Cymbalta Oral

This drug should also not be used with the following medications because very serious (possibly fatal) interactions may occur:

• sibutramine
• thioridazine
• tryptophan

If you are currently using any of these medications listed above, tell your doctor or pharmacist before starting duloxetine.

Before using this medication, tell your doctor or pharmacist of all prescription and nonprescription/herbal products you may use, especially of:

• drugs removed from your body by certain liver enzymes (e.g., cimetidine, antipsychotics such as perphenazine, antiarrhythmics such as propafenone/flecainide/quinidine, certain quinolone antibiotics such as ciprofloxacin, tricyclic antidepressants-TCAs such as desipramine/imipramine)
• drugs to treat high blood pressure (e.g., clonidine, guanethidine)
• "water pills" (diuretics such as furosemide)
• drugs that can cause bleeding/bruising (e.g., aspirin, antiplatelet drugs such as clopidogrel, NSAIDs such as ibuprofen, "blood thinners" such as heparin/warfarin)

Aspirin can increase the risk of bleeding when used with this medication (see above). If your doctor has directed you to take low-dose aspirin for heart attack or stroke prevention (usually at dosages of 81-325 milligrams a day), you should continue taking it unless your doctor instructs you otherwise. Discuss the risks and benefits with your doctor.

Also tell your doctor if you take any other drugs that increase serotonin, such as buspirone, dextromethorphan, lithium, meperidine, propoxyphene, phentermine, SSRIs, other SNRIs, tryptophan, St. John's wort, drugs used to treat migraines such as "triptans" and dihydroergotamine, street drugs such as MDMA/"ecstasy," amphetamine. (See also Side Effects section.)

Tell your doctor or pharmacist if you also take drugs that cause drowsiness, such as certain antihistamines (e.g., diphenhydramine), anti-seizure drugs (e.g., carbamazepine), medicine for sleep or anxiety (e.g., lorazepam, zolpidem), muscle relaxants, narcotic pain relievers (e.g., codeine), psychiatric medicines (e.g., chlorpromazine, quetiapine, nortriptyline, trazodone).