Duloxetine: what it treats, how to take it, side effects
Last updated September 3, 2026.
Duloxetine is an SNRI antidepressant that also treats several kinds of chronic pain. You may know it as Cymbalta. It increases the amounts of serotonin and norepinephrine in the brain - which is why one capsule can cover mood and nerve pain at once.
What does it treat?
Depression and generalized anxiety disorder, plus the pain of diabetic neuropathy, fibromyalgia, and ongoing bone or muscle pain. MedlinePlus also notes stress urinary incontinence in women as another use. It controls these conditions; it does not cure them.
How do you take it?
One or two times daily, with or without food, at the same time every day. The label's typical path: start at 30 mg once daily for a week to let your body adjust, then increase to 60 mg once daily - and there is no evidence that doses above 60 mg a day add benefit. Swallow the delayed-release capsules whole; never split, chew, or crush them. Full benefit takes 1 to 4 weeks or longer. The rule that bites people: do not stop suddenly. Withdrawal brings nausea, vomiting, diarrhea, anxiety, dizziness, tiredness, headache, pain, burning, numbness, or tingling in the hands or feet, irritability, insomnia, sweating, and nightmares - your doctor will reduce the dose gradually. Missed dose: take it when you remember unless the next one is close; never double up.
Side effects to know
- Common: nausea, dry mouth, drowsiness, dizziness, tiredness, constipation, decreased appetite, and sweating. Dizziness and fainting when standing up too fast are common early on and after dose increases - rise slowly.
- Serious: liver injury (loss of appetite, unusual bruising or bleeding, itching, upper right stomach pain, yellowing skin or eyes, dark urine); serotonin syndrome (agitation, hallucinations, fever, sweating, confusion, fast or irregular heartbeat, severe muscle stiffness or twitching, loss of coordination, nausea, vomiting, diarrhea); seizures; allergic reactions with facial or throat swelling or breathing trouble; difficulty urinating; and extreme tiredness or weakness with confusion and unsteady walking. Angle-closure glaucoma is a specific one: nausea, eye pain, vision changes like colored rings around lights, and eye swelling or redness mean emergency care. The boxed warning covers increased suicidal thoughts and actions in people under 24, most likely in the first months and at dose changes - watch for new or worsening depression, agitation, panic attacks, insomnia, hostility, impulsivity, severe restlessness, and any talk of self-harm.
Who should not take it?
Anyone who has taken an MAO inhibitor, thioridazine, linezolid, or methylene blue within the past two weeks - and after stopping duloxetine, wait at least 5 days before an MAOI. The label says avoid it in chronic liver disease or cirrhosis and in severe kidney impairment. MedlinePlus tells you to disclose heavy alcohol use (alcohol raises the risk of serious side effects), low sodium, glaucoma, a recent heart attack, high blood pressure (it can raise yours - expect regular checks), diabetes, seizures, coronary artery disease, bleeding problems, slow stomach emptying, and liver or kidney disease. St. John's wort, tryptophan, proton pump inhibitors, cimetidine, aspirin, and NSAIDs all interact. Duloxetine may make you drowsy, dizzy, and affect judgment - no driving until you know it. Late pregnancy needs a direct conversation with your doctor.
When is it an emergency?
Call 911 for seizures, trouble breathing or swallowing, or fainting. Yellowing skin or eyes with dark urine, and the serotonin-syndrome cluster, mean immediate care. Thoughts of harming or killing yourself mean calling your doctor right away - or call or text 988, the Suicide and Crisis Lifeline, any time. For an overdose, call Poison Control at 1-800-222-1222. Pymander's escalation routing is built and tested specifically for this class of decision; see the safety architecture working paper.
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Common questions
Why can't I stop duloxetine suddenly?
Because the withdrawal is rough. MedlinePlus lists it: nausea, vomiting, diarrhea, anxiety, dizziness, tiredness, headache, pain, burning, numbness, or tingling in the hands or feet, irritability, insomnia, sweating, and nightmares. Your doctor reduces the dose gradually - the label says the same. Never quit cold because you feel better.
Can I drink alcohol while taking duloxetine?
Ask your doctor, and expect caution. MedlinePlus says alcohol can increase the risk of serious side effects from duloxetine and tells you to disclose heavy drinking - the liver is the concern, since the drug itself can injure it. Many people on it skip alcohol entirely.
How long does duloxetine take to work?
MedlinePlus says it may take 1 to 4 weeks or longer to feel the full benefit. The label's usual start - 30 mg once daily for a week, then 60 mg - exists to make the adjustment smoother. Early nausea is common and usually passes within days of each change.
Is duloxetine the same as an SSRI?
Close, but it hits two chemicals. Duloxetine is an SNRI - a serotonin and norepinephrine reuptake inhibitor - increasing both substances in the brain, while SSRIs work on serotonin alone. That norepinephrine leg is part of why it also treats nerve pain, fibromyalgia, and chronic muscle and bone pain.
Does duloxetine raise blood pressure?
It can. MedlinePlus says duloxetine may cause high blood pressure and that you should have yours checked before starting and regularly during treatment. If you already have high blood pressure, your doctor factors that in before prescribing.
What does duloxetine withdrawal feel like?
The official term is discontinuation symptoms: nausea, vomiting, diarrhea, anxiety, dizziness, tiredness, headache, burning or tingling in hands and feet, irritability, insomnia, sweating, and nightmares, per MedlinePlus. They come on when doses are missed or stopped abruptly, which is why the taper is gradual and why the daily schedule matters.