| As with other antidepressants, Cymbalta has been associated with cases of clinically significant hyponatremia (seeHyponatremia, under PRECAUTIONS ). Postmarketing reports indicate that transaminases, bilirubin and alkaline phosphatase have occurred in patients with chronic liver or cirrhosis. For this reason, Cymbalta should ordinarily not be prescribed for patients with use. Liver transaminase elevations resulted in the discontinuation of 0? Pediatric Use Safety and effectiveness in the pediatric population have not been established ( see BOX WARNING and WARNINGSClinical Worsening and Suicide Risk). Such monitoring should include daily observation by families caregivers. Symptom Checker To check symptoms start here. Visit WebMD for additional health information on anxiety and depression. g. , hyperreflexia, incoordination) and/or gastrointestinal symptoms (e. Some cases presented features resembling neuroleptic malignant syndrome. Anyone the use of Cymbalta in a child or adolescent must balance the potential risks with the clinical need. Such complications can arise immediately upon delivery. Of the 1074 patients in the DPN premarketing studies, 33% (357) were 65 years of age or over. with these diagnoses were generally excluded from clinical studies during the product’s premarketing testing. At the highest 200 mg BID dose, the increase in mean rate was 5. g. Of the 1074 patients in the DPN studies, 33% were 65 years of age or over. In placebo-controlled clinical trials, seizures/convulsions occurred in 0. Learn more about bipolar mania. There has been a long-standing concern that antidepressants may have a role in inducing worsening of depression and the emergence of suicidality in certain patients. At the highest 200 mg BID dose, the increase in mean pulse rate was 5. Post-weaning growth and reproductive performance of the progeny not affected adversely by maternal duloxetine treatment. , agitation, hallucinations, coma), autonomic instability (e? Screening Patients for Bipolar Disorder A major depressive episode may be the initial presentation of bipolar disorder? g. 8 bpm and increases in mean blood pressure were 4. The average risk of such events in patients receiving antidepressants was 4%, twice the placebo risk of 2%. There was considerable variation in risk among drugs, but a tendency toward an increase for almost all drugs studied. It should be noted that Cymbalta is approved use in treating bipolar depression. The risk of blood decreases may be greater in patients taking concomitant medications that induce orthostatic hypotension (such as antihypertensives) or are potent CYP1A2 inhibitors (see CLINICAL PHARMACOLOGY , Drug-Drug Interactions, and PRECAUTIONS , DRUG INTERACTIONS ) and in taking at doses above 60 mg daily. In three clinical trials of Cymbalta for the management of neuropathic pain associated with diabetic peripheral neuropathy , the mean duration of diabetes was approximately 12 years, the mean baseline fasting blood glucose was 176 mg/dL, and the mean baseline hemoglobin A 1c (HbA 1c ) was 7. |