Buy Duloxetine (Cymbalta) Cas 116539-59-4

Duloxetine, sold under the brand name Cymbalta among others,^[1] is a medication used to treat major depressive disorder, generalized anxiety disorder, obsessive–compulsive disorder, fibromyalgia, neuropathic pain, central sensitization, and other types of chronic pain.^[9][10] It is taken by mouth.^[9]

Duloxetine is a serotonin–norepinephrine reuptake inhibitor (SNRI).^[11] The precise mechanism for its antidepressant and anxiolytic effects is not known.^[9]

Common side effects include dry mouth, nausea, constipation, loss of appetite, drowsiness, sexual problems, and increased sweating.^[12] Severe side effects include an increased risk of suicide, serotonin syndrome, mania, and liver problems.^[9] Antidepressant withdrawal syndrome may occur if stopped.^[9] Use during the later part of pregnancy may increase the risk of bleeding or cause complications for the fetus.^[12]

Duloxetine was approved for medical use in the United States^[9][13] and the European Union in 2004.^[4][6] It is available as a generic medication.^[11] In 2023, it was the 31st most commonly prescribed medication in the United States, with more than 18 million prescriptions.^[14][15]

The main uses of duloxetine are in major depressive disorder, generalized anxiety disorder, neuropathic pain, chronic musculoskeletal pain, and fibromyalgia.^{[3][9][16][17]}

Duloxetine is recommended as a first-line agent for the treatment of chemotherapy-induced neuropathy by the American Society of Clinical Oncology,^[18] as a first-line therapy for fibromyalgia in the presence of mood disorders by the German Interdisciplinary Association for Pain Therapy,^[19] as a Grade B recommendation for the treatment of diabetic neuropathy by the American Association for Neurology^[20] and as a level A recommendation in certain neuropathic states by the European Federation of Neurological Societies.^[21]

A 2014 Cochrane review concluded that duloxetine is beneficial in the treatment of diabetic neuropathy and fibromyalgia but that more comparative studies with other medicines are needed.^[22] The French medical journal Prescrire concluded that duloxetine is no better than other available agents and has a greater risk of side effects.^[23] Whereas duloxetine has shown efficacy in treating painful diabetic peripheral neuropathy by blocking late Nav 1.7 sodium ion channels and increasing norepinephrine, serotonin, and dopamine in the central nervous system (CNS) and while improving mean NPRS scores and achieving a ≥50% pain response in more patients compared to placebo, it has been associated with potentially serious adverse reactions including hepatotoxicity, serotonin syndrome, severe skin reactions, increased risk of bleeding, increased blood pressure and sexual dysfunction.^[24]

Duloxetine was approved for the treatment of major depression in 2004.^[3][4] A 2025 systematic review assessing the benefits and harms of duloxetine in depression found an average change of 1.81 points on the 53-point Hamilton Depression Rating Scale and a small beneficial effect on quality of life, effects below the review’s predefined minimal clinically important differences. There was insufficient data to assess suicide or other serious adverse events. All results assessed were at a high risk of bias.^[25] A 2012 Cochrane Review did not find greater efficacy of duloxetine compared to SSRIs and newer antidepressants. Additionally, the review found evidence that duloxetine has increased side effects and reduced tolerability compared to other antidepressants. It thus did not recommend duloxetine as a first-line treatment for major depressive disorder, given the (then) high cost of duloxetine compared to inexpensive off-patent antidepressants and lack of increased efficacy.^[26] Duloxetine appears less tolerable than some other antidepressants.^[27] Generic duloxetine became available in 2013.^[28]