The Duloxetine Interactions Guide: What Not To Eat, Take or Drink

Last Updated: May 21, 2024

Dr. Norman Chazin Reviewed by Dr. Norman Chazin
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Duloxetine, often prescribed under the brand name Cymbalta, is a powerful antidepressant widely prescribed for conditions such as major depressive disorder (MDD), generalized anxiety disorder (GAD), diabetic neuropathy, and fibromyalgia.

While its efficacy in treating these conditions is well-documented, Duloxetine’s potential interactions encourage patients and healthcare providers to pay close attention throughout treatment. Since these interactions range from benign to potentially life-threatening, this article will help you avoid adverse effects and ensure the medication’s efficacy.

Continue reading to learn more about Duloxetine interactions.

Interactions of Duloxetine Overview

Duloxetine, often marketed under the brand name Cymbalta, is a serotonin-noradrenaline reuptake inhibitor (SNRI) FDA-approved medication used to treat a variety of conditions, both approved and off-label, including:

  • Major depressive disorder
  • Anxiety disorders
  • Diabetic neuropathic pain
  • Fibromyalgia
  • Stress urinary incontinence

Duloxetine is typically taken in capsule form, allowing for effective oral absorption. It can be taken with or without food. Do not crush or chew the capsule. This medication can interact with other medicines, foods, and substances, ranging from minor to severe, and can impact your treatment’s effectiveness and well-being.

Duloxetine Drug Interactions: What Not To Take

Duloxetine interactions with other drugs, it’s crucial to be aware of potential drug interactions that could affect your health. Certain medications, when combined with Duloxetine, can lead to serious side effects or reduce the effectiveness of your treatment.

These interactions include:

Monoamine Oxidase Inhibitors (MAOIs)

Mixing Duloxetine with MAOIs can be highly dangerous, potentially leading to serotonin syndrome, a rare but life-threatening drug side effect of serotonergic substances. Symptoms of serotonin syndrome can emerge within hours and, if not treated, can be fatal.

These symptoms include but are not limited to:

  • Severe agitation
  • Confusion
  • Rapid heart rate
  • Fever
  • Seizures
  • Coma

Tricyclic Antidepressants (TCAs)

Similar to MAOIs, TCAs can increase the risk of serotonin syndrome when taken with Duloxetine. The symptoms can manifest in the same way as interaction with MAOIs.

Other Antidepressants (SSRIs and SNRIs)

Mixing different antidepressants is a common approach for patients who do not see improvements with monotherapy. Combining Duloxetine with other antidepressant medications should be done under strict medical supervision since they also pose a risk of slightly increasing serotonin levels.

This elevation can lead to a milder form of serotonin syndrome, with symptoms including headache, nausea, diarrhea, and dizziness. If you were prescribed both medications, monitoring these symptoms closely with your healthcare provider is vital.

Blood Thinners

Duloxetine increases the risk of bleeding by blocking the serotonin transporter in platelets. When platelets cannot accumulate serotonin, they become dysfunctional and disrupt the clotting process.

Mixing Duloxetine with blood thinners like warfarin can increase the risk of bleeding. Since bleeding is already a complication associated with warfarin therapy, this interaction may cause complications such as easy bruising, nosebleeds, bleeding gums, heavy menstrual periods, and even internal bleeding.

Pain Medications

Duloxetine interactions with ibuprofen or naproxen, non-steroidal anti-inflammatory drugs (NSAIDs), can cause bleeding in the stomach and other parts of the gastrointestinal (GI) tract. When taken with Duloxetine, the bleeding risk increases, leading to complications akin to those associated with blood thinners, including easy bruising and various types of bleeding.

Vitamins and Herbal Supplements

It’s equally important to consider vitamins and Duloxetine herbal interactions.

Certain supplements might interact with Duloxetine, potentially altering its effectiveness or increasing side effects. For example, St. John’s Wort, used for depression, can also contribute to serotonin syndrome when used with Duloxetine.

Other Common Drug Interactions of Duloxetine

Duloxetine and Tramadol Interactions

Both Duloxetine and tramadol affect serotonin levels. Combining them can increase the risk of serotonin syndrome, a severe condition with symptoms like agitation, confusion, tremors and rapid heart rate.

Duloxetine Interactions with Gabapentin

Both medications are generally well-tolerated when taken together. However, both can cause drowsiness, dizziness and trouble focusing. Both medications can affect the central nervous system, potentially leading to increased sedation and impairment.

Duloxetine with Xanax

Combining duloxetine with Xanax (alprazolam) can lead to increased sedation, dizziness, and difficulty concentrating. Both medications have central nervous system depressant effects, which can enhance these side effects when taken together.

Duloxetine Interactions with Antibiotics

Certain antibiotics can interact with Duloxetine, leading to altered effectiveness and increased risk of side effects. These interactions may enhance side effects like gastrointestinal issues, dizziness and drowsiness or impact the absorption and metabolism of both medications.

Duloxetine with Tylenol

Combining duloxetine with Tylenol (acetaminophen) is generally considered safe. Yet, both medications are metabolized by the liver, and using them together over an extended period might increase the risk of liver damage.

Duloxetine and Esomeprazole Interactions

There are no major known interactions between these medications. However, esomeprazole may alter the absorption and effectiveness of duloxetine, potentially leading to increased side effects or reduced therapeutic benefits.

Duloxetine Interactions: What Not To Eat

Although Duloxetine is quite flexible regarding food interactions, there are specific dietary considerations you should keep in mind:

  • A high-sodium diet while taking Duloxetine could potentially lead to increased blood pressure.
  • Moderate foods high in tyramine as it can affect blood pressure in some individuals.
  • Grapefruit interferes with drug breakdown, increasing medication levels in the body.

It’s vital to monitor blood pressure when undergoing Cymbalta treatment, as this antidepressant can raise blood pressure. This is due to its influence on norepinephrine, a chemical messenger that regulates mood, and its tendency to narrow blood vessels.

Duloxetine Interactions: What Not To Drink

Consuming certain beverages while taking Duloxetine can lead to adverse effects or interfere with the medication’s effectiveness. These beverages include:

Duloxetine Interactions with Alcohol

Combining Duloxetine with alcohol can heighten side effects like drowsiness, dizziness and impaired concentration. It also increases the risk of liver damage since the liver metabolizes Duloxetine. Drinking alcohol can also negatively affect mood and mental health, making it best to abstain from alcohol during Duloxetine treatment.

Caffeine

While not strictly prohibited, it’s wise to monitor your caffeine intake. Duloxetine can sometimes elevate blood pressure and excessive caffeine consumption may double this effect. If you are sensitive to caffeine or have a history of high blood pressure, consider reducing your intake.

When to Seek a Doctor

Knowing when to seek medical advice for duloxetine interactions is crucial for your well-being. You should contact your doctor if you experience any of the following:

  • If you encounter severe side effects such as allergic reactions, difficulty breathing or chest pain.
  • If your symptoms worsen or become more frequent after starting Duloxetine.
  • If you develop new symptoms that you suspect may be related to Duloxetine or its interactions.
  • If you plan to start, stop or adjust the dosage of any medication while taking Duloxetine.
  • If you have persistent concerns or questions about Duloxetine interactions.

Duloxetine Interactions − Bottom Line

Full disclosure of all your current medications—including prescription drugs, over-the-counter medications and herbal supplements—is crucial before starting Duloxetine. This allows your healthcare provider to assess potential interactions thoroughly and, if necessary, suggest alternative treatments or adjust dosages to minimize risks.

If you have concerns about addiction or dependence with Duloxetine, discuss them with your doctor. They can guide responsible use and monitor you for any signs of misuse.

People Also Ask

What painkillers can I take with Duloxetine?

Acetaminophen (Tylenol) is generally safe to take with duloxetine. However, it’s essential to consult your doctor before combining any painkillers with duloxetine to avoid potential interactions or adverse effects.

How much alcohol can you drink on Cymbalta?

It’s recommended to avoid alcohol entirely while taking Cymbalta (duloxetine) due to the increased risk of side effects and potential interactions, as even moderate alcohol consumption can exacerbate adverse effects.

What not to take with Cymbalta?

Avoid MAOIs, some antidepressants, blood thinners, and certain pain meds while taking Cymbalta due to interaction risks. Talk to your doctor for safe alternatives.

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Page Sources

  1. Dhaliwal, J. S., Spurling, B. C., & Molla, M. (2023, May 29). Duloxetine. StatPearls - NCBI Bookshelf
  2. Hansbauer, M., & Strauss, C. (2021). Severe serotonin syndrome under duloxetine in a patient with coeliac disease — Is there a connection? A case report. European Journal of Psychiatry, 35(3), 193–196.
  3. Scotton, W. J., Hill, L. J., Williams, A. C., & Barnes, N. M. (2019). Serotonin Syndrome: Pathophysiology, Clinical Features, Management, and Potential Future Directions. International Journal of Tryptophan Research : IJTR, 12.
  4. Palaniyappan, L., Insole, L., & Ferrier, N. (2009). Combining antidepressants: a review of evidence. Advances in Psychiatric Treatment, 15(2), 90–99.
  5. GGC Medicines: SSRIs/SNRIs - Risk of bleeding. (n.d.). GGC Medicines
  6. Cochran, K. A., Cavallari, L. H., Shapiro, N. L., & Bishop, J. R. (2011). Bleeding Incidence with Concomitant Use of Antidepressants and Warfarin. Therapeutic Drug Monitoring, 33(4), 433.
  7. Venerito, M., Wex, T., & Malfertheiner, P. (2010). Nonsteroidal Anti-Inflammatory Drug-Induced Gastroduodenal Bleeding: Risk Factors and Prevention Strategies. Pharmaceuticals, 3(7), 2225-2237.
  8. St. John’s Wort and Depression: In depth. (n.d.). NCCIH
  9. Calvi, A., Fischetti, I., Verzicco, I., Murri, M. B., Zanetidou, S., Volpi, R., Coghi, P., Tedeschi, S., Amore, M., & Cabassi, A. (2021). Antidepressant Drugs Effects on Blood Pressure. Frontiers in Cardiovascular Medicine, 8.
Retrieved on May 21, 2024.

Published on: May 30th, 2019

Updated on: May 21st, 2024

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