Cymbalta interactions

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Cymbalta Interactions: Key Insights

Interaction with Warfarin: Elevated INR Levels

Severe Elevation of INR

Cymbalta (duloxetine hydrochloride) has been reported to cause significant interactions with warfarin, leading to severe and persistent elevation of the International Normalized Ratio (INR). In a documented case, a 44-year-old woman with a stable INR experienced a dramatic increase in INR levels after starting Cymbalta, despite discontinuing warfarin . This interaction underscores the importance of closely monitoring INR levels when Cymbalta is co-administered with warfarin.

Mechanism of Interaction

The interaction between Cymbalta and warfarin can be attributed to several factors. Duloxetine inhibits CYP1A2 and CYP2D6, enzymes involved in the metabolism of warfarin. This inhibition can lead to increased warfarin levels in the blood, thereby elevating INR . Additionally, both drugs are highly protein-bound, which means that duloxetine can displace warfarin from its binding sites, potentially leading to toxic effects .

Clinical Implications

Monitoring and Management

Given the potential for severe interactions, it is crucial for healthcare providers to monitor patients closely when prescribing Cymbalta alongside warfarin. Regular INR checks and adjustments to warfarin dosage may be necessary to prevent adverse effects .

Alternative Medications

In cases where the interaction poses a significant risk, considering alternative medications that do not interact with warfarin may be advisable. This approach can help mitigate the risk of elevated INR and associated complications.

Conclusion

Cymbalta's interaction with warfarin highlights the need for vigilant monitoring and careful management of patients receiving both medications. Understanding the mechanisms behind this interaction can aid in preventing severe complications and ensuring patient safety.

Sources and full results

Most relevant research papers on this topic

39 INTERACTION OF DULOXETINE HYDROCHLORIDE WITH WARFARIN CAUSING PERSISTENT, SEVERE ELEVATION OF INTERNATIONAL NORMALIZED RATIO.

Duloxetine hydrochloride interaction with warfarin can cause persistent, severe elevation of an International Normalized Ratio (INR), highlighting the need for close monitoring of toxic drug interactions between the two drugs.

Case Report

2006·

0citations

·Q. Khalil 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·

110citations

·F. Bymaster 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.

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

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·

26citations

·Sohita Dhillon

[Cymbalta (duloxetine) in the treatment of anxiety-depressive disorders in patients with discirculatory encephalopathy].

Cymbalta is a safe and effective treatment for anxiety-depressive disorders in patients with discirculatory encephalopathy, reducing complaint frequency and improving cognitive functions.

Non-RCT

2009·

0citations

·G. V. Rzheusskaia 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.

[Cymbalta (duloxetine) in the treatment of anxiety-depressive disorders in patients with discirculatory encephalopathy].

Cymbalta is a safe and effective treatment for anxiety-depressive disorders in patients with discirculatory encephalopathy, improving cognitive functions and reducing complaint frequency.

Non-RCT

2009·

0citations

·Beliavskiĭ Nn et al.

Cymbalta in the treatment of chronic pain syndromes

Cymbalta effectively reduces depression and pain intensity in chronic pain syndromes, with mild side effects.

2009·

0citations

·Odinak Mm et al.

A first look at duloxetine (Cymbalta) in a postmortem laboratory.

Duloxetine (Cymbalta) has been detected and quantitated in 12 postmortem cases, providing valuable information for forensic toxicologists in analyzing casework.

Observational Study

2006·

51citations

·D. Anderson et al.

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