Cymbalta contraindications

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Contraindications of Cymbalta (Duloxetine)

Hypersensitivity to Components

Cymbalta (duloxetine) is contraindicated in individuals who have shown hypersensitivity to any of its components. This includes the active ingredient, duloxetine, as well as other ingredients such as sucrose .

Combination with MAOIs

Duloxetine should not be used in combination with monoamine oxidase inhibitors (MAOIs). This combination can lead to serious, potentially life-threatening conditions such as serotonin syndrome .

Liver Disease and Hepatic Impairment

Patients with liver disease resulting in hepatic impairment should avoid using Cymbalta. The drug's metabolism can be significantly affected in these individuals, leading to increased risk of adverse effects .

Severe Renal Impairment

Cymbalta is contraindicated in patients with severe renal impairment, defined as a creatinine clearance of less than 30 ml/min. The drug's clearance is reduced in these patients, which can lead to toxicity .

Use with Potent CYP1A2 Inhibitors

The use of potent inhibitors of the enzyme CYP1A2, such as fluvoxamine, ciprofloxacin, and enoxacin, is contraindicated with Cymbalta. These inhibitors can increase the plasma concentration of duloxetine, leading to heightened risk of adverse effects 12.

Pregnancy and Breastfeeding

Cymbalta should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Breastfeeding is not recommended while taking Cymbalta, as the drug can be excreted in breast milk and may harm the nursing infant .

Pediatric and Elderly Populations

The use of Cymbalta in children or adolescents is not recommended due to insufficient data on safety and efficacy. Similarly, use in the very elderly population (over 75 years) is not recommended until more efficacy data are available 12.

History of Mania, Bipolar Disorder, or Seizures

Patients with a history of mania, bipolar disorder, or seizures should use Cymbalta with caution. The drug can exacerbate these conditions, leading to severe adverse effects .

Increased Intra-Ocular Pressure

Cymbalta should be used with caution in patients with increased intra-ocular pressure or those at risk of acute narrow-angle glaucoma. The drug can exacerbate these conditions .

Hypertension and Cardiac Disease

Patients with known hypertension and/or other cardiac diseases should have their blood pressure monitored regularly while on Cymbalta. The drug can cause increases in blood pressure, which may be problematic for these patients .

Concomitant Use with Contraindicated Drugs

Concomitant use of Cymbalta with certain drugs can lead to serious adverse effects. For instance, combining duloxetine with SSRIs, venlafaxine, or other serotonergic drugs can increase the risk of serotonin syndrome. Additionally, the use of metoclopramide with duloxetine is contraindicated due to the risk of adverse interactions 23.

Conclusion

Cymbalta (duloxetine) has several contraindications that must be carefully considered before prescribing. These include hypersensitivity to its components, combination with MAOIs, liver disease, severe renal impairment, use with potent CYP1A2 inhibitors, and specific conditions such as pregnancy, breastfeeding, and certain psychiatric and ocular conditions. Monitoring and caution are essential to ensure patient safety and efficacy of the treatment.

Sources and full results

Most relevant research papers on this topic

IPM volume 22 issue 1 Cover and Back matter

Cymbalta is a safe and effective treatment for major depressive episodes, but use with caution in children, adolescents, and high-risk patients.

2005·

0citations

Prescribing patterns and safety monitoring of duloxetine using the Danish Register of Medicinal Product Statistics as a source

The Danish Register of Medicinal Product Statistics (RMPS) effectively monitors duloxetine use and potential safety issues, highlighting potential risks when prescribing the drug to individuals under 18 years old and concomitantly with contraindicated drugs.

Observational Study

2013·

4citations

·A. Johansen et al.

The prevalence of duloxetine in medico-legal death investigations in Victoria, Australia (2009-2012).

Duloxetine is prevalent in coronial cases in Australia, and its use with other drugs may increase the risk of fatal combined drug toxicity.

Observational Study

2014·

10citations

·J. Pilgrim et al.

Duloxetine

Duloxetine is an effective and well-tolerated alternative to SSRIs and other SNRIs for treating major depressive disorder, particularly for those with painful physical symptoms.

Meta-Analysis

2007·

66citations

·J. Frampton et al.

Acute Massive Pulmonary Thromboembolism Due to Acute Intoxication by Duloxetine: A Case Report

Acute intoxication of Duloxetine can cause serious side effects, including venous thrombosis, cardiac respiratory arrest, and death.

Case Report

2012·

8citations

·F. Mari et al.

Duloxetine (Cymbalta), a dual inhibitor of serotonin and norepinephrine reuptake.

Duloxetine (Cymbalta) is a dual inhibitor of serotonin and norepinephrine reuptake, effective in treating depression in clinical trials.

Highly Cited

2003·

109citations

·F. Bymaster et al.

Duloxetine in fibromyalgia: rejection. Marketing authorization rejected and rightly so.

The European marketing authorization committee has ruled against the utilisation of duloxetine (Cymbalta) in the treatment of diffuse idiopathic polyalgic syndrome, alias fibromyalgia. A coherent position, given this psychotropic drug's unfavourable risk-benefit balance.

2009·

0citations

Duloxetine

Duloxetine treatment may improve cognition, depression, anxiety, pain, and quality-of-life in older adults with major depressive disorder, with well-tolerated side effects.

Rigorous Journal

2012·

25citations

·Sohita Dhillon

FDA warns that antidepressants may increase suicidality in adults

The FDA has warned that antidepressants may increase suicidality in adults, highlighting a higher than expected suicide rate among patients taking duloxetine (marketed as Cymbalta).

Rigorous Journal

2005·

6citations

·J. Lenzer

Rapid Rituximab Infusion May Be Practical

• In clinical trials across indications relative to placebo, treatment with Cymbalta was associated with mean increases of 0.5 mm Hg in systolic blood pressure and 0.8 mm Hg in diastolic blood pressure compared to mean decreases of 0.6 mm Hg systolic and 0.4 mm Hg diastolic in placebo-treated patients. There was no significant difference in the frequency of sustained (3 consecutive visits) elevated blood pressure. Blood pressure should be measured prior to initiating treatment and periodically measured throughout treatment.

RCT

2011·

0citations

·D. Mahoney

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