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People living with systemic lupus erythematosus (SLE) often take multiple medications, which may raise their risk of drug interactions (side effects caused by taking multiple drugs at the same time). Sometimes, it may be difficult to tell whether you’re experiencing symptoms of lupus or side effects of a drug interaction.
“I haven’t been feeling like myself for a few weeks now. A lot of brain fog and feeling blahhh,” wrote one MyLupusTeam member. “Not sure if it’s from the lupus, or if the meds aren’t interacting well.”
More than 2,000 MyLupusTeam members report having taken Cymbalta, a formulation of duloxetine. If you take duloxetine, do you know which medications it can interact with? Duloxetine can interact with many medicines, including nonsteroidal anti-inflammatory drugs (NSAIDs), which people with lupus often take.
Cymbalta is a brand-name formulation of duloxetine, a medication frequently used to treat depression, which is common in people with lupus. Duloxetine is also used to treat certain kinds of pain, including neuropathic (nerve) pain. More than 48,000 members of MyLupusTeam report experiencing one or more types of pain as symptoms of their lupus.
Duloxetine is a type of drug called a serotonin and norepinephrine reuptake inhibitor (SNRI). It improves symptoms of depression by increasing the amount of serotonin and norepinephrine (two neurotransmitters that affect mood) in the brain.
Like many medications, duloxetine can interact with hundreds of other drugs. Read on to learn about five common drugs that can interact with duloxetine.
NSAIDs are used to treat the pain caused by inflammation. For people with lupus, NSAIDs can improve joint and muscle discomfort caused by chronic inflammation. Commonly used over-the-counter NSAIDs include ibuprofen, aspirin, and naproxen.
NSAIDs alone can have some serious side effects, including abnormal bleeding and worsening of kidney disease. These side effects are especially important to consider if you have lupus nephritis — kidney disease caused by lupus.
In clinical trials for duloxetine, there were higher rates of serious bleeding events in people taking duloxetine than in those taking a placebo (inactive drug). The study found that individuals taking NSAIDs had higher rates of bleeding events, whether they were taking the study drug or a placebo.
While the research didn’t find that combining NSAIDs and duloxetine increases bleeding risk, the prescribing information for duloxetine cautions against using the two medications together. This caution is in part based on other research about different types of antidepressants.
Research has found that combining NSAIDs with a different class of antidepressant called selective serotonin reuptake inhibitors (SSRIs) can increase a person’s risk of bleeding in their upper gastrointestinal (GI) tract. The upper GI tract includes the esophagus, stomach, and the first part of the small intestine.
Ask your doctor if it’s safe to take NSAIDs with duloxetine. Your doctor will consider factors like your risk of bleeding problems.
Beta-blockers are a family of drugs used to treat heart disease, including conditions that are common in people with lupus, like hypertension (high blood pressure). These medications help slow your heartbeat to lower your blood pressure. Beta-blockers are typically prescribed for high blood pressure if other treatments haven’t worked.
Some examples of beta-blockers include:
Duloxetine decreases the activity of an enzyme that breaks down beta-blockers. Enzymes are proteins that speed up chemical reactions in the body, including drug breakdown in the liver. As a result, taking duloxetine at the same time as a beta-blocker may increase the effects of the beta-blocker. Adverse effects of beta-blockers may include a low heart rate and low blood pressure, which can be serious.
One study reviewed serious side effects related to blood pressure or blood flow in people taking a beta-blocker with certain types of antidepressants. The study looked at antidepressants, including duloxetine, that impact a specific enzyme that affects how the body processes beta-blockers, as well as antidepressants that don’t impact that specific enzyme. Those taking antidepressants like duloxetine were at increased risk of hospitalization or emergency visits for serious side effects.
Taking duloxetine doesn’t automatically mean you can’t take a beta-blocker. Generally, people taking a beta-blocker will have their heart rate and blood pressure monitored to look out for side effects. If you’re also taking duloxetine, your doctor may recommend additional monitoring or a lower dose of the beta-blocker.
Several categories of antidepressants interact with duloxetine. These interactions result from the impact of these drugs on serotonin levels. Duloxetine and some other antidepressants increase serotonin levels, which can cause serotonin syndrome. This risk can be greater when duloxetine is taken with another antidepressant.
Serotonin syndrome results from high blood levels of serotonin. In severe and life-threatening cases, serotonin syndrome can cause high fever, seizures, and loss of consciousness. For this reason, doctors are advised to use caution when combining duloxetine with certain antidepressants. These include:
Prescribing information for duloxetine lists monoamine oxidase inhibitors (MAOIs), another family of antidepressants that affect serotonin, as a contraindication. This means it’s not safe to use these two medications together.
Warfarin is a prescription drug used to prevent blood clots. This type of drug is called an anticoagulant or blood thinner.
Based on case reports, taking duloxetine with warfarin may increase bleeding risk. The prescribing information for duloxetine recommends caution if taking these two drugs at the same time.
Talk to your doctor about appropriate precautions if you’re taking both of these medications. Your doctor may recommend more frequent blood testing to check how well your blood clots.
Ciprofloxacin and levofloxacin are a kind of antibiotic known as fluoroquinolones. This category of antibiotics is used to treat respiratory and urinary tract infections. Moxifloxacin is an example of another fluoroquinolone.
Fluoroquinolones impact the CYP1A2 enzyme. This enzyme affects how the body processes duloxetine and other substances. Prescribing information for duloxetine warns against taking it with drugs that have a strong impact on the CYP1A2 enzyme, called potent or major CYP1A2 inhibitors. Ciprofloxacin falls into that category as a moderate-to-strong CYP1A2 inhibitor.
In studies of other CYP1A2 inhibitors, taking these drugs with duloxetine led to very high levels of duloxetine in the blood. This could lead to serious side effects, including:
This article reviews five potential drug interactions, but there are many drugs that might not be safe to take with duloxetine or that may require extra caution. Make sure all of the providers on your healthcare team have an updated list of all the prescription medications, over-the-counter treatments, and supplements you take.
It’s also important for all of your healthcare providers to understand your entire health picture. You may be at greater risk of certain drug interactions depending on certain health factors, such as your kidney or liver health, or previous bleeding episodes.
If you have concerns about potential interactions between duloxetine and other drugs you’re taking, talk with your doctor. They’ll review your medications and make sure you’re safe from dangerous interactions.
On MyLupusTeam, people share their experiences with lupus, get advice, and find support from others who understand.
Do you take duloxetine along with other medications? Let others know in the comments below.
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A MyLupusTeam Member
I found out from my pharmacist that metaxalone shouldn't be taken with duloxetine. I then looked it up n found it to be dangerous.