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Product:

Condition:

Byetta^®
(exenatide) injection Capastat^® Sulfate
(capreomycin for injection, USP) Cialis^®
(tadalafil) Cymbalta^®
(duloxetine hydrochloride) Evista^®
(raloxifene HCl) Forteo^®
(teriparatide [rDNA origin] injection) Lilly Glucagon
(glucagon by injection [rDNA origin]) Humalog^®
(insulin lispro injection [rDNA origin]) Humalog^® Mix50/50™
(50% insulin lispro protamine suspension, 50% insulin lispro injection [rDNA origin]) Humalog^® Mix75/25™
(75% insulin lispro protamine suspension, 25% insulin lispro injection [rDNA origin]) Humulin^®
(human insulin [rDNA origin]) Humatrope^®
(somatropin [rDNA origin] for injection) Prozac^®
(fluoxetine hydrochloride) Quinidine Gluconate Injection, USP
ReoPro^®
(abciximab) Seromycin^®
(cycloserine capsules, USP) Symbyax^®
(olanzapine and fluoxetine hydrochloride) Xigris^®
(drotrecogin alfa [activated]) Zyprexa^®
(olanzapine)

Acute Bipolar Mania Adult Growth Hormone Deficiency Bipolar Depression Diabetes Diabetic Peripheral Neuropathic Pain (DPNP) Erectile Dysfunction Idiopathic Short Stature (ISS) Major Depressive Disorder (MDD) Osteoporosis Pediatric Growth Hormone Deficiency Schizophrenia Severe Sepsis Turner Syndrome

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Cymbalta® (duloxetine HCl) is approved for the treatment of depression and generalized anxiety disorder, and for the management of diabetic peripheral neuropathic pain and fibromyalgia.

Product Information

Clinical Pharmacology and Metabolic Profile^1-3

Cymbalta Metabolism⁴:

Metabolized by CYP2D6 and 1A2
- Coadministration of Cymbalta with potent CYP1A2 inhibitors should be avoided
- Concomitant use of Cymbalta with potent inhibitors of CYP2D6 would be expected to, and does, result in higher concentrations of Cymbalta
Moderate inhibitor of 2D6
Clinically insignificant inhibition of 1A2⁵
No in vitro inhibition of 3A4, 2C9, and 2C19
No in vitro induction of CYP isoenzymes
Coadministration of Cymbalta with other drugs that are extensively metabolized by 2D6 and which have a narrow therapeutic index should be approached with caution (tricyclic antidepressants, phenothiazines, and Type 1C antiarrhythmics)
Cymbalta and thioridazine should not be coadministered

Clinical Pharmacology

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The table shows the effect of these antidepressants on the metabolism of desipramine 50 mg. Desipramine is metabolized by CYP2D6, so the area under the curve (AUC) (desipramine plasma concentration vs time) will be increased by any compound that inhibits CYP2D6. Cymbalta, at 120 mg/day, is intermediate between Prozac and Zoloft in its effects on CYP2D6.^1-3

Prozac is a registered trademark of Eli Lilly and Company. Zoloft is a registered trademark of Pfizer. For important safety information regarding Prozac^® (fluoxetine HCl) and Zoloft^® (sertraline HCl), see their respective package inserts.

References:

Preskorn SH, et al. J Clin Psychopharmacol. 1994;14:90-98.
Sharma A, et al. J Clin Pharmacol. 2000;40(2):161-167.
Skinner MH, et al. Clin Pharmacol Ther. 2003;73(3):170-177.
Cymbalta full Prescribing Information, 2009.
Lobo ED, et al. In vitro and in vivo evaluations of cytochrome P450 1A2 interactions with duloxetine. Clin Pharmacokinet. 2008;47(3):191-202.

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Cymbalta has been added to the Anthem Blue Cross Blue Shield National Preferred Formulary.

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