Horrible side effects of Cymbalta?
 

I have idiopathic neuropathy,and my neurologist has been pushing me to try Cymbalta to help manage the pain in my legs and feet. I finally relented and started a 30mg dosage 4 days ago.

I have always felt a little off and tired due to the neuropathy, but now I am completely exhausted and feel loopy like a bad high pretty much all the time. Is this what most people experience starting this drug and will the effects lessen soon? Has Cymbalta significantly helped anyone else out there with nerve pain?

I am tired of putting drugs into my body and not knowing what they are going to do to me...unless it is really going to help! I was on Tramadol 50-100mg a day and felt like that was helping more than this drug but worry about being on pain meds for the rest of my life? So confused...

Hi Cat,

My doctor is pressuring me (strongly suggesting) to try Cymbalta (duloxetine) too. I've been down the road with other SNRIs, as well as SSRIs and TCAs, and had very bad reactions to all of them. He seems to have forgotten all that. Worse still, he knows (or should know) I'm currently taking other meds that increase my risk of serotonin syndrome/toxicity, yet seems oblivious to piling on more.

There was another thread about Cymbalta recently...

Cymbalta now in generic form: duloxetin HCL

...and there is much more in the archives (Search)—bad and good—including side effects and duration.

Doc

May I ask how old you are? If pain meds help, and tramadol is near the bottom of the pyramid as far as heavy pain meds go, I think they have fewer side effects than antidepressants. Many people ignore the fact that lots of drugs have dependency issues, not just opiates. If you have started the Cymbalta it is probably worth sticking it out for a while and doing your research to see if it helps. If it doesn't I would stick with the tramadol. If you are very young or very old there could be reasons to avoid some pain meds which is why I impertinently asked about your age.

I have only been taking the Cymbalta for a few days and thus far it just makes me feel worse. I am 40??

Thanks Dr. Smith. I have read several of your other very informative and sympathetic posts and it is appreciated to those of us who are clueless.

I am going to call my doctor tomorrow and tell her what I am feeling. If she says to stick it out a few more days, I am not sure what to do. This is my first time trying an AD so it is highly likely I cannot tolerate them well either. My family says to keep on taking it and see what happens, but on the other hand they are out to dinner right now and I am sitting at home feeling like a zombie and posting on a computer!

It is funny that I am so desperate for a doctor to solve my problems I will believe anything they tell me. After all the doctors I have been through the past few years, you would think one would learn! So glad to have found this forum and all of you who really understand and care enough to share your knowledge and stories.

I understood that about the Cymbalta. I had a really bad experience with Effexor and had to discontinue after a few days. I could barely see, my pupils were so dilated, and I couldn't stop yawning, couldn't sleep. I was only suggesting that since you have started, if possible stick with it a for a couple of weeks to see if it can help. A lot of people end up with an anti-seizure medication, an anti-depressant, and an opiate for severe PN. I am on 1800 mg. Gabapentin and 30mgx3 time release morphine with oxycodone 7.5 / 325 for breakthrough pain. I have severe leg pain most likely from muscle atrophy.
Age factors into any decision about pain management and a lifelong chronic illness. If you are very young opiates are not a great idea as they do have to be adjusted upwards after a while, although this process can be very slow. The prospect of taking these meds for most of one's life is not ideal. Any side effects would be magnified and there may be cognitive losses. In the elderly cognitive effects may be much more pronounced. Your age makes it more complicated to make the call, all you can do is read everything you can about the options in pain management. Neuropathic pain is notoriously hard to treat but hopefully you can find something that gives you a decent quality of life without too many side effects.

Many of us have had bad experiences with doctors. You learn very quickly not to trust them too far or believe everything they say. PN is a very difficult disease to treat and very elusive to diagnose. Patients easily can become better informed than their doctors if they do their research.

I've had more than one doctor tell me that savvy patients often do know more about their afflictions/conditions/diseases than their doctors do, and no wonder. As it was put to me by the doctors...

A doctor has to learn about hundreds/thousands of diseases in a very short time in med school and afterward in residency. During that same short time, they have to learn about everything else—medications, surgery, procedures, anatomy, etc. Once they get into practice, they may have several hundred patients with different problems, as well as keeping abreast of new developments/education.

OTOH, we individual patients only have ourselves (and maybe immediate family) to concern ourselves with, and only a few medical conditions; we've got many many more hours—running into years—available to research our individual conditions. It's true that we lack much of the associated background and formal education, but some of us learn that (or as much of it as we need/can stand) as we go. And we can read 10-100 times or more articles about our respective PNs, treatment, etc.

Now if we could only get PAID what those guys get... :cool2:

Doc

To Cat1234 and Susanne C :)
 

Antidepressants also take about a month to level up in the body. While it is definitely worth talking with your doc about the issues it will take time for the body to get used to them and for them to start having a constant effect.

I'm on Lyrica, One of the anti seizure drugs and I was off work for a month while getting used to it. Was a long time to be stuck not doing much at all.

Exactly. That is why you need a doctor who knows a lot about your disease. In a CMTers case, we need an expert neurologist who knows CMT. Fortunately I knew about CMT for many, many years as it goes way back in the family. Family history certainly does help.

I have researched CMT for many years as well and have seen it first hand many times. My support group of course is full of people with CMT and in all stages of it. You can spot a CMTer by the way they walk without a doubt. That is if you know CMT.

Thanks for bringing up what regular doctors, shall we say, go thru. Most have never even seen anyone with CMT or if they have they have diagnosed it as something else. My regular doctor said she had had ten minutes on it. In my case, I'm the only one she has seen, and not for CMT, so why would she read up on it. She will probably never see another person with CMT. And a doctor's time is limited so on with the more obvious things people come in for.

It's not like the old days either where you could really visit with your doctor and talk about a lot of stuff. Now you have to be careful what you say to your doctor, your eye doctor, your chiropractor, you name it as they write it all down and there it is in your records and out there and you thought you were only telling them.

We got lucky. That's exactly the kind of doctor we (are fortunate to) have. :p

The art of medicine consists in amusing the patient while nature cures the disease. —Voltaire

Doc

SO TRUE Dr. Smith! I never thought of it that way. Instead of switching doctors continously, I am learning to be my own advocate. My binder of medical records is the size of The Odyssey these days! Now if I could figure out what is causing my neuropathy, it would really help..

Spoke to my doctor and she wants me to try Lexapro so here we go again...hoping this one works? I really want to be off all meds but hearing what you and others are on Susanne C. makes me change my tune. It sounds like meds are going to be a part of my life now and that they can help improve my quality of life.

Yesterday I tried to stop taking the Tramadol and ended up in worse shape. Sometimes I think in the back of my mind the meds are contributing to my inability to get better. It does not sound like this way of thinking is going to help from what you all are telling me.

I am on Synthroid 50mg 1x day, Linzess 290mg 1x day (for constipation but I usually end up with diarrhea from it), and Tramadol 50-100mg a day depending on the day. Plus I am taking all the vitamin supplements Mrs. D has on the sticky thread.

Thanks again Kitts, Susanne and Dr.Smith. If any of you have any experience with Lexapro love to hear your story!

there is a major interaction between Tramadol and SSRI antidepressants.

This link is for Tramadol + Cymbalta:
http://www.drugs.com/interactions-ch...221-0,949-2273

Considered MAJOR...

Taking SSRIs with OTC medications with Dextromethorphan in them also is not recommended. This may result in too much serotonin actions too.

Tramadol has some antidepressant actions in it, but they are mild.
But combined with other drugs that increase serotonin, this may be contributory to serotonin syndrome.

I saw that too but my doctor and pharmacist both said it is extremely rare and if I start having any of those symptoms then be worried. It seems like many people are on SSRIs and pain killers? Everything is so confusing.

May I ask what meds you are on Mrs.D? And the cause of your neuropathy? You seem to be the foremost expert on this forum and I am wondering what works for you :)

My PN was the worst over 30 yrs ago....none of these drugs were available then... except for Elavil and opiates.

My PN improved considerably with treatment for my low thyroid.

I do have arthritis too, and use 1/2 to 1 tramadol 50mg very seldom at night, if things are too overwhelming for me.

But I prefer topical products over oral today. Salonpas patches (arthritis), Lidoderm RX patches severe nerve issues, Biofreeze for burning (not frequent anymore--- avoidance of potatoes fixed that), and magnets for nighttime pain.

I never used the new SSRI drugs, or gabapentin/Lyrica, or opiates. (I had opiates in the hospital for my C-section, and that was the only time).

I have pre-diabetes now, so sometimes my feet flare up, but not terribly. I've learned to live it all, for the most part.

I am currently on a new gluten free attempt...since my GI issues have been more active than usual. I also have congenital malrotation of the GI tract, and hereditary angioedema. So my GI problems are far and away the worst now than ever!

Other pain killers do not have this interaction.... only Tramadol.

Just because some professionals think this is rare... is not a good reason not to pay attention to it. I had a rare event from a common blood pressure pill... it was almost fatal.... and my doctor thought it was "rare" and that didn't help me one bit.

Here are links for tramadol and Cymbalta.... listing the
% of reported side effects to the FDA. It is thought that only a very small % are ever reported however...so the
numbers on this site only reflect the reported ones:

http://www.drugcite.com/?q=tramadol

http://www.drugcite.com/?q=Cymbalta&a=&s=

I currently take Cymbalta and tramadol. I also discussed the interactions with my doctor and pharmacist. I was told by both it was ok to use together. I did choose to stay with it.
I was thinking just the other night that I have spent so much time trying to avoid any opiates. I have refused them due to fear of addiction.

Then I thought to myself, I am pumping all this poison into my body. Such meds as Enbrel and IVIG and my next try rituxan. I avoid the drugs that don't cause other diseases and take the ones that can cause lymphoma etc.

I don't know which train of thought is right?

We are always being bombarded with conflicting information so it is hard to tell Kitt!

I started the Lexapro last night but only at 5mg to start with. I am more along the lines of you Mrs. D to not take these drugs. I feel like it is poisoning my body and could cause even more medical issues down the line. But my poor family has dealt with me long enough and I am willing to try just about anything to have a better quality of life.

It scares me that I am 40 and have so much more time to live with this-especially when it is all of a sudden rapidly getting worse and nobody can pinpoint why.

I checked out your old thread Mrs. D http://neurotalk.psychcentral.com/sh...hlight=Lexapro and do not see that you reviewed Lexapro unless I missed something. Have you researched this SSRI at all? Any thoughts??

Thanks again...

Lexapro is on that list.

It is an SSRI (but does not have mixed neurotransmitter effects like the SNRIs...like Cymbalta or Effexor or Savella.)

It is a metabolite of Celexa --which had 2 racemic forms one of which was the active Lexapro. When Celexa's patent expired the company put Lexapro out. It is much more potent and active than the Celexa-- the latter is often given to serotonin sensitive people because it is much weaker.

The rationale for using antidepessants involves MIXED acting ones primarily. This is because the central (in the brain) pain loop reacts best to mixed types.

If you are overly sensitive to serotonin type drugs...then the obvious choice to me is using a dopamine acting type. That
would be Wellbutrin (Bupropion). Starting with low doses and working up. Some people here have had success with this drug, and for men especially, it interferes with sexual activities the least.

I would bring this up with your doctor and here is a medical paper illustrating its usefulness with pain treatment:
http://www.ncbi.nlm.nih.gov/pubmed/18457535

Good information although a bit above my head to be honest! I made an appointment to go back in this Thursday and see my doctor again. Just took my 5mg Lexapro after dinner and within an hour I already feel dizzy and "off." I feel like that half the time anyway these days so who knows.

I should probably start a new thread about this, but since I have your attention Mrs. D perhaps I should see if you can shed any light on possible neuropathy causes my doctors are overlooking? As most of us, I would just like to know what is causing my pain so I can at least stop the progression! So far, this is what my bloodwork has shown:

Lyme Disease Negative
Total Protein SPEP 6.6
Albumin SPEP 4.5
Alpha-1-Glob SPEP 0.1
Alpha-2-Glob SPeP 0.6
Beta-Glob SPEP 0.5
Gamma-Glob SPEP 1.0
Vitamin B6 23.1
Syphilis Negative
Vitamin B12 938
Folate RBC 452
ESR 4
CRP <029
Anti-Ro Negative
Anti-La Negative
Sjogren's SS-A Antibody 236 (Johns Hopkins lip biopsy came back inconclusive although 3 blood tests show positive for SS-A)
Sjogren's SS-B Antibody 26
SCL-70 Antibody 28
RNP Antibody 18
JO-1 Antibody 32
Histone Antibody 22
Centromere Antibody 15
C3 53
C4 14
IG-G 1160
IG-A 263
IG-M 100
Anti-Thyroglubolin Ab 6
Thyroperoxidase Ab 15
HIV NonReact
Rheumatoid Factor Screen <20
Antinuclear Antibody 1:40
FSH 7.3
T3 Uptake 35.3 (on synthroid)
T3 Total 40
T4 5.0
T7 1.77
TSH 1.1
Estradiol <12
Progesterone <0.2
Testosterone 19
Glucose Serum 48 was most recent but it has been as high as 91 in some tests
Bun 21
Creatinine 0.75
Egr 100
Bun/Creatinine Ratio 28
Sodium 133
Potassium 3.7
Chloride 97
Carbon Dioxide 23
Calcium 8.6
WBC 3.5
RBC 4.34
Hemoglobin 13.9
Hematocrit 42.5
MCV 98
MCH 32.0
MCHC 32.7
RDW 13.4
Platelets 193
Homocysteine 11.5
Methylmalonic Acid 0.13
Arsenic 4.4
Mercury 33.9 (high but toxicologist dismissed it as neuropathy cause?)
Lead 1
Copper 884
Zinc 67
Also tested negative twice for celiac

I know that is a lot of information but if anything stands out to you PLEASE let me know! I wish you were my doctor after reading all your posts!!! I will understand if this is way too much to digest and you can just say hope your doctor helps on Thursday :)

Thanks again-and to anyone else who might be able to help...

If you figure that one out let me know?!!

Will do! You made me smile:)

Cat:
 

Three words: Liza Jane's Charts ;)

Doc

Started cymbalta friday night, other than the side affects my nerves felt good until I woke up today. Not sure if its from the cymablta but I am lit up more than I was before cymbalta. Anyone else experience this?

The norepi side of the Cymbalta is stimulating to some people.

You'll have to keep track of your blood pressure if you feel these energizing side effects. Avoid caffeine too. Cymbalta can raise blood pressures in people with that tendency.

That would be good if it raised my blood pressure since its always on the low side. I have an addiction to caffeine but haven't had any since september. It used to bring me great happiness.

Hi, was in to see my gp today to get blood results everything a ok. Asked about my pain, gave her the low down. Taking me off the nortriptyline and putting me on Cymbalta. She also stated that she is taking me off of tramadol as the two together do not play well. So going back on t3's. Hope I can get some weight off now as that nortriptyline and lyrica (still taking) put a lot on my belly.

I had to quit cymbalta. My doctor said to try and tough it out unless it was unbearable. On a scale of 1-10 the pain it caused my nerves was a 20. I don't think it directly was affecting my nerves but was probably irritating my stomach which inflames my nerves just like any PPI drug does. I feel alot better now being off it except now I can't sleep at all.

Yep I agree about Drs. writing info into record. I have a history of depression, nobody ever asks what triggered it, only that I have peroids of it. Mine came on when I was going from dr to dr trying to find out what my problem was. Finally found cancer in 3 places, but all a dr sees is the word depression and they look at you differently.

Been off nortriptolyne and tramadol for a month and have lost 10 lbs, hand jerks are gone and feel more alert then before. Also was taken off of prevacid (on it for 15 years) and put on tecta for my heartburn.

So now on Cymbalta and lyrica for the control of the burning and electric sharp razor pains. Just a few sneak in during each week. Using t3 for the walking pain (about 12 to 15 a day).

I wear really good sneakers with good form and gel soles built in to help with walking around.

My pain are in my feet, ankles , thighs and just starting in the hands which I hope passes quickly as I use a keyboard all day for work.

Still holding and going strong.

You all, take care!!

I originally posted this on the thread regarding something for immediate relief of pain, the other day, I & believe since it was an older posting, it was largely ignored. So, if anyone can benefit, here it is again:

Like the Vowel Lady, I have had good luck with Kerasal Neurocream. It is a capsicum cream (hot pepper cream) which is considered a third line treatment for neuropathic pain. Unlike Capzasin-HP, the Neurocream comes in a tube with a nice sponge applicator attached to the end of the tube, so your hands never touch the cream. It also contains some cyanocobalamin B12 and camphor. In my case, it has reduced to the "folded sock" pain behind my toes to a bearable level, and for her, the burning in the soles of the feet, I believe.

I have been using it just every 12 hours in the ball of my feet area. I tried skipping the morning application, and after 3 days, the pain started to return, so I know it's still working for me. LOL. A tube has lasted me a couple of months. You can get it at Walmart (just under $16), and most drug stores. Kerasal has been putting a $2.00 coupon on their website pretty regularly.

Incidently, my Neurologist referred me to it, as one of his other patients told him about the Neurocream. He knew I wasn't keen on adding another drug as I also take 30mg daily of nortriptyline.

http://www.kerasal.com/neurocream.shtml

Tramadol and Cymbalta
 

I took Tramadol and Tylanol for 10 years for Restless Leg and insomnia, and then for RLS, insomnia, and fibromyalgia. It worked great until... it stopped working. I had no side effects when I stopped. But have had no happy solutions since. I've tried Celexa, Cymbalta, but Tylanol seems to be the best, though not perfect by any means.

http://neurotalk.psychcentral.com/sh...52#post1093052

Doc

SSRI antidepressants can cause derangements
In dopamine levels (lowers it)
Which results in RLS type movements
In the legs, neck spasms, mouth and tongue
Movements that resemble Tardive diskinesia.

You can Google this --
"SSRI movement disorder side effects"

I take 30 mgs of Cymbalta daily and have for about 5 years. It helps me with the pain, yes. It would be a lot worse without the Cymbalta. So far I've not had to up my dose.

I have no side effects from the Cymbalta at all. I went from 75mgs of Effexor a day directly to the 30 of Cymbalta. So I wouldn't have had or rather expected any side effects. Give it a few weeks. The sides should ease. And if not, than the drug simply isn't going to be a good one for you. It can take 2 to 4 weeks or so for the side effects to go away. And even then, if your doc wants to up the dose you may experience a bit of the same side effects again for a few days, at that time.

I also take Ultram (Tramadol). It mutes a lot of the nerve pain for me. It doesn't work for everyone and there are drugs that are much more...disruptive, shall we say? Like true narcotics such as Vicodin. I've been taking Ultram for about the same amount of time as the Cymbalta. I can't take gabapentin (Neurontin) because it makes me suicidal and that's the first line drug given for PN.

Unless they figure out some way to heal the nerves and prevent any further damage medications and such are the only recourse we have as far as I know. I look at it as sort of like being diabetic and needing insulin. I need these medications to live a semi-normal life. :Dunno:

Holy cow! According to the Walmart website that cream is $15.98 for 2 ounces! :-(

I assume you were directing this comment about the price of the Neurocream. They always have a coupon for $2.00 off on the Neurocream website. Even without the coupon, a tube last me 2-3 months, which is under $8.00 a month. My insurance c0-payment is $10 a month for generic drugs. Doesn't seem bad to me since it completely relieves the 'folded sock' pain just behind my toes. And it's still working for me after 10 months now.

How about all these "wonder supplements", such as one I've seen for $60 for a months supply? Is that worth trying out? Not for me.

I've been taking this combination for a number of years with no issues. True, I'm on the lowest dose of Cymbalta one can take without dividing up the capsules. I also seldom take more than 150 mgs total of Ultram (Tramadol) a day.

I'm limited in what I can and cannot take. I have no insurance, can't work, can't get disability. My docs simply throw meds at my symptoms. Though with PN I think that's the majority of treatment anyway.

As I've said before, I can't take the most common drug given for PN: Neurontin. It made me suicidal. So I'm kind of stuck. I tried the B12 and other supplements listed here and had no change. I just plug along hoping and praying Va will get off its butt and expand Medicaid. That's my only hope. Or wait a few more years and then try for disability going back against my late husbands social security.

If and when they expand medicaid I might finally be able to get the testing done I so desperately need. Even then, it may still be idiopathic. sigh

Ah! Thank you for that! I wasn't sure how long 2oz should last. It might be worth a try for me.

Right now my sleep issues are because the pain is always worse at night but if I take the dose of Ultram needed to stop the pain enough to sleep, the Ultram keeps me awake. This cream might be what I could use at night instead of Ultram. So thanks for the added info! <3

You are welcome. It works really well for my particular pain & for another lady on this forum. As they say, your results may differ. It is a cream made from captain hot peppers, but has a foam applicator on the end of the tube, to help keep it off your hands, & out of the eyes. Of course, pay attention to the instructions before using.

I was given a "tryout" on Tramedol (Ultram) at my last visit to my primary Dr. Made me happy the first very few times I took it, but now has just dulled the ache in my feet, and also helps me keep from thinking about my feet (a more subdued "happy", LOL) I only take one occasionally at the start of my day (lasts me about 10 hours or so), knowing that that particular day will be a bit better than the others.