If it is almost time for the next dose, skip the missed dose and take the next dose at the regular time. The amount of Cymbalta in breast milk was approximately 7 mcg/day while on that dose; the estimated daily infant dose was approximately 2 mcg/kg/day, which is less than 1% of the maternal dose. Sample monograph from Handbook of Drug Administration via Enteral Feeding Tubes, 3rd edition When ciprofloxacin, levofloxacin and ofloxacin were added directly to enteral feeds, a loss of dose was observed for all antibiotics; however, the losses were 83%, 61% and 46%, respectively.10 A reduction in absorption was also noted when the enteral feed was resumed immediately following dosing. Similar effects would be expected with other potent CYP2D6 inhibitors (e.g., fluoxetine, quinidine) Concomitant administration of Cymbalta 40 mg twice daily with fluvoxamine 100 mg, a potent CYP1A2 inhibitor, to CYP2D6 poor metabolizer subjects (n=14) resulted in a 6-fold increase in duloxetine AUC and CSerotonin release by platelets plays an important role in hemostasis. All pregnancies have a background risk of birth defect, loss, or other adverse outcomes. Elsevier Science There were suicides in the adult Cymbalta trials, but the number was not sufficient to reach any conclusion about Cymbalta effect on suicide.It is unknown whether the suicidality risk extends to longer-term use, i.e., beyond several months. Treatment with Cymbalta and any concomitant serotonergic agents, should be discontinued immediately if the above events occur and supportive symptomatic treatment should be initiated.Inform patients about the risk of bleeding associated with the concomitant use of Cymbalta and NSAIDs, aspirin, or other drugs that affect coagulation Severe skin reactions, including erythema multiforme and Stevens-Johnson Syndrome (SJS), can occur with Cymbalta. The clinician should, nevertheless, be aware of the possibility of emergent symptoms of serotonin syndrome with such use The use of MAOIs intended to treat psychiatric disorders with Cymbalta or within 5 days of stopping treatment with Cymbalta is contraindicated because of an increased risk of serotonin syndrome.
Therapy with Cymbalta may be resumed 24 hours after the last dose of linezolid or intravenous methylene blue The risk of administering methylene blue by non-intravenous routes (such as oral tablets or by local injection) or in intravenous doses much lower than 1 mg/kg with Cymbalta is unclear. In the past I've used a couple of the older SSRI (paxil) and the side effects are almost worse than depression. The 20 and 60 mg capsules also contain iron oxide yellow.Although the exact mechanisms of the antidepressant, central pain inhibitory and anxiolytic actions of duloxetine in humans are unknown, these actions are believed to be related to its potentiation of serotonergic and noradrenergic activity in the CNS.Preclinical studies have shown that duloxetine is a potent inhibitor of neuronal serotonin and norepinephrine reuptake and a less potent inhibitor of dopamine reuptake. Message: Administer Cymbalta orally (with or without meals) and swallow whole.

Cymbalta® is indicated for the treatment of: 1. Consequently, physicians should carefully evaluate patients for a history of drug abuse and follow such patients closely, observing them for signs of misuse or abuse of Cymbalta (e.g., development of tolerance, incrementation of dose, drug-seeking behavior).In drug dependence studies, duloxetine did not demonstrate dependence-producing potential in rats.In postmarketing experience, fatal outcomes have been reported for acute Cymbalta overdoses, primarily with mixed overdoses, but also with Cymbalta only, including 1000 mg of Cymbalta (approximately 8.3 times the maximum recommended dosage).