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CYMBALTA

CYMBALTA
Cymbalta

DESCRIPTION / DEFINITIONS: Cymbalta® (citalopram hydrobromide) is a selective serotonin and norepinephrine reuptake inhibitor (SNRI) reuptake inhibitor.

ABUSE: Cymbalta is a drug prescribed for the treatment of depression.

ADDICTION / DEPENDENCE: Half life and metabolism, Black Box Warning.

SIDE EFFECTS: Heart attack, suicide, paranoid reactions (see list below).

WITHDRAWAL SYMPTOMS: Nausea, headaches, insomnia (see list below).

TREATMENT: Medical detoxification.

DESCRIPTION / DEFINITIONS

Cymbalta® (citalopram hydrobromide) is a selective serotonin and norepinephrine reuptake inhibitor (“SNRI”).

Although there are no medical tests to determine if a person has insufficient serotonin or norepinephrine, SNRI drugs like Cymbalta increase the amount of serotonin norepinephrine in the brain. According to its label, “The mechanism of action of citalopram HBr as an antidepressant is presumed to be linked to potentiation of serotonergic activity in the central nervous system.”

ABUSE

Cymbalta is a drug prescribed for the treatment of depression.

ADDICTION / DEPENDENCE

HALF LIFE AND METABOLISM

The biological half life of a substance is the time it takes for a drug to lose half of its pharmacologic activity. This is significant because it affects how soon withdrawal symptoms may appear.

The half life of Cymbalta is an average of about 12 hours (range 8 to 17 hours).

Cymbalta is mainly metabolized through the P450 pathway in the liver and the enzymes primarily handling the metabolism are CYP1A2 and CYP2D6.

The CYP enzymes are the major enzymes involved in drug metabolism, and since many drugs may increase or decrease the activity of various CYP isozymes, this is a major source of adverse drug interactions, since changes in CYP enzyme activity may affect the metabolism and clearance of various drugs. For example, if one drug inhibits the CYP-mediated metabolism of another drug, the second drug may accumulate within the body to toxic levels, possibly causing an overdose.

BLACK BOX WARNING

The Food and Drug Administration (FDA) has decided that some drugs pose very serious risks and have required these drugs have what is called a black box warning. Cymbalta has a black box warning. Here is the warning.

WARNING: Suicidality and Antidepressant Drugs

Antidepressants increased the risk compared to placebo of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults in short-term studies of major depressive disorder (MDD) and other psychiatric disorders. Anyone considering the use of Cymbalta or any other antidepressant in a child, adolescent, or young adult must balance this risk with the clinical need. Short-term studies did not show an increase in the risk of suicidality with antidepressants compared to placebo in adults beyond age 24; there was a reduction in risk with antidepressants compared to placebo in adults aged 65 and older. Depression and certain other psychiatric disorders are themselves associated with increases in the risk of suicide. Patients of all ages who are started on antidepressant therapy should be monitored appropriately and observed closely for clinical worsening, suicidality, or unusual changes in behavior. Families and caregivers should be advised of the need for close observation and communication with the prescriber. Cymbalta is not approved for use in pediatric patients.

(See WARNINGS: Clinical Worsening and Suicide Risk, PRECAUTIONS: Information for Patients, and PRECAUTIONS: Pediatric Use.)

SIDE EFFECTS

The following information is taken from the Cymbalta label:

  • abdominal pain

  • abnormal dreams

  • aggression

  • agitation

  • akathisia (psychomotor restlessness)

  • anaphylactic reaction

  • anger

  • angioneurotic edema

  • anorexia

  • anorgasmia/orgasm abnormal

  • anxiety

  • apathy

  • asthenia

  • blood cholesterol increased

  • bruxism

  • chills/rigors

  • cold sweat

  • completed suicide

  • constipation

  • cough

  • decreased appetite

  • dehydration

  • dermatitis contact

  • diarrhea

  • diplopia

  • disorientation/confusional state

  • disturbance in attention

  • dizziness

  • dry mouth

  • dysarthria

  • dysgeusia

  • dyskinesia

  • dyslipidemia

  • dyspepsia

  • dysuria

  • ear pain

  • ecchymosis

  • ejaculation delayed

  • ejaculation disorder

  • erectile dysfunction

  • eructation

  • erythema

  • erythema multiforme

  • extrapyramidal disorder

  • fatigue

  • feeling abnormal
  • feeling hot and/or cold

  • flatulence

  • flushing

  • gait disturbance

  • gastric ulcer

  • gastritis

  • gastroenteritis

  • glaucoma

  • gynecological bleeding

  • halitosis

  • hallucinations

  • headache

  • hematochezia

  • hostility

  • hot flush

  • hyperglycemia

  • hyperhidrosis

  • hyperlipidemia

  • hypersensitivity

  • hypertensive crisis

  • hypomania

  • hypothyroidism

  • impulsivity

  • increase the risk of bleeding events

  • increased tendency to bruise

  • influenza

  • insomnia

  • irritability

  • laryngitis

  • lethargy

  • libido decreased

  • loose stools

  • malaise

  • mania

  • melena

  • menopausal symptoms

  • micturition urgency

  • migraine

  • mood swings

  • muscle cramp

  • muscle spasm

  • muscle tightness

  • muscle twitching

  • musculoskeletal pain

  • myalgia

  • myocardial infarction
  • myoclonus

  • nasopharyngitis

  • nausea

  • night sweats

  • nocturia

  • orthostatic hypotension

  • palpitations

  • panic attacks

  • parasthesia/hypoesthesia

  • penis disorder

  • peripheral coldness

  • pharyngolaryngeal pain

  • photosensitivity reaction

  • pollakiuria

  • polyuria

  • poor quality sleep

  • pruritus

  • pyrexia

  • rash

  • seasonal allergy

  • serious skin reactions including Stevens-Johnson Syndrome

  • serotonin syndrome

  • sexual dysfunction

  • sleep disorder

  • somnolence

  • stomatitis

  • suicide attempt

  • supraventricular arrhythmia

  • syncope

  • tachycardia

  • thirst

  • throat tightness

  • tinnitus

  • tremor

  • trismus

  • upper respiratory tract infection

  • urinary tract infection

  • urine odor abnormal

  • urticaria

  • vertigo

  • vision blurred

  • visual disturbance

  • vomiting

  • weight decreased

  • weight increased

  • yawning

WITHDRAWAL SYMPTOMS

Cymbalta can be a very difficult drug to stop taking. Here are some of the Cymbalta withdrawal symptoms:

  • agitation

  • confusion

  • depression

  • diarrhea

  • dizziness

  • dreams, including vivid dreams

  • drowsiness

  • electric shock-like sensations
  • fatigue/malaise

  • feelings of being hot or cold

  • feelings of unreality

  • flatulence

  • flu-like Feelings

  • headache

  • insomnia
  • irritability

  • mood swings

  • muscle spasms

  • nausea

  • other strange tingling or painful sensations

  • sweating

  • tremor

TREATMENT

Withdrawal from Cymbalta should only be done under the care of a health practitioner. The safest way is to withdraw at an inpatient medical detox facility with a protocol that includes hydration, vitamins and supplements for biological balancing. Call us to talk to a Detox Advisor.
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