What is the Cost of Duloxetine?

Millions of Americans are affected by common health conditions like major depressive disorder, generalized anxiety disorder, fibromyalgia, chronic low back pain, and diabetic neuropathy.

For people suffering from one or more of these conditions, it might be hard to believe that one medication can treat all of these conditions at once, but it’s true.

Duloxetine is a medication with many different applications for a variety of both physical and mental health conditions, but what is the cost of duloxetine? 

What is Duloxetine?

Duloxetine, which is perhaps more well known under the brand name Cymbalta, is a drug belonging to a class of medications called selective serotonin norepinephrine reuptake inhibitor antidepressants (SNRIs).

SSNRIs are commonly used to treat mental health conditions that include depression and anxiety.

The medication was first approved by the U.S. Food and Drug Administration (FDA) in August 2004 for the treatment of depression, and it quickly became extremely popular in the United States. 

An estimated 16.5 million prescriptions were written for duloxetine in 2017, making it the 46th most popularly prescribed drug in the United States. In order to preserve its integrity, duloxetine should be stored at room temperature. 

What is Duloxetine Used to Treat?

The initial FDA approval in 2004 for duloxetine was for the treatment of clinical depression or major depressive disorder. In subsequent years, the medication has been approved to treat several other physical and mental health conditions, including general anxiety disorder (GAD) in adults and children who are at least seven years old, diabetic neuropathy, chronic muscle or joint pain, and fibromyalgia.

A brief explanation of each of these conditions and their associated symptoms is provided below.

Clinical Depression/Major Depressive Disorder

Major depressive disorder, also known as clinical depression, is a mental health condition that is  identified by feelings of sadness that are persistent, intense, and last for extended periods of time, usually at least two weeks or more.

Clinical depression impacts people’s mood and behaviors but also manifests itself in physical ways through changes to sleep and appetite.

It is common for people with major depressive disorder to lose interest in hobbies or activities that they once enjoyed, experience difficulty performing daily tasks, and experience suicidal thoughts or behaviors. 

An estimated seven percent of American adults experience an episode of major depressive disorder each year, making it one of the most common mental health issues.

The following symptoms are commonly associated with major depressive disorder:

• Difficult concentrating and low energy
• Sleeping and eating more or less than usual
• Feeling sad, empty, or tearful
• Mood swings
• Nervous energy
• Feelings of moving or thinking in slow motion
• Suicidal thoughts or behaviors
• Feelings of worthlessness, guilt, hopelessness, or helplessness
• Lost of interest in activities you used to enjoy

Generalized Anxiety Disorder

Our bodies naturally respond to stress in the form of anxiety, which is defined by fear or apprehension about what is to come.

Although all people experience anxiety at some point in their lives, anxiety becomes a mental health issue when feelings of anxiety last longer than six months, are extreme in nature, and begin to interfere with your life. People with generalized anxiety disorder, or GAD, often cannot pinpoint the source or reason for their anxiety and frequently recognize that their feelings are irrational; however, they are unable to control them.

Symptoms commonly associated with generalized anxiety disorder may culminate in a panic attack and can include rapid breathing, restlessness, an increased heart rate, trouble concentrating, and difficulty falling asleep.

A more acute form of anxiety, called an anxiety attack or panic attack, has symptoms that include dry mouth, sweating, chills or hot flashes, feeling faint or dizzy, shortness of breath,apprehension and worry, restlessness, distress, fear, numbness or tingling.

Fibromyalgia

Fibromyalgia is somewhat of a medical mystery. This chronic condition is defined by unexplainable chronic musculoskeletal pain that occurs all over the body for no obvious reason.

In addition to pain that occurs all over the body, fibromyalgia symptoms also include mood issues, fatigue, sleep issues, memory issues, tension headaches, temperomandibular joint (TMJ) disorders, depression, irritable bowel syndrome (IBS), and anxiety.

Although researchers are not exactly sure what causes fibromyalgia, it is believed that the condition is caused by the brain improperly processing pain signals and amplifying painful sensations, altering the function of the central nervous system. People sometimes first experience fibromyalgia following an episode of physical trauma or significant psychological stress, while others find that their symptoms build slowly over time.

Diabetic neuropathy

Patients with diabetes who are unable to control their high blood sugar can experience complications of the disease that include a type of nerve damage called diabetic peripheral neuropathic pain.

Diabetic neuropathy occurs as a result of damage to the nerves in the body, particularly in the legs and feet, caused by long term uncontrolled high blood sugar levels.

Symptoms of diabetic neuropathy can range from blood vessels and heart problems to pain and numbness in the legs and feet to digestive issues or urinary tract problems. 

What is the Cost of Duloxetine?

Duloxetine is a generic medication, but it is also available as Cymbalta, the brand name medication.

Like most medications, Cymbalta is substantially more expensive than the generic form of the drug, duloxetine.

As a generic drug, duloxetine is covered by most Medicare and insurance plans, but patients may be able to find the drug at a cheaper price by using a pharmacy discount card or coupon or paying the cash price.

The following table compares the costs of a 30 day supply of Cymbalta and duloxetine.

Costs of a 30-Day Supply of Cymbalta and Duloxetine

	Cymbalta	Duloxetine
20 mg oral capsules	$243.72	$46.18
30 mg oral capsules	$277.60	$18.22
60 mg oral capsules	$277.60	$22.94

It is common for SSNRIs like duloxetine to need to be adjusted several times before you find the right dose, so don’t be discouraged if it doesn’t feel perfect right away.

Adults with major depressive disorder typically begin treatment with duloxetine at a dose of 40 mg per day, taken as one 20 mg release capsule twice per day.

Your healthcare provider may choose to increase your dose over time to a maintenance dose of 60 mg per day, taken either as one 30 mg capsule twice per day or one 60 mg capsule taken once daily.

The maximum daily dosage for treatment of major depressive disorder should not exceed 120 mg per day, even if you are off schedule and need to miss your next dose. 

Generalized anxiety disorder in adults is usually treated with a duloxetine dose of one 60 mg capsule per day. As is the case with major depressive disorder, the daily dose for generalized anxiety disorder should not exceed 120 mg per day. 

Elderly patients may be more likely to experience side effects, so they are likely to be prescribed an initial dose of 30 mg.

Children taking duloxetine typically begin treatment at a dose of 30 mg per day before increasing to 60 mg per day, with a maximum of 120 mg per day. 

Patients taking duloxetine for treatment of fibromyalgia or diabetic peripheral neuropathy will generally be prescribed 60 mg taken once per day.

There is no evidence to support that taking a dose higher than 60 mg per day yields any additional benefit to the patient.

Duloxetine can cause withdrawal symptoms when the dosage of the medication is changed or stopped abruptly, particularly in patients who have been taking the medication for more than six weeks.

Therefore, patients should not change their dose of duloxetine or stop taking the medication without consulting with their doctor. Withdrawal symptoms resulting from duloxetine are so common that there is a syndrome called Cymbalta Withdrawal Syndrome named after the brand name version of the medication.

Cymbalta Withdrawal Syndrome has a high likelihood of occurrence and can be experienced even when discontinuing the medication under the guidance of your doctor.

However, withdrawing from duloxetine under a doctor’s medical can help to reduce your symptoms and allow your doctor to manage your symptoms appropriately.

You should seek medical advice if you experience symptoms of duloxetine withdrawal, which include:

• Irritability
• Insomnia
• Dizziness
• Drowsiness or fatigue
• Increased sweating
• Paresthesias
• Seizures
• Electrical shock sensations
• Nausea
• Vomiting
• Vivid nightmares
• Feelings of anxiety
• Malaise
• Muscle spasms or tremors
• Headache
• Depressive symptoms

Are There Any Side Effects Associated With Duloxetine?

Possible side effects of duloxetine generally fall into two categories: common and less common. Common side effects associated with duloxetine include:

• Constipation
• Abdominal Pain or Stomach Pain
• Tremor
• Dry mouth
• Nausea
• Muscle weakness
• Low blood pressure
• Weight loss
• Excessive sweating
• Vomiting
• Loss of appetite
• Tiredness or sleepiness
• Skin rash
• Lightheadedness
• Bruising Easily

Less common adverse effects that may occur in long-term users of duloxetine include:

• Sexual dysfunction
• Frequent urination
• Colitis
• Liver disease or damage in individuals who mix the medication with alcohol

Some potential drug interactions between the use of duloxetine hydrochloride and the following over the counter and prescription drugs may exist: non-steroidal anti-inflammatory drugs (NSAIDs), tricyclic antidepressants, antipsychotics including thioridazine, other SNRIs including venlafaxine, selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine, fluvoxamine, and paroxetine due to increased risk of serotonin syndrome, monoamine oxidase inhibitors (MAO inhibitors/MAOIs) including methylene blue, phenelzine, tranylcypromine, and isocarboxazid, antibiotics such as linezolid, and St. John’s Wort. 

References, Studies and Sources: 

https://clincalc.com/DrugStats/Drugs/Duloxetine

https://www.webmd.com/drugs/2/drug-91490-2114/duloxetine-oral/duloxetine-sprinkle-capsule-oral/details

https://www.drugs.com/duloxetine.html

https://medlineplus.gov/druginfo/meds/a604030.html

https://www.mayoclinic.org/drugs-supplements/duloxetine-oral-route/description/drg-20067247

https://www.health.harvard.edu/a_to_z/major-depression-a-to-z