Buy Duloxetine (Cymbalta) Cas 116539-59-4

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]

Duloxetine is more effective than placebo in the treatment of generalized anxiety disorder (GAD).^[29] A review from the Annals of Internal Medicine lists duloxetine among the first line drug treatments along with citalopram, escitalopram, sertraline, paroxetine, and venlafaxine.^[30]

Duloxetine was approved for the pain associated with diabetic peripheral neuropathy (DPN) by the US FDA.^[31][32][33] The response is achieved in the first two weeks on the medication. Duloxetine slightly increased the fasting serum glucose.^[34]

The comparative efficacy of duloxetine and established pain-relief medications for diabetic peripheral neuropathy is unclear. A systematic review noted that tricyclic antidepressants (imipramine and amitriptyline), traditional anticonvulsants and opioids have better efficacy than duloxetine. Duloxetine, tricyclic antidepressants, and anticonvulsants have similar tolerability while opioids cause more side effects.^[35] Another review in Prescrire International considered the moderate pain relief achieved with duloxetine to be clinically insignificant and the results of the clinical trials unconvincing. The reviewer saw no reason to prescribe duloxetine in practice.^[36] The comparative data collected by reviewers in BMC Neurology indicated that amitriptyline, other tricyclic antidepressants, and venlafaxine may be more effective. The authors noted that the evidence in favor of duloxetine is much more solid, however.^[37] A Cochrane review concluded that the evidence in support of duloxetine’s efficacy in treating painful diabetic neuropathy was adequate and that further trials should focus on comparisons with other medications.^[22] A crossover trial found that duloxetine, pregabalin, and amitriptyline offered similar levels of pain relief.^[38] Duloxetine also has similar effect on pain relief in diabetic neuropathic pain as gabapentin.^[39] Comparing at various doses, the strongest effect on relieving diabetic neuropathic pain is on 120 mg/d dose.^[39] Combination treatment of duloxetine and pregabalin offered additional pain relief for people whose pain is not adequately controlled with one medication and was safe.