Buy Duloxetine (Cymbalta) online
How and where to order Cymbalta (Duloxetine Hydrochloride) 20 mg, 30 mg, 40 mg, 60 mg capsules or tablets online:
Indications and usage:
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|Forms:||Cymbalta (Duloxetine HCl) 20 mg, 30 mg, 40 mg, 60 mg tablets or capsules
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Cymbalta (Duloxetine Hydrochloride) is a serotonin and norepinephrine reuptake inhibitor (SNRI) indicated for the treatment of the following conditions:
Major depressive disorder (MDD) in adults.
Generalized anxiety disorder (GAD) in adults and pediatric patients 7 years of age and older.
Diabetic peripheral neuropathic pain (DPNP) in adults.
Fibromyalgia (FM) in adults and pediatric patients 13 years of age and older.
Chronic musculoskeletal pain in adults.
Dosage and administration:
Take Cymbalta once daily, with or without food. Swallow whole; do not crush, chew, or open capsule.
||40 mg/day to 60 mg/day
||Acute treatment: 40 mg/day (20 mg twice daily) to 60 mg/day (once daily or as 30 mg twice daily);
Maintenance treatment: 60 mg/day
||60 mg/day (once daily)
||60 mg/day (once daily)
|GAD Pediatrics (7 to 17 years of age)
||30 to 60 mg/day (once daily)
|FM (2.5) Adults and Pediatrics (13 to 17 years of age)
||60 mg/day (once daily)
|Chronic Musculoskeletal Pain
||60 mg/day (once daily
Discontinuing Duloxetine capsules: gradually reduce dosage to avoid discontinuation symptoms.
Dosage forms and strengths:
Cymbalta (Duloxetine Hydrochloride) delayed-release capsules: 20 mg, 30 mg, 40 mg, 60 mg.
Signs and symptoms
In postmarketing experience, fatal outcomes have been reported for acute Cymbalta overdoses, primarily with mixed overdoses, but also with Duloxetine only, including 1000 mg of Cymbalta (approximately 8.3 times the maximum recommended dosage). Signs and symptoms of overdose (Duloxetine Hydrochloride alone or with mixed drugs) included somnolence, coma, serotonin syndrome, seizures, syncope, tachycardia, hypotension, hypertension, and vomiting.
Management of overdose
There is no specific antidote to a Cymbalta overdosage, but if serotonin syndrome ensues, specific treatment (such as with cyproheptadine and/or temperature control) may be considered. In case of acute overdose with Duloxetine HCl, treatment should consist of those general measures employed in the management of overdose with any drug, such as assuring an adequate airway, oxygenation, and ventilation and monitoring cardiac rhythm and vital signs. Gastric lavage with a large-bore orogastric tube with appropriate airway protection, if needed, may be indicated if performed soon after ingestion or in symptomatic patients. Induction of emesis is not recommended. Activated charcoal may be useful in limiting absorption of duloxetine from the gastrointestinal tract. Administration of activated charcoal has been shown to decrease duloxetine AUC and Cmax by an average of one-third, although some patients had a limited effect of activated charcoal. Due to the large volume of distribution of duloxetine, forced diuresis, dialysis, hemoperfusion, and exchange transfusion are unlikely to be beneficial. In managing overdose, the possibility of multiple drug involvement should be considered. A specific caution involves patients who overdose with Cymbalta and tricyclic antidepressants. In such a case, decreased clearance of the parent tricyclic and/or its active metabolite may increase the possibility of clinically significant sequelae and extend the time needed for close medical observation.
Concomitant use of an MAOI antidepressant with Cymbalta is contraindicated.
Use of Duloxetine pills within 14 days of stopping an MAOI antidepressant is contraindicated.
In linezolid- or intravenous methylene blue-treated patients,initiation of Cymbalta (Duloxetine Hydrochloride) is contraindicated.
Warnings and Precautions:
Increased risk of suicidal thinking and behavior in children, adolescents, and young adults taking antidepressants.
Monitor for worsening and emergence of suicidal thoughts and behaviors.
Hepatotoxicity: hepatic failure, sometimes fatal, has been reported. Discontinue Cymbalta in patients who develop jaundice or other evidence of clinically significant liver dysfunction and should not be resumed unless another cause can be established. Avoid use in patients with substantial alcohol use or evidence of chronic liver disease.
Orthostatic hypotension, falls and syncope: consider dosage reduction or discontinuation if these events occur.
Serotonin syndrome: increased risk when co-administered with other serotonergic agents (e.g., SSRIs, SNRIs, triptans), but also when taken alone. If it occurs, discontinue Duloxetine.
Increased risk of bleeding: may increase the risk of bleedingevents. Concomitant use of antiplatelet drugs and anticoagulants may increase this risk.
Severe skin reactions: severe skin reactions, including erythema multiforme and Stevens-Johnson Syndrome (SJS), can occur; Discontinue at the first appearance of blisters, peeling rash, mucosal erosions, or any other sign of hypersensitivity if no other etiology can be identified.
Activation of mania or hypomania: prior to initiating, screenpatients for personal or family history of bipolar disorder, mania, or hypomania.
Angle-closure glaucoma: has occurred in patients with untreated anatomically narrow angles treated with antidepressants.
Seizures: prescribe with care in patients with a history of seizure disorder.
Blood pressure increases: monitor blood pressure prior to initiating treatment and periodically throughout treatment.
Inhibitors of CYP1A2 or thioridazine: avoid co-administration with Cymbalta (Duloxetine) pills.
Hyponatremia: can occur in association with SIADH; consider discontinuation.
Glucose control in diabetes: in DPNP patients, increases in fasting blood glucose, and HbA1c have been observed.
Conditions that slow gastric emptying: use cautiously in these patients.
Side effects, adverse reactions:
Most common adverse reactions ( >= 5% and at least twice the incidence of placebo-treated patients):
Adults: nausea, dry mouth, somnolence, constipation, decreased appetite, hyperhidrosis.
Pediatric patients: decreased weight, decreased appetite, nausea, vomiting, fatigue, diarrhea.
To report suspected adverse reactions of Cymbalta (Duloxetine Hydrochloride) capsules or tablets, contact Eli Lilly pharmaceutical company or your local FDA.
Potent inhibitors of CYP1A2 should be avoided.
Potent inhibitors of CYP2D6 may increase Cymbalta concentrations.
Duloxetine HCl is a moderate inhibitor of CYP2D6.
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Use in specific populations:
Pregnancy: third trimester use may increase risk for symptoms of poor adaptation (respiratory distress, temperature instability, feeding difficulty, hypotonia, tremor, irritability) in the neonate.
Hepatic impairment: avoid use in patients with chronic liver disease or cirrhosis.
Renal impairment: avoid use in patients with severe renal impairment, GFR < 30 mL/minute.
Where to buy duloxetine online:
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Here is a list of popular medications containing duloxetine as a main active pharmaceutical ingredient; their trade names, forms, doses, companies - manufacturers, distributors, suppliers, researchers and developers:
|Trade name of the drug
||Pharmaceutical forms and doses
||Capsules, Gastro-Resistant; Oral; Duloxetine Hydrochloride 20 mgCapsules, Gastro-Resistant; Oral; Duloxetine Hydrochloride 40 mg
||Eli LillyBoehringer Ingelheim
||Capsules, Delayed Release Pellets; Oral; Duloxetine Hydrochloride 20 mgCapsules, Delayed Release Pellets; Oral; Duloxetine Hydrochloride 30 mgCapsules, Delayed Release Pellets; Oral; Duloxetine Hydrochloride 60 mg
||Eli LillyAspenBoehringer IngelheimDKSHFour StarIcepharmaPhadiscoShionogi & Co.Y.C. WooZuellig Pharma
||Capsules, Delayed Release; Oral; Duloxetine Hydrochloride 40 mgCapsules; Oral; Duloxetine Hydrochloride 20 mgCapsules; Oral; Duloxetine Hydrochloride 30 mgCapsules; Oral; Duloxetine Hydrochloride 40 mgCapsules; Oral; Duloxetine Hydrochloride 60 mg
||Sun Pharmaceutical IndustriesS.J. & G. Fazul Ellahie
||Capsules, Delayed Release; Oral; Duloxetine Hydrochloride 30 mgCapsules, Delayed Release; Oral; Duloxetine Hydrochloride 60 mg
||Capsules, Gastro-Resistant; Oral; Duloxetine Hydrochloride 30 mgCapsules, Gastro-Resistant; Oral; Duloxetine Hydrochloride 60 mg
||Eli LillyBoehringer IngelheimDr. Esteve Laboratorios
||Capsules; Oral; Duloxetine Hydrochloride 30 mgCapsules; Oral; Duloxetine Hydrochloride 60 mg
||Dr. Reddy's Laboratories