Cymbalta contains the active ingredient duloxetine in the form of duloxetine hydrochloride. It belongs to the drug class of selective serotonin and norepinephrine reuptake inhibitors (SNRIs) and is available as delayed-release capsules for oral administration in strengths of 20 mg, 30 mg, or 60 mg. Key inactive ingredients include crospovidone, hydroxypropyl cellulose, and hypromellose.

How should I use this medication?

Take this medication by mouth with water. Take it as directed on the prescription label at the same time every day. Do not cut, crush, or chew this medication. Swallow the capsules whole. Some capsules may be opened and sprinkled on applesauce. Check with your care team or pharmacist if you are not sure. You can take this medication with or without food. Do not take your medication more often than directed. Do not stop taking this medication suddenly except upon the advice of your care team. Stopping this medication too quickly may cause serious side effects or your condition may worsen. A special MedGuide will be given to you by the pharmacist with each prescription and refill. Be sure to read this information carefully each time. Talk to your care team about the use of this medication in children. While it may be prescribed for children as young as 7 years for selected conditions, precautions do apply.

Overdosage: If you think you have taken too much of this medicine contact a poison control center or emergency room at once. NOTE: This medicine is only for you. Do not share this medicine with others.

What if I miss a dose?

If you miss a dose, take it as soon as you can. If it is almost time for your next dose, take only that dose. Do not take double or extra doses.

Where should I keep my medication?

Keep out of the reach of children and pets. Store at room temperature between 15 and 30 degrees C (59 to 86 degrees F). Get rid of any unused medication after the expiration date. To get rid of medications that are no longer needed or have expired: -Take the medication to a medication take-back program. Check with your pharmacy or law enforcement to find a location. -If you cannot return the medication, check the label or package insert to see if the medication should be thrown out in the garbage or flushed down the toilet. If you are not sure, ask your care team. If it is safe to put it in the trash, take the medication out of the container. Mix the medication with cat litter, dirt, coffee grounds, or other unwanted substance. Seal the mixture in a bag or container. Put it in the trash.

NOTE: This sheet is a summary. It may not cover all possible information. If you have questions about this medicine, talk to your doctor, pharmacist, or health care provider.

What side effects may I notice from receiving this medication?

Side effects that you should report to your care team as soon as possible: -Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat -Bleeding—bloody or black, tar-like stools, red or dark brown urine, vomiting blood or brown material that looks like coffee grounds, small, red or purple spots on skin, unusual bleeding or bruising -Increase in blood pressure -Liver injury—right upper belly pain, loss of appetite, nausea, light-colored stool, dark yellow or brown urine, yellowing skin or eyes, unusual weakness or fatigue -Low sodium level—muscle weakness, fatigue, dizziness, headache, confusion -Redness, blistering, peeling, or loosening of the skin, including inside the mouth -Serotonin syndrome—irritability, confusion, fast or irregular heartbeat, muscle stiffness, twitching muscles, sweating, high fever, seizures, chills, vomiting, diarrhea -Sudden eye pain or change in vision such as blurry vision, seeing halos around lights, vision loss -Thoughts of suicide or self-harm, worsening mood, feelings of depression -Trouble passing urine Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome): -Change in sex drive or performance -Constipation -Diarrhea -Dizziness -Dry mouth -Excessive sweating -Loss of appetite -Nausea -Vomiting

This list may not describe all possible side effects. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What should I tell my care team before I take this medication?

They need to know if you have any of these conditions: -Bipolar disorder -Glaucoma -High blood pressure -Kidney disease -Liver disease -Seizures -Suicidal thoughts, plans, or attempt by you or a family member -Take medications that treat or prevent blood clots -Taken an MAOI, such as Carbex, Eldepryl, Marplan, Nardil, or Parnate in the last 14 days -Trouble passing urine -An unusual reaction to duloxetine, other medications, foods, dyes, or preservatives -Pregnant or trying to get pregnant -Breastfeeding

What may interact with this medication?

Do not take this medication with any of the following: -Desvenlafaxine -Levomilnacipran -Linezolid -MAOIs, such as Carbex, Eldepryl, Emsam, Marplan, Nardil, and Parnate -Methylene blue (injected into a vein) -Milnacipran -Safinamide -Thioridazine -Venlafaxine -Viloxazine This medication may also interact with the following: -Alcohol -Amphetamines -Aspirin and aspirin-like medications -Certain antibiotics, such as ciprofloxacin and enoxacin -Certain medications for blood pressure, heart disease, irregular heart beat -Certain medications for mental health conditions -Certain medications for migraine headache, such as almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan, zolmitriptan -Certain medications that treat or prevent blood clots, such as warfarin, enoxaparin, and dalteparin -Cimetidine -Fentanyl -Lithium -NSAIDS, medications for pain and inflammation, such as ibuprofen or naproxen -Phentermine -Procarbazine -Rasagiline -Sibutramine -St. John's Wort -Theophylline -Tramadol -Tryptophan

This list may not describe all possible interactions. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.

What should I watch for while using this medication?

Tell your care team if your symptoms do not get better or if they get worse. Visit your care team for regular checks on your progress. Because it may take several weeks to see the full effects of this medication, it is important to continue your treatment as prescribed by your care team. This medication may cause serious skin reactions. They can happen weeks to months after starting the medication. Contact your care team right away if you notice fevers or flu-like symptoms with a rash. The rash may be red or purple and then turn into blisters or peeling of the skin. You may also notice a red rash with swelling of the face, lips, or lymph nodes in your neck or under your arms. Watch for new or worsening thoughts of suicide or depression. This includes sudden changes in mood, behaviors, or thoughts. These changes can happen at any time but are more common in the beginning of treatment or after a change in dose. Call your care team right away if you experience these thoughts or worsening depression. This medication may cause mood and behavior changes, such as anxiety, nervousness, irritability, hostility, restlessness, excitability, hyperactivity, or trouble sleeping. These changes can happen at any time but are more common in the beginning of treatment or after a change in dose. Call your care team right away if you notice any of these symptoms. This medication may affect your coordination, reaction time, or judgment. Do not drive or operate machinery until you know how this medication affects you. Sit up or stand slowly to reduce the risk of dizzy or fainting spells. Drinking alcohol with this medication can increase the risk of these side effects. This medication may increase blood sugar. The risk may be higher in patients who already have diabetes. Ask your care team what you can do to lower your risk of diabetes while taking this medication. This medication can cause an increase in blood pressure. This medication can also cause a sudden drop in your blood pressure, which may make you feel faint and increase the chance of a fall. These effects are most common when you first start the medication or when the dose is increased, or during use of other medications that can cause a sudden drop in blood pressure. Check with your care team for instructions on monitoring your blood pressure while taking this medication. Your mouth may get dry. Chewing sugarless gum or sucking hard candy and drinking plenty of water may help. Contact your care team if the problem does not go away or is severe.

What are the most serious risks of this medication?

This medication may increase thoughts of suicide. This may be more common in children, teenagers, and young adults. The risk may increase after first starting the medication and after dose changes. Talk to your care team right away if you have changes in mood and behavior or thoughts of self-harm or suicide.