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Cymbalta for Osteoarthritis - What You Need to Know

Osteoarthritis Added to List of Indications

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Updated March 30, 2013

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

Cymbalta (duloxetine hydrochloride), an oral drug manufactured by Lilly, was first approved by the U.S. FDA in 2004 for major depressive disorder. Since then, it has received approval for a variety of conditions, mostly those related to mental health. But now Cymbalta is emerging as a new treatment for chronic musculoskeletal pain, including osteoarthritis and chronic low back pain, since the FDA approved it for that use in 2010.

How Does Cymbalta Work for Osteoarthritis and Pain?

Cymbalta is classified as a selective serotonin and norepinephrine reuptake inhibitor (SNRI). It works by increasing natural substances in the brain, serotonin and norepinephrine, which are believed to stop pain signals to the brain.

What Is the Basis of Cymbalta's Approval and Use for Osteoarthritis?

The approval of Cymbalta for musculoskeletal pain, including osteoarthritis and low back pain, was based on the results of double-blind, placebo-controlled, randomized clinical trials -- three studies for low back pain and two for osteoarthritis. Results revealed that patients taking Cymbalta had significantly greater pain reduction than patients taking placebo.

What Are the Available Doses of Cymbalta?

Cymbalta is available by prescription only. The drug is available as a delayed-release capsule in 20, 30, and 60 mg. strengths. Your doctor will prescribe the appropriate dose for your condition and may start you on a lower dose and increase the dose. Be sure to swallow the capsule whole without crushing, splitting, chewing, or opening the capsule.

Are There Any Other Special Instructions Regarding How to Take Cymbalta?

Take your prescription exactly according to directions on the label. You can take Cymbalta with or without food. If it causes stomach upset, take with food. Be sure not to stop the drug suddenly or without first discussing discontinuation with your doctor. If you stop suddenly, you may experience unpleasant or adverse side effects.

Is Cymbalta Unsuitable for Certain People?

Your doctor will decide if Cymbalta is an appropriate treatment for you. Be sure to inform your doctor if you have a known allergy to duloxetine, or if you take thioridazine or a MAO inhibitor. Give your doctor a list of all medications and vitamins which you take. Discuss any other medical conditions you have as well as habits such as alcohol use.

What Common Side Effects Are Associated With Cymbalta?

Common side effects may include nausea, dry mouth, constipation, sleepiness, sweating and decreased appetite. Less common side effects include vomiting, diarrhea, stomach pain, changes to urinary habits, dizziness, headache, tiredness, muscle pain, muscle cramps, changes to sexual habits, or shaking. Cymbalta may cause other side effects, some of which may be severe. If you experience severe side effects that seem like an emergency situation, seek immediate medical attention.

What Special Warnings Are Associated With Cymbalta?

According to prescribing information for Cymbalta provided by the manufacturer, "All patients being treated with antidepressants for any indication should be monitored appropriately and observed closely for clinical worsening, suicidality, and unusual changes in behavior, especially during the initial few months of a course of drug therapy, or at times of dose changes, either increases or decreases. Anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia (psychomotor restlessness), hypomania, and mania have been reported in adult and pediatric patients being treated with antidepressants for major depressive disorder as well as for other indications, both psychiatric and nonpsychiatric." Keep in mind that these warnings are associated with people taking these drugs for depression -- not arthritis pain.

Are There Drug Interactions Linked With Cymbalta?

Certain drugs taken with Cymbalta may increase or decrease the effect of the drug. Drugs to be especially careful with, which may cause drug interactions, include:

  • quinolones
  • antidepressants
  • antipsychotic medications
  • narcotic pain medications
  • sleep medications
  • tranquilizers

Is Cymbalta Safe for Pregnant or Nursing Women?

The effects of Cymbalta on pregnancy or breastfeeding is unknown. Consult your doctor but most likely it is ill-advised in most cases.

Sources:

Duloxetine. PubMed Health. Revised 2/1/2011.

Physician Desk Reference. 2011 Edition.

Cymbalta. Prescribing Information. Eli Lilly and Co. Revised May 6, 2011.
http://pi.lilly.com/us/cymbalta-pi.pdf

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