Cymbalta's Interactions: Alcohol, Vitamins, Meals, and More Explored
Cymbalta, which is the brand name for duloxetine, is a medication utilized for various conditions in adults, such as generalized anxiety disorder, major depressive disorder (commonly known as depression), chronic musculoskeletal pain, fibromyalgia, and pain related to diabetic neuropathy. It's also approved for treating generalized anxiety disorder in children aged 7 and above, and fibromyalgia in children aged 13 and above.
Cymbalta is available as a delayed-release capsule, meaning it gets released into your body after passing through your stomach. This medication might interact with certain supplements and other drugs, but it's not known to interact with alcohol or specific foods.
For further details about Cymbalta, including its uses, check out this article.
Avoiding Cymbalta
There are certain factors or conditions that could make your doctor hesitant to prescribe Cymbalta due to potential risks. These are referred to as contraindications. The contraindications of Cymbalta include:
- Currently taking or recently stopped using a monoamine oxidase inhibitor (MAOI)
CYP1A2 inhibitors
MAOIs are a type of antidepressant. Taking Cymbalta with an MAOI increases your risk of serotonin syndrome, a condition caused by high serotonin levels, resulting in symptoms such as nausea, vomiting, hallucinations, and changes in blood pressure.
• fluvoxamine (Luvox)*• ciprofloxacin (Cipro)• cimetidine (Tagamet HB)
The following are examples of MAOIs that interact with Cymbalta:
can increase the risk of side effects from Cymbalta
- linezolid (Zyvox)
- methylene blue (ProvayBlue)
- selegiline (Emsam)
- isocarboxazid (Marplan)
- phenelzine (Nardil)
Due to the risk of serotonin syndrome, doctors typically won't prescribe Cymbalta and an MAOI at the same time. Your doctor will have you wait at least 2 weeks after stopping an MAOI before starting Cymbalta treatment, and they will usually have you wait at least 5 days after stopping Cymbalta before starting an MAOI.
CYP2D6 inhibitors
Before starting Cymbalta treatment, inform your doctor about any contraindications that might apply to you. They can then decide if the medication is appropriate for you.
• paroxetine (Brisdelle, Paxil)*• fluoxetine (Prozac)*• quinidine
Cymbalta and alcohol
can increase the risk of side effects from Cymbalta
There's no known interaction between Cymbalta and alcohol. However, both substances can impact your liver. Your risk of liver problems with Cymbalta might be higher when consuming large amounts of alcohol while taking the medication.
If you consume alcohol, consult your doctor, and they can advise you on safe alcohol consumption during Cymbalta treatment.
amphetamines
Cymbalta interactions with other medications
• amphetamine/ dextroamphetamine (Adderall, Adderall XR)• dextroamphetamine (Dexedrine, Xelstrym)• methamphetamine (Desoxyn)
Before starting treatment with Cymbalta, share with your doctor and pharmacist all the prescription, over-the-counter, and other medications you take. This information can help prevent potential interactions.
can increase the risk of side effects from Cymbalta and amphetamines
If you have any questions about drug interactions that may affect you, speak to your doctor or pharmacist.
Here's a chart showing drugs that can interact with Cymbalta, but remember that this chart does not include all drugs that may interact with Cymbalta. Some of these interactions are explained in detail just below in "Drug interactions in depth."
triptans
| Drug category or substance | Examples | Impact on interaction with Cymbalta's effects || --- | --- | --- || CYP1A2 inhibitors | - fluvoxamine (Luvox)
- ciprofloxacin (Cipro)
- cimetidine (Tagamet HB) | Might amplify Cymbalta's side effects || CYP2D6 inhibitors | - paroxetine (Brisdelle, Paxil)
- fluoxetine (Prozac)
- quinidine | Could heighten Cymbalta's side effects || amphetamines | - amphetamine
- dextroamphetamine (Adderall, Adderall XR)
- dextroamphetamine (Dexedrine, Xelstrym)
- methamphetamine (Desoxyn) | Potential to intensify Cymbalta's side effects and amphetamines' effects || triptans | - zolmitriptan (Zomig)
- eletriptan (Relpax)
- sumatriptan (Imitrex) | Might enhance Cymbalta's side effects and triptans' effects || monoamine oxidase inhibitors (MAOIs)† | - selegiline (Emsam)
- isocarboxazid (Marplan)
- methylene blue (ProvayBlue)
- linezolid (Zyvox) | Possible to boost Cymbalta's side effects and MAOIs' effects || tricyclic antidepressants (TCAs) | - nortriptyline (Pamelor)
- amitriptyline
- imipramine | Prospective to escalate Cymbalta's side effects and TCAs' effects || selective serotonin reuptake inhibitors (SSRIs) | - citalopram (Celexa)
- escitalopram (Lexapro)
- sertraline (Zoloft) | May amplify Cymbalta's side effects and SSRIs' effects || other serotonin-norepinephrine reuptake inhibitors (SNRIs)‡ | - venlafaxine (Effexor XR)
- desvenlafaxine (Pristiq)
- milnacipran (Savella) | Might augment Cymbalta's side effects and other SNRIs' effects || nonsteroidal anti-inflammatory drugs (NSAIDs) | - aspirin
- naproxen (Aleve)
- ibuprofen (Advil, Motrin) | Potential to amplify Cymbalta's side effects and NSAIDs' effects || certain antiarrhythmics | - flecainide
- propafenone
- quinidine | Could intensify Cymbalta's side effects and antiarrhythmics' effects || lithium (Lithobid) | - | May boost Cymbalta's side effects and lithium's effects || tramadol (ConZip, Qdolo) | - | Possible to escalate Cymbalta's side effects and tramadol's effects || fentanyl (Actiq) | - | Could amplify Cymbalta's side effects and fentanyl's effects || buspirone | - | May amplify Cymbalta's side effects and buspirone's effects || thioridazine | - | Could boost Cymbalta's side effects and thioridazine's effects || warfarin (Jantoven) | - | May amplify Cymbalta's side effects and warfarin's effects |
• zolmitriptan (Zomig)• eletriptan (Relpax)• sumatriptan (Imitrex)
* This medication is also an SSRI, which is another type of drug that interacts with Cymbalta.
† For details about this interaction, see “When to avoid Cymbalta” above.
‡ Cymbalta is a sort of SNRI.
can increase the risk of side effects from Cymbalta and triptans
In-depth analysis of drug interactions
Below, we explore some drug interactions related to Cymbalta.
monoamine oxidase inhibitors (MAOIs)†
Certain antiarrhythmics
• selegiline (Emsam)• isocarboxazid (Marplan)• methylene blue (ProvayBlue)• linezolid (Zyvox)
Antiarrhythmics are medications that are used to treat arrhythmias (irregular heart rates or rhythms).
can increase the risk of side effects from Cymbalta and MAOIs
Impact on interaction. The impact of Cymbalta's interaction with the antiarrhythmic medication depends on the specific antiarrhythmic medication.
Combining Cymbalta with quinidine could potentially increase the risk of side effects produced by Cymbalta. On the other hand, using Cymbalta alongside flecainide or propafenone might elevate the risk of side effects from flecainide or propafenone.
tricyclic antidepressants (TCAs)
Explanation. Below is an analysis of the interaction between Cymbalta and certain antiarrhythmic medications.
• nortriptyline (Pamelor)• amitriptyline• imipramine
Two enzymes, namely cytochrome P450 2D6 (CYP2D6) and CYP1A2, are responsible for breaking down Cymbalta in the body. The antiarrhythmic medication quinidine inhibits (slows down) the activity of CYP2D6. As a result, using Cymbalta alongside quinidine could potentially increase the level of Cymbalta in the body. This might potentially lead to a higher risk of side effects from Cymbalta. (For more information about Cymbalta's side effects, check out this article.)
can increase the risk of side effects from Cymbalta and TCAs
Cymbalta hampers the functionality of the enzyme CYP2D6. Consuming Cymbalta together with medications metabolized by this enzyme might result in increased levels of these medications within your system. This is applicable to medications like flecainide and propafenone, which CYP2D6 breaks down. This situation may potentially enhance the risk of side effects associated with flecainide or propafenone when taken along with Cymbalta.
Before commencing Cymbalta use, it's essential to inform your physician if you're currently taking any antiarrhythmic drugs. They can offer guidance on potential interactions between these medications and Cymbalta.
selective serotonin reuptake inhibitors (SSRIs)
Ciprofloxacin
• citalopram (Celexa)• escitalopram (Lexapro)• sertraline (Zoloft)
Ciprofloxacin is an antibiotic used to combat various bacterial infections.
can increase the risk of side effects from Cymbalta and SSRIs
By taking Cymbalta in conjunction with ciprofloxacin, there's a heightened risk of side effects from Cymbalta.
Cymbalta is metabolized by two enzymes: CYP2D6 and CYP1A2. Ciprofloxacin inhibits the activity of CYP1A2, resulting in an elevated level of Cymbalta in your body. This increase could potentially enhance the risk of side effects related to Cymbalta. (For more information on Cymbalta's side effects, check out this article.)
other serotonin-norepinephrine reuptake inhibitors (SNRIs)‡
Before starting Cymbalta treatment, ensure that you inform your physician if you're taking ciprofloxacin. They can determine if it's safe for you to use both medications simultaneously.
• venlafaxine (Effexor XR)• desvenlafaxine (Pristiq)• milnacipran (Savella)
If you encounter a bacterial infection while administering Cymbalta, make sure your treatment physician is aware that you're taking Cymbalta. This knowledge can help them determine whether ciprofloxacin is the optimal treatment option.
can increase the risk of side effects from Cymbalta and other SNRIs
Warfarin
Jantoven (warfarin) is a blood thinner, also known as an anticoagulant. It is used to treat or prevent blood clots in specific situations.
nonsteroidal anti-inflammatory drugs (NSAIDs)
Taking Cymbalta in conjunction with warfarin may enhance the risk of bleeding from Cymbalta.
• aspirin• naproxen (Aleve)• ibuprofen (Advil, Motrin)
Cymbalta belongs to a class of drugs known as serotonin-norepinephrine reuptake inhibitors (SNRIs). These drugs modify chemicals in the body called norepinephrine and serotonin. These chemicals help platelets (a type of red blood cell) aggregate to form blood clots. By altering norepinephrine and serotonin, Cymbalta can hinder platelet clotting. If your blood isn't able to clot effectively, your risk of bleeding will increase.
can increase the risk of side effects from Cymbalta and NSAIDs
When Cymbalta is taken with warfarin, the risk of bleeding with Cymbalta is amplified. This is because warfarin works by inhibiting the production of certain clotting factors in the blood. By preventing your body from creating these factors, warfarin makes your blood less likely to clot. This further increases your risk of bleeding.
Before starting Cymbalta treatment, inform your physician if you're taking warfarin. They can assess if it's safe for you to administer both medications concurrently.
certain antiarrhythmics
If your doctor prescribes Cymbalta alongside warfarin, be vigilant for symptoms of severe bleeding. Examples include bloody urine, bloody stool, and coughing up blood. If you experience such symptoms, inform your doctor promptly. They will instruct you on how to manage this side effect.
• flecainide• propafenone• quinidine
Remember that Cymbalta may interact with blood thinners other than warfarin. If you require using Cymbalta and a blood thinner, consult your doctor. They will offer guidance on whether it's safe to take Cymbalta with other blood thinners, such as Xarelto (rivaroxaban) or Eliquis (apixaban).
can increase the risk of side effects from Cymbalta and antiarrhythmics
Cymbalta and other interactions
Cymbalta may have interactions with supplements, foods, vaccines, and even lab tests. You can read more about such interactions below.
lithium (Lithobid)
Cymbalta interactions with supplements
—
Cymbalta might interact with tryptophan supplements. Co-administration of Cymbalta with these supplements can elevate the risk of serotonin syndrome as a side effect of the drug. (Serotonin syndrome is caused by an abnormally high serotonin level in the blood.)
can increase the risk of side effects from Cymbalta and lithium
Before you commence treatment with Cymbalta, share information about your supplements, herbs, and vitamins with both your doctor and pharmacist. This will help in preventing potential interactions.
If you have questions about drug interactions that may affect you, consult your doctor or pharmacist.
tramadol (ConZip, Qdolo)
Cymbalta and herbs
—
Cymbalta may interact with the herbal supplement St. John's wort. Using Cymbalta simultaneously with this supplement may heighten the risk of serotonin syndrome as a side effect of the drug.
can increase the risk of side effects from Cymbalta and tramadol
It's crucial to converse with your doctor or pharmacist before consuming any herbal products during Cymbalta treatment.
Cymbalta and vitamins
fentanyl (Actiq)
There have been no reported interactions between Cymbalta and vitamins. Bear in mind that you should still confer with your doctor or pharmacist before ingesting any such products during your Cymbalta treatment.
—
Cymbalta and Test Reports
can increase the risk of side effects from Cymbalta and fentanyl
No findings of test conflicts with Cymbalta have been recorded. If you're interested in learning more about undergoing certain tests during your Cymbalta treatment, feel free to discuss it with your doctor.
Cymbalta and Cannabis or CBD
buspirone
Cannabis (commonly known as marijuana) and cannabis derivatives, like cannabidiol (CBD), have been documented to interact with Cymbalta.
—
The impact of cannabis derivatives on Cymbalta can vary from individual to individual. For instance, cannabis derivatives might elevate or reduce the level of Cymbalta in your body. An elevated Cymbalta level could bump up your risk of side effects from the drug. Conversely, a lowered Cymbalta level could reduce the drug's effectiveness.
can increase the risk of side effects from Cymbalta and buspirone
Before you initiate Cymbalta treatment, it's essential to inform your doctor and pharmacist if you consume cannabis. By sharing this detail, you may help avoid potential interactions.
Note: Cannabis is unlawful at a federal level but is legal in many states to various degrees.
thioridazine
Cymbalta and Health Interactions
—
Certain medical conditions and other factors might boost the risk of interactions with Cymbalta. Prior to taking Cymbalta, make sure to talk to your doctor about your health background. Cymbalta might not be the appropriate treatment for you if you have certain medical conditions or other health factors.
can increase the risk of side effects from thioridazine
Health conditions or factors that might interact with Cymbalta include:
Younger than 24 years. Cymbalta carries an increased risk of suicidal thoughts and behaviors, particularly in children and young adults under 24 years. The drug has a boxed warning about this risk. For more information, see “Boxed warning: Increased risk of suicidal thoughts and behaviors” at the beginning of this article.
warfarin (Jantoven)
Diabetes. If you have diabetes, remember to inform your doctor before taking Cymbalta. The drug can make it challenging to manage your blood sugar level. For this reason, your doctor may have you monitor your blood sugar level more frequently while taking Cymbalta.
—
Seizures. Cymbalta might cause seizures. The risk of this side effect could be greater for people with a seizure disorder, such as epilepsy. Before taking Cymbalta, tell your doctor if you have a seizure disorder. They can advise you on whether Cymbalta is safe to take.
can increase the risk of side effects from Cymbalta and warfarin
Severe kidney failure. Having severe kidney failure might boost your risk of side effects with Cymbalta. As a result, doctors typically won't prescribe Cymbalta for people with severe kidney failure. If you have this condition, talk with your doctor about other treatment options.
Mania or bipolar disorder. If you have mania or bipolar disorder, Cymbalta may enhance your risk of a manic or mixed episode. This risk is also amplified if a family member has these conditions. Cymbalta is not approved to treat depression in people with bipolar disorder. Prior to initiating Cymbalta treatment, inform your doctor about any mental health conditions you and your family members have or have had. They can advise you on whether it’s safe for you to take Cymbalta.
Liver disease. Cymbalta can lead to liver issues. As a result, Cymbalta might worsen liver disease in people who already have the condition. Due to this risk, doctors typically won't prescribe Cymbalta for people with liver disease, such as cirrhosis. If you have liver disease, your doctor can evaluate whether Cymbalta is safe for you.
Bleeding problems. Cymbalta may cause unusual bleeding as a side effect. If you have bleeding issues, such as hemophilia, you might have an increased risk of this side effect. Before taking Cymbalta, inform your doctor if you have any known bleeding issues. This will help them decide whether Cymbalta is the right treatment option for your condition.
Slowed stomach emptying. Cymbalta capsules are equipped with a coating that protects the drug from stomach acid. Having a condition that slows the emptying of your stomach might prompt your body to degrade this coating too fast. Consequently, Cymbalta could be less effective than usual in dealing with your condition.
Before taking Cymbalta, ensure your doctor is aware if you have a condition that causes slowed stomach emptying. Examples of these conditions include an underactive thyroid and diabetes. Your doctor can recommend whether you should take Cymbalta.
Narrow eye angles. Before initiating Cymbalta treatment, inform your doctor if you have narrow eye angles. Cymbalta can cause dilated pupils, which may trigger closed-angle glaucoma in people with narrow eye angles. Closed-angle glaucoma is a medical emergency that can cause vision loss and severe eye pain. Your doctor might advise you to undergo an eye exam before taking Cymbalta.
High blood pressure. If you have high blood pressure, inform your doctor before taking Cymbalta. The drug may increase your blood pressure, which could exacerbate your condition. Your doctor can determine whether it’s safe to take Cymbalta.
Sodium levels and dehydration. Using Cymbalta might lead to a low sodium level in your blood. This risk might increase if you're dehydrated or taking a diuretic medication. These drugs are used to decrease the amount of water and sodium in your body. Your doctor can provide advice on whether Cymbalta is suitable for you.
Pregnancy. The safety of Cymbalta during pregnancy isn't fully known. If you're pregnant or planning to become pregnant, consult your doctor before taking the medication. Details about Cymbalta during pregnancy
Breastfeeding. Cymbalta can pass into breast milk, which may cause side effects in a nursing infant. If you're considering breastfeeding while on Cymbalta, speak with your doctor. More info about Cymbalta and breastfeeding
Allergic reactions. If you've had an allergic reaction to Cymbalta or any of its ingredients, your doctor may not prescribe it. You can discuss alternative treatments with them.
Frequently Asked Questions about Cymbalta and interactions
Does Cymbalta interact with Lyrica?
There's no known interaction between Cymbalta and Lyrica (pregabalin).
Both Cymbalta and Lyrica are used to manage fibromyalgia and pain related to diabetic neuropathy. In certain cases, a doctor may prescribe Cymbalta alongside Lyrica to treat these conditions.
For more info on Cymbalta and Lyrica, talk to your doctor or pharmacist.
Is there an interaction between Cymbalta and Xanax?
Cymbalta is not known to interact with Xanax (alprazolam).
Both Cymbalta and Xanax can be used to manage generalized anxiety disorder (GAD). In certain situations, a doctor may prescribe Cymbalta alongside Xanax. This is because it may take several weeks for Cymbalta to reduce the symptoms of anxiety. Xanax can be used to provide temporary relief from anxiety while you wait for Cymbalta to take effect.
Your doctor and pharmacist can provide more information on Cymbalta and Xanax.
Do Cymbalta and omeprazole interact?
There's no known interaction between Cymbalta and Prilosec (omeprazole).
Omeprazole is used to treat conditions such as heartburn and gastroesophageal reflux disease (GERD). Other treatments for heartburn, like Tagamet HB (cimetidine), are known to interact with Cymbalta. These medications can raise the level of Cymbalta in your body, which may increase your risk of Cymbalta side effects. However, omeprazole does not have this effect.
For more information about using Cymbalta with omeprazole, contact your doctor or pharmacist.
Preventing interactions
You can take various steps to avoid interactions with Cymbalta. Reach out to your doctor and pharmacist before starting treatment. For example, share the following details:
- If you drink alcohol or use cannabis.
- Any other medications, supplements, herbs, or vitamins you take.
- Complete a , which your doctor and pharmacist can assist you with.
Reading the label and included paperwork for Cymbalta can also be helpful. Look for colored stickers that mention an interaction or consult the Medication Guide for more information. If you find this information difficult to understand, ask your doctor or pharmacist for help.
Lastly, take Cymbalta as prescribed by your doctor to minimize the risk of interactions.
Additional resources
Beyond learning about interactions, you may find these resources useful:
- Cymbalta overview. For a general overview of Cymbalta, see this article.
- Side effects. If you'd like to know about Cymbalta's side effects, check out this article or refer to the Cymbalta Prescribing Information.
- Dosage information. To learn about the dosage of Cymbalta, see this article.
- Drug comparison. Find information comparing Cymbalta to Lexapro and Effexor XR in this article.
- Condition facts. Learn more about your condition by visiting our:
- Mental health hub and list of depression articles.
- Anxiety hub and list of anxiety and stress articles.
- List of fibromyalgia articles.
- Diabetes hub and list of diabetes articles.
Warning: Medical News Today has taken great care to ensure that all data is accurate, thorough, and current. However, please do not consider this piece as a replacement for the advice of a qualified medical practitioner. It's crucial to consult your doctor or another healthcare expert before starting any medication. The information provided regarding medications is subject to change and is not meant to encompass all potential uses, instructions, cautions, warnings, drug interactions, allergic reactions, or side effects. The absence of such information for a particular medication does not imply that the drug or drug mixture is safe, effective, or suitable for every patient or for all specific purposes.
Paraphrased version of the original disclaimer.
- The medication Cymbalta, used for various conditions including generalized anxiety disorder and depression, can interact with monoamine oxidase inhibitors (MAOIs) like selegiline, causing a condition called serotonin syndrome with symptoms such as nausea, vomiting, hallucinations, and changes in blood pressure.
- Cymbalta may also interact with certain serotonin-norepinephrine reuptake inhibitors (SNRIs) such as venlafaxine and desvenlafaxine, potentially increasing the risk of side effects.
- For individuals with fibromyalgia and chronic musculoskeletal pain, Cymbalta can help manage the associated mental health symptoms, like anxiety and depression, which often accompany these conditions.
- People with diabetes should be aware that Cymbalta can help manage pain related to diabetic neuropathy, but they should also carefully consider the potential interactions with other diabetes medications.
- While there's no known interaction between Cymbalta and alcohol, consuming large amounts of alcohol while taking the medication may increase the risk of liver problems. It's important to consult your doctor regarding safe alcohol consumption during Cymbalta treatment.
