to be treated for improvement of 50% or more was eight. Based on only one study, it is not possible to determine whether the 20 mg dose is effective, and the 120 mg dose was no more effective than 60 mg.

We calculated that there were sufficient trials for diabetic neuropathy to draw these conclusions and no further trials are required. For fibromyalgia and the painful symptoms associated with depression, more trials are needed to make strong claims about the effectiveness of duloxetine.

Most people who take duloxetine will have at least one side effect. They are mostly minor and the most common are feeling unwell, insomnia or drowsiness, headache, dry mouth, constipation or dizziness. About one in six people will stop taking duloxetine due to side effects. Serious problems associated with duloxetine are very rare.

Although duloxetine is useful in the treatment of neuropathic pain and fibromyalgia, there is little evidence from clinical trials comparing duloxetine with other antidepressants as to which is better.

We conclude that duloxetine can be used to treat pain associated with diabetic neuropathy and possibly fibromyalgia.

The information contained in this review is current up to November 2013, when the most recent literature search was made.

If you found this evidence helpful, please consider donating to Cochrane. We are a charity that produces accessible evidence to help people make health and care decisions.

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Translation notes:

Translation notes: Translation: Alexandrova Elvira Grigorievna. Editing: Gamirova Rimma Gabdulbarovna, Ziganshina Lilia Evgenievna. Russian translation project coordination: Kazan Federal University. For questions related to this translation, please contact us at: lezign@gmail. com

Treatment and prevention of irritable bowel syndrome

Treatment of irritable bowel syndrome (IBS) depends on the symptoms. Your doctor should develop an individual treatment for you. If you are concerned about loose stools, then the treatment for you will not be the same as the treatment for patients with constipation.

If your doctor says the problem is “in your head” or there is nothing you can do, see another doctor. Many patients successfully get rid of IBS. You need a doctor who can explain IBS and is interested in helping you identify the causes of your symptoms.

Your treatment may be based on the physical or psychological causes of your illness. This may be lifestyle changes, pharmacological or psychological treatment. The right treatment for IBS may be found through trial and error, but it will eventually be found. The following are some aspects of the treatment of irritable bowel syndrome.

Nutrition for Irritable Bowel Syndrome

Certain foods can trigger an flare-up/attack. It is advisable to keep a log of all foods so that you can later calculate which ones led to the disorder. To identify the foods that are causing your symptoms, eat regularly and write down the foods you ate before your symptoms began. Look for patterns. Often the symptoms do not depend on any particular food, but on its amount at a time. A dietitian can be consulted to identify foods that cause symptoms and prescribe a treatment plan. A nutritionist will determine how your body reacts to a particular food. Sometimes intolerance to something (for example, lactose intolerance) is revealed.

For example, caffeine, milk, chocolate, nicotine, alcohol and an abundance of fatty foods cause symptoms in someone. However, for some people with IBS, these foods do not cause symptoms.

The traditional treatment for IBS, especially constipation, is to eat fiber-rich foods. Fiber reduces the transit time through the large intestine and reduces pressure on it. You need to eat more fresh vegetables and fruits, eat grains and bran. Your doctor may also recommend soluble fiber supplements.

For some IBS patients, fiber makes symptoms worse because it can be broken down in the colon by bacteria; this will release gas, which will cause bloating. Fiber intake should be discussed with your doctor. You may need to avoid certain types of fiber, particularly gas-producing foods such as cabbage, cauliflower, broccoli, and legumes. But it is not certain that abstaining from certain foods will eliminate the symptoms.

Medications for irritable bowel syndrome

Your doctor may prescribe certain medications to manage your IBS symptoms. Drug therapy recommended by a physician may include:

• Spasmolytic anticholinergics. These drugs reduce intestinal spasms and may relieve pain, bloating, and discomfort associated with IBS. Examples of such drugs are Dicyclomine (Bentyl) and Hyoscyamine (Levsin). Studies show that these drugs are of limited effectiveness and are best taken if symptoms occur after a meal. Side effects include dry mouth/nose/throat, palpitations, constipation, accommodation disorder (blurred vision of objects), and urinary problems.

• Antidiarrheals, such as Loperamide (Imodium). These drugs are quite effective against diarrhea and are used for frequent loose stools or urgency to defecate.

• Laxatives (such as fiber). They are taken if the main symptom is constipation. Laxatives include psyllium (Metamucil), methylcellulose (Citrucel), and calcium polycarbophil (Equalactin).

• Alocetron (Lotronex) is used to treat symptoms such as severe diarrhea or abdominal pain. Alocetron is a serotonin 5-HT3 receptor blocker and inhibits the action of serotonin in the intestine. Shortly after Lotronex appeared on the market, it was removed from the market, as it was not 100% safe, but then it was put on the market again and now it is an affordable drug. However, due to its potential side effects, Lotronex is only recommended for use in patients with severe symptoms when prescribed by a gastroenterologist, who should provide the patient with proper instructions for use.

• Tricyclic antidepressants such as amitriptyline (Elavil, Endep, Vanatrip), desipramine (Norpramine), and nortriptyline (Pamelor, Aventil) are often used for symptoms such as pain or diarrhea. They are used in smaller doses in IBS than in depression and reduce pain signals between the gut and the brain. These drugs can also help with sleep disturbances and fibromyalgia, the latter often found among the symptoms of IBS.

• Your doctor may also prescribe selective serotonin reuptake inhibitors (SSRIs) to reduce the depression and anxiety associated with IBS in some patients. SSRI drugs include fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil). Your doctor may also recommend other types of antidepressants, such as mirtazapine (Remeron), venlafaxine (Effexor), and duloxetine (Cymbalta).

• Sedatives can help reduce anxiety, which can make IBS symptoms worse. Doctors sometimes prescribe sedatives such as diazepam (Valium), lorazepam (Ativan), and clonazepam (Klonopin) for people with short-term anxiety attacks that worsen IBS symptoms. These drugs should only be taken under medical supervision as they are addictive.

• Lubiprostone (Amitiza) is used to increase intestinal secretion. It is prescribed for the treatment of severe constipation in women over 18 who are not responding to other treatments.

• IBS can also be treated with antibiotics, but it’s not entirely clear what benefit they bring. Antibiotics can help those with IBS caused by an overgrowth of bacteria in the gut, but antibiotics can be dispensed with at present to eliminate the bacteria.

How to eliminate or minimize the symptoms of IBS

In IBS, the gut is sensitive to irritants. Symptoms can be minimized or eliminated by identifying what causes the bowel to malfunction. Here are some guidelines that might help:

– Eat regularly by the clock, chew your food slowly and thoroughly, avoid fatty foods and too much caffeine.

— Get regular physical activity. This can help relieve symptoms and feelings of anxiety, which can improve bowel function.

– Do not delay or hasten a bowel movement.

– Do not strain during bowel movements, try to relax and take your time.

Because the large intestine becomes very sensitive in IBS, the symptoms can be triggered by normal events such as eating or distension due to gas or bowel contents. Following these tips will help you prevent seizures:

Schedule your meals. Eating causes contractions in the large intestine. Usually, within 30 to 60 minutes after eating, there is an urge to defecate. In IBS, the urge may be more frequent, causing cramps or diarrhea.

Eat small meals. The body’s response to food often depends on calories and especially on the amount of fat it contains. Also, large amounts of food can cause cramps and diarrhea in people with IBS. Symptoms are relieved by eating smaller amounts of food, but more often, or just eating small meals. In any case, try to stick to a regular meal schedule.

Change your diet. For some people, a diet of low-fat, high-fiber foods may help. For some, a diet of foods rich in protein and carbohydrates is needed. Fat greatly stimulates the contractions of the large intestine after eating. The use of caffeine in many people, and especially in people with IBS, leads to frequent loose stools. Important – the diet should be made for each individual.

In many cases, eating foods containing fiber can relieve constipation, but not pain. Sources of fiber include cereals, peas, beans, fruits and vegetables, and whole grain breads. Fiber can also be consumed in the form of dietary fiber supplements, which can be found over the counter, but you should consult your doctor before taking.

Some medications (including antibiotics) can trigger IBS attacks in some people. You need to tell your doctor all about your problem so that he can recommend other drugs to treat the symptoms of IBS that will not cause attacks.

Physical, emotional or environmental stress can also cause or worsen symptoms. Stress management and relaxation can reduce or prevent symptoms. Cognitive behavioral therapy, stress prevention, hypnosis, and relaxation can also reduce the symptoms of IBS. Such treatment also reduces anxiety and other psychological symptoms. You can write down what activities trigger your symptoms. Many patients will be better able to control their condition if their IBS symptoms are found to be related to childhood abuse or trauma.

Prevention of irritable bowel syndrome

Irritable bowel syndrome (IBS) is one of those diseases that cannot be “prevented”. This is not a disease that can be avoided by following certain recommendations. However, the symptoms of IBS—chronic crampy abdominal pain, discomfort, bloating, and changes in bowel habits—can be prevented, reduced, and sometimes reversed by addressing its causes.

People with IBS have a more sensitive colon and are very sensitive to both food (even normal gastrointestinal activity) and environmental factors such as stress.

Although doctors don’t know exactly why some people get IBS and some never get it, IBS is a serious functional disorder. Don’t believe if someone tells you that the symptoms are “in your head”.

Lifestyle advice

1. Ask your doctor if you have IBS.

Although over 20 percent of the population suffers from IBS, only 15 percent of people with the condition seek medical attention. If you have severe stomach pain or bowel problems, see your doctor. He will be able to make an accurate diagnosis and begin treatment to relieve symptoms.

2. Keep a journal to identify foods that trigger IBS

People with IBS are encouraged to monitor foods that aggravate the disease. To do this, record the entire diet and note the time of onset or worsening of IBS symptoms. Notes with information about the type and amount of food eaten, as well as the time of eating, should be done for two to four weeks. It is also necessary to record the time of onset of symptoms – disorders, pain, discomfort, etc.

3. Create a personalized diet

You can create a personalized diet to relieve the symptoms of IBS. There is a certain group of foods that exacerbate the symptoms of IBS. These are fatty foods, dairy products, chocolate, alcohol, caffeinated drinks (such as coffee, tea, cola, and energy drinks), sorbitol sweeteners (found in some chewing gums), and foods that cause gas (such as beans and some other vegetables) . However, not all people with IBS need to avoid these foods. Many of them also have lactose intolerance, which causes intestinal problems and abdominal pain, which is similar to the symptoms of IBS. For people with lactose intolerance, to improve the condition, it is enough to remove most dairy products from their diet. Women with IBS who suffer from constipation need to drink more water and eat fiber-rich foods. If you decide to see a nutritionist, we recommend that you contact a qualified dietitian who can explain the relationship between food intake and intestinal problems, as well as design a diet for you that minimizes intestinal disturbances.

4. Avoid unnecessary surgery if you have IBS

Be sure to tell your doctor before surgery that you have IBS. According to studies, patients with IBS are more at risk of unnecessary removal of the appendix or gallbladder than others. According to a survey of 90,000 people, hysterectomy and back surgery are also the most common among IBS patients. Studies have found that gallbladder removal is twice as common in people with IBS as in people without the disease. However, studies have shown that operations on the coronary arteries and for gastric and duodenal ulcers occur in almost equal numbers in patients with IBS and in patients without.