Cymbalta interactions: Alcohol, medications, and other factors

Cymbalta (duloxetine) is a brand-name prescription drug used to treat the conditions below:

• generalized anxiety disorder
• major depressive disorder
• chronic (long-term) musculoskeletal pain
• fibromyalgia
• pain related to diabetic neuropathy

As with other medications, Cymbalta can interact with supplements and certain other drugs. However, it’s not known to interact with alcohol or any foods. An interaction occurs when one substance causes another substance to have a different effect than expected.

For details about Cymbalta’s interactions, keep reading. For additional information about Cymbalta, including details about its uses, see this article.

In some cases, a factor or condition could prevent your doctor from prescribing Cymbalta due to the risk of harm. This is known as a contraindication. The contraindications of Cymbalta include:

Currently taking or having recently taken a monoamine oxidase inhibitor

Monoamine oxidase inhibitors (MAOIs) are a type of antidepressant.

Taking Cymbalta with an MAOI can increase your risk of serotonin syndrome. This syndrome is caused by a high level of the chemical serotonin in the body. Serotonin syndrome can lead to symptoms such as nausea and vomiting, hallucinations, and changes in blood pressure.

Below are examples of MAOIs that interact with Cymbalta:

• linezolid (Zyvox)
• methylene blue (Provayblue)
• selegiline (Emsam)
• isocarboxazid (Marplan)
• phenelzine (Nardil)

Due to the risk of serotonin syndrome, doctors typically will not prescribe Cymbalta with an MAOI. Your doctor will likely have you wait at least 2 weeks after you’ve stopped taking an MAOI before starting your Cymbalta treatment.

After you stop taking Cymbalta, they’ll usually have you wait at least 5 days before you start treatment with an MAOI.

Before you start Cymbalta treatment, it’s important to tell your doctor if this contraindication applies to you. They can determine whether to prescribe the medication.

There’s not a known interaction between Cymbalta and alcohol.

However, both Cymbalta and alcohol can cause liver problems. Your risk of liver problems with Cymbalta may be higher if you drink large amounts of alcohol while taking the drug.

If you drink alcohol, talk with your doctor. They can advise you on how much alcohol, if any, is safe for you to consume during Cymbalta treatment .

Before you start treatment with Cymbalta, tell your doctor and pharmacist which prescription, over-the-counter, and other medications you take. By sharing this information with them, you may help prevent possible interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Here’s a chart of drugs that can interact with Cymbalta. Keep in mind that this chart does not include all drugs that may interact with Cymbalta. Some of these interactions are described in detail just below in “Drug interactions in depth.”

* For details about this interaction, see “When to avoid Cymbalta” above.
† Cymbalta is a type of SNRI.

Here’s a closer look at certain drug interactions of Cymbalta.

Certain antiarrhythmics

Antiarrhythmics are medications that treat arrhythmias (irregular heart rates or rhythms).

Interaction result. The interaction between Cymbalta and the antiarrhythmic drug depends on the specific antiarrhythmic.

Taking Cymbalta with quinidine could increase your risk of side effects from Cymbalta. However, taking Cymbalta with flecainide or Rythmol SR (propafenone) could increase your risk of side effects from flecainide or propafenone.

Interaction explained. Below are details about the interaction between Cymbalta and certain antiarrhythmic drugs.

Two enzymes called cytochrome P450 2D6 (CYP2D6) and CYP1A2 break down Cymbalta in the body. An enzyme is a type of protein.

The antiarrhythmic drug quinidine inhibits (slows down) the activity of CYP2D6. As a result, taking Cymbalta with quinidine could raise the level of Cymbalta in your body. This could increase your risk of side effects from Cymbalta. (For details about Cymbalta’s side effects, see this article.)

Cymbalta inhibits (slows down) the activity of the enzyme CYP2D6. Taking Cymbalta with other medications broken down by this enzyme could lead to higher levels of the other medications in your body. This is the case for flecainide and propafenone, which is broken down by CYP2D6. As a result, you may have an increased risk of side effects from flecainide or propafenone if you take either of these drugs with Cymbalta.

Steps you or your doctor may take. Before taking Cymbalta, tell your doctor if you’re taking any antiarrhythmic drugs. They can advise you on whether these medications may interact with Cymbalta.

Ciprofloxacin

Cipro (ciprofloxacin) is an antibiotic used to treat different types of bacterial infections.

Interaction result. Taking Cymbalta with ciprofloxacin could increase your risk of side effects from Cymbalta.

Interaction explained. Cymbalta is broken down in the body by two enzymes: CYP2D6 and CYP1A2. Ciprofloxacin slows down the activity of CYP1A2. This means that taking Cymbalta with ciprofloxacin could raise the level of Cymbalta in your body. The higher level could increase your risk of side effects from Cymbalta. (For details about Cymbalta’s side effects, see this article.)

Steps you or your doctor may take. Before taking Cymbalta, be sure to tell your doctor if you’re taking ciprofloxacin. They can advise you on whether it’s safe to take these medications together.

If you develop a bacterial infection while taking Cymbalta, be sure the doctor who’s treating the infection knows you’re taking Cymbalta. They can help determine whether ciprofloxacin is the right treatment.

Warfarin

Jantoven (warfarin) is a blood thinner, which is also known as an anticoagulant. The drug is used to treat or help prevent blot clots in certain situations.

Interaction result. Taking Cymbalta with warfarin can increase the risk of bleeding from Cymbalta.

Interaction explained. Cymbalta belongs to a class of drugs called serotonin-norepinephrine reuptake inhibitors (SNRIs). These drugs affect chemicals in the body called norepinephrine and serotonin. The chemicals help platelets (a type of red blood cell) cluster together to form blood clots. By affecting norepinerphine and serotonin, Cymbalta can prevent platelets from forming blood clots. If your blood can’t clot properly, your risk of bleeding could increase.

When Cymbalta is taken with warfarin, the risk of bleeding with Cymbalta is even higher. This is because warfarin works by blocking the production of certain clotting factors in the blood. (Clotting factors are substances that help blood clot.) By preventing your body from creating these factors, warfarin makes your blood less likely to clot. This can increase your risk of bleeding further.

Steps you or your doctor may take. Before starting Cymbalta treatment, tell your doctor if you’re taking warfarin. They can recommend whether it’s safe for you to take these medications together.

If your doctor does prescribe Cymbalta with warfarin, watch for symptoms of severe bleeding. Examples include bloody urine, bloody stool, and coughing up blood. If you have these symptoms, tell your doctor right away. They’ll instruct you on how to manage this side effect.

Keep in mind that Cymbalta may interact with blood thinners other than warfarin. If you need to take Cymbalta and a blood thinner, talk with your doctor. They can advise you on whether it’s safe to take Cymbalta with other blood thinners, such as Xarelto (rivaroxaban) or Eliquis (apixaban).

Cymbalta may have other interactions, such as with supplements, foods, vaccines, or even lab tests. You’ll find details below.

Cymbalta interactions with supplements

Cymbalta may interact with tryptophan supplements. Taking Cymbalta with these supplements can increase the risk of serotonin syndrome as a side effect of the drug. (Serotonin syndrome is caused by a high blood level of the chemical serotonin.)

Before you start treatment with Cymbalta, tell your doctor and pharmacist which supplements, herbs, and vitamins you take. By sharing this information with them, you may help prevent possible interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Cymbalta and herbs

Cymbalta may interact with the herbal supplement St. John’s wort. Taking Cymbalta with this supplement may increase the risk of serotonin syndrome as a side effect of the drug.

It’s important to talk with your doctor or pharmacist before taking any herbal products during Cymbalta treatment.

Cymbalta and vitamins

There were no specific reports of any vitamin interactions with Cymbalta. Keep in mind that you should still talk with your doctor or pharmacist before taking any of these products during your Cymbalta treatment.

Cymbalta and food

No food interactions with Cymbalta have been reported. To learn more about eating certain foods during treatment with Cymbalta, talk with your doctor.

Cymbalta and vaccines

There were no reports of vaccine interactions with Cymbalta. You can talk with your doctor For more information about getting certain vaccines during your Cymbalta treatment.

Cymbalta and lab tests

No interactions between lab tests and Cymbalta have been reported. If you’d like to learn more about having certain lab tests during treatment with Cymbalta, talk with your doctor.

Cymbalta and cannabis or CBD

Cannabis (marijuana) and cannabis products, such as cannabidiol (CBD), have been specifically reported to interact with Cymbalta.

The effect of cannabis products on Cymbalta can vary from person to person. For example, cannabis products may raise or lower the level of Cymbalta in your body. A higher level of Cymbalta could increase your risk of side effects from the drug. On the other hand, a decreased level of Cymbalta could cause the drug to be less effective than usual.

Before you start treatment with Cymbalta, tell your doctor and pharmacist if you take cannabis. By sharing this information with them, you may help prevent possible interactions.

Note: Cannabis is illegal at a federal level but is legal in many states to varying degrees.

Certain medical conditions and other factors may increase the risk of interactions with Cymbalta. Before you take Cymbalta, be sure to talk with your doctor about your health history. Cymbalta may not be the right treatment option for you if you have certain medical conditions or other factors affecting your health.

Health conditions or factors that might interact with Cymbalta include:

Being age 24 years or younger. Cymbalta has an increased risk of suicidal thoughts and behaviors, particularly in children and young adults ages 24 years and younger. In fact, the drug has a boxed warning about this risk. This is a serious warning from the Food and Drug Administration (FDA). For more information, see “Boxed warning: Increased risk of suicidal thoughts and behaviors” at the beginning of this article.

Diabetes. If you have diabetes, be sure to tell your doctor before taking Cymbalta. The drug can make it hard to manage your blood sugar level. For this reason, your doctor may have you check your blood sugar level more often than usual while taking Cymbalta.

Seizures. Cymbalta may cause seizures. The risk of this side effect may be increased in people who have a seizure disorder, such as epilepsy. Before taking Cymbalta, tell your doctor if you have a seizure disorder. They can advise you on whether Cymbalta is safe to take.

Kidney failure. Having severe kidney failure could increase your risk of side effects with Cymbalta. Due to this risk, doctors typically will not prescribe Cymbalta for people with severe kidney failure. If you have this condition, talk with your doctor about other treatment options.

Mania or bipolar disorder. If you have mania or bipolar disorder, taking Cymbalta may increase your risk of a manic or mixed episode. This risk is also increased if a family member has these conditions. Cymbalta is not approved to treat depression in people with bipolar disorder. Before starting Cymbalta treatment, tell your doctor about any mental health conditions you and family members have or have had. They can advise you on whether it’s safe for you to take Cymbalta.

Liver disease. Cymbalta can cause liver problems. As a result, Cymbalta may worsen liver disease in people who already have the condition. Due to this risk, doctors typically will not prescribe Cymbalta for people with liver disease, such as cirrhosis. If you have liver disease, your doctor can recommend whether Cymbalta is safe for you.

Bleeding problems. Cymbalta may cause unusual bleeding as a side effect. If you have bleeding problems, such as hemophilia, you may have an increased risk of this side effect. Before taking Cymbalta, tell your doctor if you have any known bleeding problems. They can help determine whether Cymbalta is the right treatment option for your condition.

Slowed emptying of the stomach. Cymbalta capsules have a coating that protects the drug from stomach acid. Having a condition that slows the emptying of your stomach could cause your body to break down this coating too quickly. As a result, Cymbalta could be less effective than usual in treating your condition.

Before taking Cymbalta, be sure your doctor knows if you have a condition that causes slowed stomach emptying. Examples of these conditions include an underactive thyroid and diabetes. Your doctor can recommend whether you should take Cymbalta.

Narrow eye angles. Before starting Cymbalta treatment, tell your doctor if you have narrow eye angles. Cymbalta can cause dilated pupils, which may lead to closed-angle glaucoma in people with narrow eye angles. Closed-angle glaucoma is a medical emergency that can cause vision loss and severe eye pain. Your doctor may advise you to have an eye exam before taking Cymbalta.

High blood pressure. If you have high blood pressure, tell your doctor before taking Cymbalta. The drug may increase your blood pressure, which could worsen your condition. Your doctor can recommend whether it’s safe to take Cymbalta.

Dehydration or taking diuretics. Cymbalta may cause a low level of sodium in the blood. Your risk of low sodium with Cymbalta may increase if you’re dehydrated or take a diuretic drug. (Diuretics are used to decrease the levels of water and sodium in your body.) Your doctor can advise you on whether Cymbalta is right for you.

Pregnancy. It’s not known whether Cymbalta is safe to use while pregnant. If you’re pregnant or planning a pregnancy, talk with your doctor before you take the medication. For details about Cymbalta’s use during pregnancy, see this article.

Breastfeeding. Cymbalta can pass into breast milk, which may cause side effects in a breastfed child. If you’re considering breastfeeding while taking Cymbalta, talk with your doctor. To learn more about Cymbalta’s use while breastfeeding, see this article.

Allergic reaction. If you’ve had an allergic reaction to Cymbalta or any of its ingredients, your doctor will likely not prescribe Cymbalta. You can ask them about other treatments that may be better choices for you.

Here are some frequently asked questions about Cymbalta and possible interactions.

Does Cymbalta interact with Lyrica?

There’s no known interaction between Cymbalta and Lyrica (pregabalin).

Both Cymbalta and Lyrica are used to treat fibromyalgia as well as pain related to diabetic neuropathy. In some cases, your doctor may prescribe Cymbalta in combination with Lyrica to treat these conditions.

To learn more about Cymbalta and Lyrica, talk with your doctor or pharmacist.

Is there an interaction between Cymbalta and Xanax?

Cymbalta is not known to interact with Xanax (alprazolam).

Both Cymbalta and Xanax can be used to treat generalized anxiety disorder. In certain situations, your doctor may prescribe Cymbalta in combination with Xanax. This is because it can take several weeks for Cymbalta to ease the symptoms of anxiety. Your doctor may prescribe Xanax for the short-term treatment of anxiety while you wait for Cymbalta to have its full effect.

Your doctor and pharmacist can tell you more about Cymbalta and Xanax.

Do Cymbalta and omeprazole interact?

There’s not a known interaction between Cymbalta and Prilosec (omeprazole).

Omeprazole is used to treat conditions such as heartburn and gastroesophageal reflux disease (GERD). Other treatments for heartburn, such as Tagamet HB (cimetidine), are known to interact with Cymbalta. These medications can raise the level of Cymbalta in your body, which could increase your risk of side effects from Cymbalta. However, omeprazole does not have this effect.

For more information about taking Cymbalta with omeprazole, talk with your doctor or pharmacist.

You can take certain steps to help prevent interactions with Cymbalta. Your doctor and pharmacist are key resources, so reach out to them before starting treatment. For example, you should plan the following:

• Let them know if you drink alcohol or take cannabis.
• Tell them about any other medications you take, as well as any supplements, herbs, and vitamins.
• Create a medication list, which your doctor and pharmacist can help you fill out.

It’s also important to read the label of Cymbalta and other paperwork that comes with the drug. The label may have colored stickers that mention an interaction. And the paperwork, sometimes called the prescribing information, may contain details about interactions. If this information is difficult to understand, ask your doctor or pharmacist to help explain it.

You can also help prevent interactions with Cymbalta by taking it exactly as your doctor prescribes.

Besides learning about interactions, you may want to find out more about Cymbalta. These resources might help:

• Overview of Cymbalta. For a general overview of Cymbalta, you can see this article.
• Side effects. If you’re interested in learning about the side effects of Cymbalta, see this article. Another option is to refer to the Cymbalta prescribing information.
• Dosage specifics. To learn about the dosage of Cymbalta, see this article.
• Drug comparison. Find information abouthow Cymbalta compares with Lexapro and Effexor XR.
• Facts about your condition. To learn more about your condition, see our:
  • mental health hub and list of depression articles
  • anxiety hub and list of anxiety and stress articles
  • list of fibromyalgia articles
  • diabetes hub and list of diabetes articles

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.