Cymbalta: instructions for use, doctors' reviews and price

Pharmacodynamics and pharmacokinetics

Pharmacodynamics

and serotonin reuptake blocker , it also slightly inhibits dopamine ; does not have significant affinity for dopamine, histamine, cholinergic and adrenergic receptors The mechanism of action is to inhibit or stop the reuptake of norepinephrine and serotonin , resulting in increased noradrenergic and serotonergic neurotransmission in the brain.

It has a central mechanism for weakening pain, which is manifested by an increase in the pain threshold in neurogenic pain syndrome .

Pharmacokinetics

Well absorbed from the intestines, the highest concentration is achieved six hours after consumption. Taking with food indirectly reduces absorption by 11%.

Plasma protein binding reaches 90%. It is actively transformed with the participation of the enzymes CYP1A2 and CYP2D6 , resulting in the synthesis of two metabolites ( 5-hydroxy,6-methoxyduloxetine sulfate, 4-hydroxyduloxetine glucuronide ). The half-life reaches 12 hours. Excreted in urine.

CIPRALEX reviews from users

Prices for the drug CIPRALEX

Name:

TOR7
Review:
This medicine was prescribed to me by a psycho-neurologist for the treatment of anxiety-depressive disorder.
In general, doctors love this drug, it is modern, of the latest generation, with minimal side effects, not so toxic, easily tolerated, does not interact with other drugs and even with alcohol. A little about my condition, which was before I started taking Cipralex (to compare with what has become). Against the background of a long time of continuous and large volume of work, which I successfully coped with and which I loved very much, I first developed irritability, short temper, suspiciousness, poor sleep and other symptoms that were not strong, but were already interfering with a normal life. I didn’t go to the doctors because I didn’t even suspect that I had problems that needed to be treated and naturally my disease progressed. Compression of the head appeared, I began to note with horror sometimes small memory lapses (with horror, because due to my work I keep an incredibly large amount of information in my head), severe mood swings, aggression, etc. appeared, I won’t go into too much detail .well, then a very strong stressful event happened in life, which after some time made itself felt very clearly and strongly. I’ll write briefly - tears, tearfulness, the world outside the window seems gloomy, the brain builds only negative developments in the future, strong changes in mood, strong outbursts of aggression, severe sleep disturbance, I could not sleep at all for 3 nights. Either I can’t fall asleep until 5 am, and then I fall asleep for a couple of hours, or I regularly wake up at 5 am. All this was very exhausting. Previously proposed remedies either did not produce any results, or they were very short-lived. Sexual functions are impaired. After a lot of searching around with doctors - psychiatrists, psychotherapists, psychologists, neurologists, I finally found a doctor who was able to put me at ease, explained everything competently and with him I felt at ease and calm throughout the entire treatment. But we won’t delve into this either, otherwise the review will turn into a whole story, as long as a book)) If you roughly imagined my condition, and if you are looking for information about Cipralex, then I think you will understand without words what happened to me and how depressing it was) I was prescribed Cipralex 5 mg for 7 days, then 10 mg for 20 days, then the dose was increased to 15 mg and then to 20 mg. Along with Cipralex, I was prescribed a course of vitamins Magnesium B6 (I think there is no point in talking about them, everyone knows them) + Semax 3 drops in each nostril 1 time a day (1 month) + Lamictal (lamotrigine) 25 mg, then 50 mg per night all the time while taking Cipralex. During the course, various other drugs were prescribed, but this was more like concomitant therapy; the main drug in my treatment was, of course, Cipralex. Having finally cast aside my doubts, I purchased Cipralex (by the way, not every pharmacy has it). I bought it with a prescription. It's a bit expensive. RUB 2,000 per pack of 20 tablets of 20 mg. There are analogues, but the doctor said that the original is better tolerated. In almost all small pharmacies they always asked and copied the prescription, but in large chain pharmacies, oddly enough, they did not ask for a prescription. Of course, I was scared by the side effects that I had read about and spent another 3 days looking at the purchased box of Cipralex, not daring to open it) but finally, feeling unwell took over, I ignored the possible side effects and, as the doctor prescribed, I took the first half (5 mg) at night, adding Lamictal to it. Here is a small diary of my condition and sensations in the first days of treatment. 1 evening. No nausea or headaches (this is often written about). passed out at 11:30. I slept 8-30 hours without waking up at night, which seemed to me a very, very good effect, because I had serious problems with sleep. 1 day. During the day, weakness, terrible apathy. Feeling like I haven't slept all night. No nausea, no headache. Slight nervousness. At the same time, I’m good at working and concentrating. Just not as active as I would like. The pupils are large. The face is slightly red. Looks stunned. It is not advisable to get behind the wheel in terms of claims from traffic police officers. In the evening, severe bloating appeared. Day 2 Slept 7-40 without night awakenings. The weakness is gone. Little activity and at the same time apathy. Feeling like I haven't slept all night. Sweating. Big pupils. Irritability and nervousness have decreased. Abdominal pain gone. The mood is not sad. A pimple appeared on my hand and it itched. Sexual intercourse increased over time, but not significantly. Took a little while to fall asleep, went to bed at 12:30, fell asleep at 1 a.m. Day 3 Woke up at 6:30, woke up by the child. Didn't fall asleep again. Not getting enough sleep all day, but working well. A slight apathy is felt, which seems to be interrupted by stimulation. Constipation. had a stomach ache. The mood is even. no irritability. Sexual intercourse increased to 10 minutes (from 6 minutes). fell asleep quickly, at 12. Slept well. Day 4. I woke up at 5:30, lay in bed until 6:30, thought I wouldn’t fall asleep, as if I had slept enough. But I fell asleep before 8:30. got up slightly sleepy. There is a feeling of slight apathy, and at the same time slight stimulation. Pupils like saucers, all over the eye. I feel an increase in libido, which is very, very strange. Frequent sexual arousal during the day. Apathy gives way to stimulation. Thoughts get worse, thoughts get better. In the evening I decided to get some sleep, although I seemed to have slept normally. I drank 0.5 phenozepam. fell asleep. I still woke up at 6 that night. but fell asleep again. Day 5 got up at 7:40. slight weakness. overall condition is normal. The day went by rather hard, I really wanted to sleep, I was all lazy. went to bed at 12:40. fell asleep. 6th day. got up at 8:20. slight cheerfulness. I'm in a good mood. I want to do a lot today. Squeezes my head a little. By lunchtime my mood improved. I don't notice any side effects. The pupils are dilated, but it seems to me not so much anymore. Apathy is absent. But periodically there is severe drowsiness. Increased libido. 7-9 days. If you don’t lie down, but do something, you feel cheerful; if you plop down in a work chair, then apathy sets in. I had a lot of thoughts about my life in my head. I began to realize that I had actually suffered from an anxiety disorder for a long time. I remembered many different situations from my life and my reaction to them. More precisely, it all happened in my brain; I didn’t delve into it on purpose and didn’t remember it. But at the same time, inner peace appeared, some kind of confidence in myself and in the fact that I would finally be able to solve the problems I had, I would take a step forward, I would rise one step higher, I would finally do and implement everything that I had not been able to do. I had enough time and energy, which was hampered by my anxiety disorder, as I now began to realize. The fear is gone. or rather, my agrophobias and social phobias, which were present in me and which I tried not to notice, probably dulled. I feel a little drowsy. It intensifies and then disappears. Increased libido. I noticed that the cramps in my stomach have gone away, my stomach is no longer swollen, and my stomach is not twisting. (before this I had problems with my stomach, I underwent examinations and all kinds of treatments, although this was not really a cure, since no serious pathologies were detected in me. But my stomach continued to torment. And only now I realized that it was all from nerves) Dizziness appeared after bending over, or if you squatted for a while. 10-20 days. A stable state, stressful situations do not make you angry, and even if there is a conflict and you have to get excited and even raise your voice, then literally in a minute there is no anger, no aggression, the person is forgiven. You begin to like calmness, stability, equanimity, and resistance to stress. In my mind I reason that I don’t even need alcohol to relax, I don’t even want to. Sleep became better, but until 6 o’clock in the morning, then waking up/falling asleep on days 21-29, it became worse to fall asleep every other day. When I can’t fall asleep until one o’clock, I turn on phenozepam. I tried valemndine and glycine. Helps: Day 30 I noticed a clear increase in mood. I sang songs in the morning. There were a lot of thoughts running through my mind. Perhaps the connected picamilon has a psychostimulating effect. I noticed a side effect in the form of constipation. The eyes are still crazy, the pupils are all over the eyes. I don’t drive in the evening. Then the condition was almost stable and manifested itself in the following: Increased libido, which I really liked. Slight delay in ejaculation. If at all the word delay is appropriate here. Probably the sexual act just became a little longer. This is very strange, because as they say, antidepressants suppress libido and sexual function, but for me it’s the opposite. If my anxiety-depressive disorder reduced the time of sexual intercourse to 2 minutes, affected libido, lowering it, and generally discouraged the desire to have sex, then with taking the drug everything leveled out and fell into place. And it even became better than before the disease appeared. I slept much better, but not perfect. I fell asleep immediately, almost didn’t wake up at night, but often in the morning my sleep was somewhat superficial. The dreams were very colorful and it seemed that I saw a lot of them during the night, very long and naturally positive. During the day, drowsiness and apathy were also often observed. In general, I concluded that while taking Cipralex I needed to sleep longer. For example, it is rare, but when it was possible to sleep 9-9:30 hours during the night, the state was cheerful all day; if less, as was often the case, then drowsiness and apathy were present. Cognitive functions, which had malfunctioned during the illness, undoubtedly returned to normal - memory, thinking, etc. stabilized. The emotional state was practically unshakable. I didn't even know this was possible. and probably would never have known what calm iron nerves are. It can't be explained until you feel it yourself. That is, nothing pisses you off or makes you angry. Whatever the irritant. And this makes it possible to think sensibly, soberly and adequately and make decisions. The mood swings are over. Gastrointestinal problems have disappeared. I no longer get sick to my stomach before an important meeting. There are no restless thoughts about remembering to tell me how to behave, I’m just emotionally stable and calm. Everything will be fine. This is the mood. I note that the drug reached its full strength probably after 1.5 months. I didn't feel euphoria. The only side effects I can mention are constipation, and possibly drowsiness and apathy, which can be easily combated if you have time to sleep))) I took the drug for 8 months and I don’t regret it. It opened my eyes to a lot of things, and also really got rid of fears, phobias, anxiety, improved sleep, I became stress-resistant, calm, which often even pissed people off. But what to do? I can only advise them to also take this course) The course of treatment needs to be completed gradually, that is, we remove it a little at a time so as not to feel discomfort and stay on this dose for 2 weeks. And so we gradually go down to zero. Everyone has their own perception, so you need to try it. Removed 5 mg and see if you feel discomfort, add a little. Get away means not 5 mg, but 2.5 mg. I did just that, but one day I thought that maybe there was no withdrawal syndrome at all and I simply stopped taking the pills. I felt withdrawal symptoms on about the 3rd day. My hands were shaking a little, monrage, anxiety, restlessness, etc. Therefore, I quickly resumed taking the drug and then followed the withdrawal plan prescribed by the doctor. Therefore, if you approach this issue wisely, then you don’t have to be afraid of withdrawal syndrome. If anyone is concerned about the topic of alcohol, then during the period of taking the drug there were many important days, such as birthdays, weddings, etc. The doctor said that I could have 2 glasses of wine or a glass of beer, but for me everything turned out differently. I drank alcohol to the point of intoxication. It does not interact with Cipralex. In the morning, it was true that my condition was slightly serious, but after taking another pill, my condition stabilized. Of course, it is better to avoid alcoholic drinks, after all, you are treating the psyche, but alcohol, on the contrary, weakens it. But if there is a need, you can afford it. Wow, that’s it. I’ll add what I remember, write me any questions, I’ll be happy to answer. I wish you not to get sick!!! | otzovik.com Name: scoropad Cipralex is a prescription drug, so it must be selected by a psychotherapist; you should not experiment. When I came to the hospital, the doctor prescribed me Phenibut, it didn’t help me at all, but Cipralex was more suitable, and for others it was the opposite. The price is of course decent for 28 tablets, about 2000 - 2200 rubles, in my case it’s not that expensive since I take half a tablet. The packaging is convenient; you can take one tablet with you, separating it from the general plate. The tablets themselves are easily divided into two parts. Well, now about the most important thing, about the effect, I can’t say that after drinking the tablet I immediately became calm and didn’t freak out for any reason. I still get irritated when my kids throw tantrums day after day, but the effect is still there, but taking the pills has to be done on a regular basis. Another plus is that there is no addiction, I don’t feel sleepy or sluggish. | otzovik.com

Contraindications

Sensitization to the components of the drug.
Simultaneous use with MAO inhibitors.
Decompensated angle-closure glaucoma.
Age less than 18 years.
Fructose intolerance , sucrase deficiency, glucose-galactose malabsorption.
Severe liver diseases.
Concomitant use of strong CYP1A2 enzyme inhibitors.
Severe form of chronic renal failure .
Arterial hypertension.
Age less than 18 years.

It is recommended to use Cymbalta with caution for seizures, bipolar disorder and mania, intraocular hypertension , increased risk of hyponatremia , suicidal thoughts, liver and kidney dysfunction.

Side effects

More often than others, patients using duloxetine experience headache, nausea, drowsiness, dry mouth, and dizziness.
laryngitis may occur .
Changes in the immune system: hypersensitivity , anaphylactic reaction.
Changes in the hormonal sphere: hypothyroidism .
Metabolic changes: dehydration, decreased appetite, hyperglycemia, hyponatremia, paradoxical release syndrome of antidiuretic hormone .
Mental changes: anxiety, insomnia , agitation, decreased libido , unusual dreams, impaired orgasm, sleep disorders, suicidal thoughts, bruxism , disorientation, apathy, mania , aggression, hallucinations, hostility.
Changes in nervous activity: headache, dyskinesia , drowsiness, dizziness, tremor, dysgeusia, paresthesia, myoclonus, akathisia, lethargy , excitability, impaired concentration, serotonin syndrome , psychomotor agitation, decreased sleep quality, convulsions , extrapyramidal disorders.
Changes in sensory organs: mydriasis, vertigo , blurred vision, glaucoma , tinnitus, dry eyes, ear pain.
Changes in the circulation: supraventricular arrhythmia, tachycardia, hyperemia, hypertension, orthostatic hypotension, cold extremities, fainting.
Changes in breathing: pain in the oropharynx, yawning, nosebleeds.
Digestive changes: nausea, diarrhea , dry mouth, vomiting, constipation, dyspepsia, abdominal pain gastroenteritis, gastritis, belching, dysphagia , bad breath, stomatitis, hematochezia, hepatitis, liver damage, jaundice .
Skin changes: rash, increased sweating, itching , urticaria , night sweats, contact dermatitis, photosensitivity , cold sweat, Stevens-Johnson syndrome, Quincke's edema.
Changes in the musculoskeletal system: muscle stiffness, musculoskeletal pain, muscle spasms, cramps, trismus.
Changes in the genitourinary system: urinary retention, increased frequency of urination, icturia , polyuria, dysuria, impaired ejaculation, erectile dysfunction, changes in the menstrual cycle, gynecological bleeding, testicular pain, galactorrhea, menopausal symptoms, hyperprolactinemia.
General and local disorders: increased fatigue, impaired taste, atypical sensations, chest pain, feeling of cold, chills, thirst, malaise, gait disturbance.
Laboratory and physical findings: weight change; increased levels of ALT, alkaline phosphatase, AST, bilirubin, GGT, CPK; increased levels of potassium and cholesterol in the blood .

Abrupt withdrawal of the drug often causes withdrawal syndrome , which is manifested by: dizziness, headache, sensory disturbances, tremor, diarrhea, sleep disturbance, weakness, drowsiness, irritability, anxiety, nausea.

Manifestations of withdrawal syndrome

The pharmaceutical company that produces Cymbalta conducted studies of adverse reactions of the drug. It turned out that some of them develop after discontinuation of this drug.

Withdrawal syndrome most often manifests itself as headache, dizziness, and nausea. Neurological symptoms often develop, such as: loss of sensitivity, numbness or tingling sensation in the extremities, muscle twitching, tremors.

Reactions from the psyche are also possible. Insomnia most often develops, and nightmares may occur. Less commonly, predisposed patients experience delusional-hallucinatory syndrome.

Reactions from the gastrointestinal tract develop quite often. These include: nausea, vomiting, constipation or diarrhea, abdominal pain.

If the patient took Cymbalta for chronic pain, the pain syndrome may return or intensify.

Instructions for use of Cymbalta (Method and dosage)

Instructions for use of Cymbalta require swallowing the capsules whole without chewing. Do not add the product to food or mix it with liquids.

The recommended initial dose is 60 mg once daily. In some patients, to achieve a better result, it is necessary to increase the dose to 120 mg per day divided into 2 doses.

In patients with renal failure in the terminal stage, the initial dose is 30 mg of the drug once a day.

In patients with liver damage, the initial dosage of the drug should be reduced or the frequency of administration in patients with cirrhosis .

Do not suddenly discontinue drug therapy. When stopping treatment, the dosage should be slowly reduced over 10-14 days to reduce the risk of withdrawal symptoms .

Cymbalta reviews from users

Prices for the drug SYMBALTA
Name:

erika777 The drug Cymbalta was prescribed by a neurologist.
Chronic headache has been going on for more than a year. Varying in intensity. Lately, it is very rare that simple painkillers help. Since I already had an unpleasant experience with taking an antidepressant, I was wary of this (and for good reason). The doctor prescribed 30 mg, 1 capsule after breakfast. I didn’t immediately like that it was in capsules; there was no way to reduce the dosage. After taking the first one, an hour later I began to feel very nauseous, then dizziness, blurred vision, and inability to concentrate on anything appeared. I didn't eat anything all day because I was constantly feeling sick. During the day I really wanted to sleep and was tormented by yawning. There were hallucinations at night. The next day my head hurt even more. I decided that the next drug was not suitable for me and I did not want to endure so many side effects. | otzovik.com Name:
Tigrejn I like to share my experience of using various medications and I myself enjoy reading reviews about what I am prescribed before I buy. There are very few reviews about Cymbalta. Therefore, I consider it my duty to tell how I got to this drug, what it did to me and why I left it.? My condition: Sometimes I have a headache. More often this happens when there are problems with my daily routine: I usually get up for work at 6:30, and if I sleep longer on the weekend, my head hurts. If I am in one position for a long time, for example, during flights, long trips in a car or bus, my head hurts. Before the weather changes, my head hurts. It begins to hurt gradually, affecting the entire skull, it becomes difficult to think, even vision deteriorates. On a ten-point intensity scale, the pain level reached 8-9. The most effective way to get rid of it is to take 1-2 Spazgan tablets. In this case, the headache goes away, but the remaining symptoms are blurred vision, inability to think well, etc. - are saved. A day down the drain. For this reason, I was examined by a neurologist, did many tests, including an expensive MRI of the head and neck, and found out that I had an asymmetrical supply of blood to the brain, a difficulty in its outflow, and there were already small foci of degenerative changes in the brain substance. Do you know what people look like after a stroke? They forget words, their hands shake. In their brains, such changes are widespread. Having them, even small ones, is somehow scary. By the way, all the unpleasant characteristics described above are usually called vegetative-vascular dystonia in medical practice. Each such diagnosis may have a very different set of symptoms and physiological characteristics. Therefore, I strongly advise everyone who has such a diagnosis and does not know the details to find out all these details. I will also add that difficulty in blood flow is, according to doctors, one of the main reasons for deterioration of vision, because along with the brain, the eyes are also poorly nourished. The reasons for this are physiology, a sedentary lifestyle, and frequent exposure to stress. It was the doctor’s questions and reading Chertov’s text that showed that I also have asthenic syndrome. Asthenia is a painful condition manifested by increased fatigue and exhaustion with extreme instability of mood, weakening of self-control, impatience, restlessness, sleep disturbance, loss of the ability for prolonged mental and physical stress, intolerance to loud sounds, bright lights, and strong odors. Patients also experience irritable weakness, expressed by increased excitability and quickly followed by exhaustion, affective lability with a predominance of low mood with features of moodiness and displeasure, as well as tearfulness. That is why, along with the treatment of blood vessels, I was prescribed antidepressants at one stage of treatment. ? My treatment? I already have a decent path to treating headaches and VSD. At first I took the drugs Anvifen and Noben, then for a long time - Phlebodia (for veins), Noben and Tanakan. You can read how I reacted to this or that drug using the links. I did not mention here the drugs that did not have an effect, but reviews about them can also be found in the profile. The last time I left the neurologist with a prescription for Phlebodia, Cymbalta and Actovegin. ? What is Cymbalta? A prescription drug (prescription only, and the prescription remains in the pharmacy after purchase). Active ingredient: Duloxetine. Indications for use: - depression; - painful form of diabetic neuropathy; - generalized anxiety disorder. A very long and extensive list of side effects that occur with varying degrees of frequency and in almost all areas of life, for example: psyche: insomnia, anxiety; immunity: hypersensitivity; nervous system: convulsions, nervousness; vision: glaucoma; heart: tachycardia and a lot more. another. Also, many patients experience drug withdrawal syndrome. Read the instructions carefully before taking the drug, or even better, before buying it. By the way, it is not sold everywhere, sometimes you need to run and travel around the city to find it.? How to take Cymbalta? The drug Cymbalta, the active ingredient of which is duloxetine, is sold in two forms in my city, both from the pharmaceutical company Lilly (Puerto Rico): dosages of 30 and 60 mg. A dosage of 30 mg is recommended as the beginning of treatment and entry into the drug. It is sold in packs of 14 capsules (for 2 weeks, because 1 per day). The cost of the package is about 1800 rubles, depending on the pharmacy. After entering the drug, the dosage is increased to 60 mg per day. 60 mg is sold in packs of 28 capsules and costs around 3,500 rubles. I took 1 capsule per day after meals along with other medications. ? My feelings? Even after hearing the word “antidepressant”, I felt a reluctance to get involved in this. And after reading the instructions and the entire list of possible side effects, this reluctance only intensified. But I got used to trusting doctors, who more than once or twice turned out to be smarter than me and in the end were right, so I bought Cymbalta with discipline and started taking it. Getting into the drug was not easy. In the first 5 days, starting from taking the first capsule, I had: - in my stomach there was a feeling as if I had eaten enough plastic or foam, in general, something artificial that fills my entire stomach and does not allow me to eat and enjoy food; - it seemed that I was about to catch a glitch. I don’t even know how to really describe it. The head suddenly feels like a slight dizziness, and a feeling of emptiness appears in the head itself. I've never tried drugs, but it was like being in a state of moderate intoxication, only without the fun. Because of these sensations, I even took a two-day break from taking the drug, then continued the same way, 1 capsule at a time. After the break, all these sensations passed, and, having finished taking 30 mg, I switched to 60 mg. 60 mg from the entire rich list was given to me.... No, I'll start with the good. Absolute calm, mostly good mood. Healthy indifference, immunity to stress. Good, effective sleep, after which you get up rested and invigorated. High performance. Increased intellectual functions. True, the headaches never stopped. Against the background of general treatment, they became much less frequent and weaker, but the headache continued to hurt 1-2 times every 1-2 weeks. On the intensity scale it was 1-3 points, but I was sick. Well, the side effects are a whole designer bouquet. I’ll start again with the good side effects, and then we’ll move towards the bad ones. This is a decrease in appetite and weight loss. In general, on antidepressants, many people lose weight and gain wings, especially for mature women. You get the motivation to take care of yourself, go to the gym, a man appears... In general, life gets better. A very good side effect for older, plump women. I also lost a little weight on Cymbalta (I’m not very overweight, so I have no room to lose much weight). Unusual dreams. If I remembered all the dreams that I had while taking Cymbalta and wrote them down, I would definitely publish a book that would become a new word in literature. I could watch 2-3 different dreams a night, each with its own twisted plot, well-drawn characters and a crazy eclecticism of fantasy and reality, books and films, as well as all possible genres. Every night. There were even flights in my dreams, and this never happened to me even as a child. I can’t resist telling you one of my dreams, the one I still remember. For those who are not interested, scroll down, I will specifically highlight the dream in italics. It takes place in a country like the seven kingdoms, in its capital, or rather, in the royal castle of the capital. It is not a king who rules here, but a group of men and women who are not related to each other. Their origin is still unknown. The Kingdom is threatened by something, and the same threat comes from both outside and inside. One of the ladies of the court becomes curious and, caught by one of the male rulers, goes with him on a tour of the castle. By the way, this man is Nikolai Costner-Waldau (he, not Jaime Lannister). It turns out that the castle is so huge that there are corners of it where people have not gone for many years. Nikolai takes his lady to one of these places (I sometimes see myself as her, sometimes I look at everything from the outside). This is the part of the castle that faces the sea. A single tiny hidden door allows entry from the outside. You can't get here from the inside. Nikolai and I enter, he is dressed like Jaime at the beginning of the series (longer hair than in recent seasons, light suit). He's beautiful, but I find myself not attracted to him. We pass through a small passage into the castle and find ourselves in a richly furnished lobby - dark green curtains, drapes, paintings in gilded frames, a sea of precious trinkets. And, despite the fact that no one has come here for many years, not a grain of dust has appeared. The only light comes from the torch Nikolai is holding, but the lobby is still brighter than it should be with such a light source. I understand that I was in a magical place. Nikolai and I stop at the entrance leading from the lobby to the next hall and do not go further. Here the dream is transferred to the past. I see a group of several men and women on storm-battered ships, moving from somewhere from the east in search of shelter, a new home, even a piece of land in general. They are fugitives, exiles, war-torn. Their clothes are torn, they are hungry, but they do not lose hope. Their ships land on the shore of the island, on which rises a huge castle - the entire island. Nobody meets them. They walk around it, but the only tiny entrance leads only from the shore, where the ships landed. They sense danger coming from the castle, but have no choice, so they enter. They find themselves in the same lobby as I was earlier. To progress further, they need to solve many complex riddles and puzzles, and each failure results in the death of someone from the group. In the end, they reach the end and exit through the main entrance - it turns out that the castle is not on an island, but on a huge continent, and now they are the rulers of the country that is located here. They understand that they passed the tests of the castle and received the reward only because they were together, that there were many of them and each played their role. They swear to each other that they will continue to rule just as wisely and fairly, distributing responsibilities, without trying to rise above each other. This is where my dream ended. It turned out to be similar to “Game of Thrones”, and a little like “The Chronicles of Narnia”, and to computer games. Crazy and beautiful at the same time. But let's return to the medicine and side effects. Yawn. In the first half of the day after Cymbalta, productivity is very high, and in the second half, frantic yawning begins. Everything seems to be just as productive, I don’t want to sleep, but my jaw is simply indecent. Increased sweating. It seems like summer, but so much that deodorants could barely cope; I had never sweated before. Decreased libido and impaired orgasm. It’s awkward to say this, but it happened. And I think my awkwardness is a small price to pay for someone to think carefully before boarding Cymbalta. Few people like being young and almost healthy, wanting nothing and feeling nothing. And men, as the instructions say, may also have erectile dysfunction. It seems like my list is small, but for me the last point on it turned out to be decisive. At some point, I felt that it was impossible to live like this, especially if family life had just begun and I would like to not only enjoy it, but also have children. And this is difficult to do when you don't want sex. And I just finished the last box of Cymbalta (the second of 28 60 mg capsules) and quit the drug. ? Cancellation? I would not advise stopping the drug as abruptly as I did. Even at the beginning of taking 30 mg, it was necessary to set aside at least 5 capsules for withdrawal. I think it was precisely because of the suddenness that I had: - dizziness (while sitting, my head suddenly drops suddenly), - decreased performance, or rather, desire to work (I hovered over a task for several minutes before getting to it start, and in the process several more times). These withdrawal symptoms lasted about 7-10 days. Then everything returned to normal, but... my appetite returned. You just want to eat, a lot and tasty, while on Cymbalta you are indifferent to food. I even gained almost a size. And the strong appetite has not gone away for almost a month; it is very difficult to deny yourself anything. I'm like an alcoholic who has been decoded. But the headaches, on the contrary, have practically disappeared! That is, I had headaches more often on Cymbalta than without it! Probably Actovegin and Phlebodia work well here. And almost immediately the interest in sex returned and everything improved in this area)? Conclusions: “Would I take Cymbalta, knowing what would happen to me during and after taking it?” No way! And considering the price, I would have categorically refused to see a neurologist. She didn’t do anything good to me, but could she? I would not rate my condition at the time of appointment as depression. Stress and anxiety can be relieved with simpler medications, and, in the end, with the joys of life - communication with family, travel, walks, communication with animals, hobbies, etc. Do I recommend Cymbalta? No, I don't recommend it. At least for symptoms and conditions similar to mine. The waste of money and side effects are definitely not worth it. Health and goodness to everyone! | irecommend.ru

Overdose

Symptoms of overdose: coma , drowsiness , clonic convulsions , vomiting, serotonin syndrome, tachycardia.

Treatment of overdose: gastric lavage, taking enterosorbents ; if serotonin syndrome corrective therapy with Cyproheptadine . It is recommended to monitor cardiac activity along with the prescription of symptomatic treatment.

Interaction

Due to the risk of serotonin syndrome, the drug should not be used together with MAO and for another two weeks after stopping taking MAO inhibitors.

Co-administration with potential CYP1A2 and CYP1A2 enzymes may cause an increase in drug levels.

Caution should be used when used together with other drugs that affect the nervous system, including alcohol.

In rare cases, when used simultaneously with other serotonin uptake inhibitors and serotonergic drugs, may occur .

Caution should be exercised when using Cymbalta with drugs metabolized by the CYP2D6 enzyme system.

Concomitant use with anticoagulants may provoke bleeding associated with pharmacodynamic interactions.

Cymbalta®

Exacerbation of manic/hypomanic state.

As with similar drugs that affect the central nervous system, duloxetine should be used with caution in patients with a history of manic episodes.

Epileptic seizures.

As with similar drugs that act on the central nervous system, duloxetine should be used with caution in patients with a history of epileptic seizures.

Mydriaz.

Cases of mydriasis have been observed when taking duloxetine, so caution should be exercised when prescribing duloxetine to patients with elevated intraocular pressure or in individuals at risk of developing acute angle-closure glaucoma.

Increased blood pressure.

In isolated cases, a rise in blood pressure was observed during treatment with duloxetine. In patients with arterial hypertension and/or other cardiovascular diseases, it is recommended to measure blood pressure.

Impaired liver or kidney function.

In patients with severe renal impairment (creatinine clearance <30 ml/min) or severe liver failure, increased plasma concentrations of duloxetine are observed.
If duloxetine is clinically justified in such patients, lower initial doses of the drug should be used. Suicidal behavior.
The risk of committing suicide exists in all patients with depression and some other mental disorders. This danger may persist until remission occurs. As a result, patients at greatest risk of committing suicide should be under close medical supervision during pharmacotherapy. As well as taking other drugs that have a mechanism of pharmacological action similar to duloxetine (SSRIs, SNRIs), taking duloxetine during treatment or upon its cessation in a number of cases was associated with the development of suicidal thoughts and suicidal behavior. Duloxetine has not been studied in patients under 18 years of age and this drug is not intended for use in such patients. A cause-and-effect relationship between taking duloxetine and the occurrence of suicidal events in patients of this age group has not been established. However, some analytical reviews of the results of a number of studies using antidepressants for the treatment of mental disorders indicate an increased risk of developing suicidal thoughts and/or suicidal behavior in children, adolescents and adults under 25 years of age compared with placebo. Clinicians should encourage patients to report any disturbing thoughts and feelings at any time.

Increased risk of bleeding.

SSRIs and SNRIs, including duloxetine, may increase the risk of bleeding, including gastrointestinal bleeding (see section "Side effects"). Therefore, duloxetine should be prescribed with caution to patients taking anticoagulants and/or drugs that affect platelet function (eg, NSAIDs, aspirin) and to patients with a history of bleeding.

Hyponatremia.

Very rarely, cases of hyponatremia have been reported (in some cases, serum sodium levels were lower than 110 mmol/l). Most of these cases occurred in elderly patients, especially in combination with a recent history of altered fluid balance or in the presence of conditions predisposing to altered fluid balance.

Hyponatremia may manifest as nonspecific symptoms (such as dizziness, weakness, nausea, vomiting, confusion, drowsiness, lethargy). Signs and symptoms seen in more severe cases included fainting, falls and seizures.

Monoamine oxidase inhibitors (MAOIs).

Severe reactions, sometimes fatal, have been reported in patients taking a serotonin reuptake inhibitor in combination with a MAOI, including pyrexia, rigidity, myoclonus, peripheral disturbances with possible dramatic fluctuations in vital signs, and mental status changes including marked agitation with transition to delirium and coma. These reactions have also been observed in patients who were discontinued with a serotonin reuptake inhibitor shortly before being prescribed an MAOI. In some cases, patients experienced symptoms consistent with neuroleptic malignant syndrome. The effects of combined use of duloxetine and MAOIs have not been evaluated in humans or animals. Therefore, given the fact that duloxetine is a reuptake inhibitor of both serotonin and norepinephrine, it is not recommended to take duloxetine in combination with an MAOI or for at least 14 days after stopping treatment with an MAOI. Based on the length of the half-life of duloxetine, you should wait at least 5 days after stopping duloxetine before taking an MAOI.

Increased activity of liver enzymes.

Some patients treated with duloxetine in clinical studies experienced increased liver enzyme activity. The observed deviations were, as a rule, transient in nature and disappeared spontaneously or after discontinuation of duloxetine. Serious increases in liver enzyme activity (10 times or more above the upper limit of normal), as well as liver damage of cholestatic or mixed origin, were rare, and in some cases were associated with excessive alcohol consumption or pre-existing liver disease. It is recommended to use duloxetine with caution in patients who drink significant quantities of alcohol, as well as with existing liver disease.

Analogs

Level 4 ATC code matches:
Pipofezin

Bethol

Incazan

Melitor

Azafen

Miaser

Velafax

Mirtazonal

Venlaxor

Remeron

Venlafaxine

Lerivon

Mirtazapine

Velaxin

Coaxil

Pyrazidol

Deprim

Gelarium Hypericum

Negrustin

Trittico

Duloxetine Canon, Alventa, Velaxin, Venlift, Gelarium Hypericum, Deprim Forte, Coaxil, Melitor, Mirazep, Neuroplant, Trittico.

Cymbalta price, where to buy

Buying Cymbalta 30 mg No. 14 in Russia will cost 880-970 rubles.

In Ukraine, the price of this form of release starts from 750 hryvnia.

Online pharmacies in RussiaRussia

ZdravCity

Cymbalta capsules 60 mg 14 pcs. Lilly del Caribe Inc./Lilly S.A.
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Cymbalta capsules 30 mg 14 pcs. Lilly del Caribe Inc. /Lilly S.A
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Cymbalta capsules 60 mg 28 pcs. Lilly del Caribe Inc. /Lilly S.A
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