Can Cymbalta and Strattera be taken together? (3+ risks)

In this article, we will answer the question “Can Cymbalta and Strattera be taken together?”. We will discuss the possible risks of using both these medications simultaneously. We will also discuss what alternative treatment options are available.

Can Cymbalta and Strattera be taken together?

Yes, Cymbalta and Strattera can be taken together but with immense caution. Both medications tend to cause common side effects which can aggravate when they are used simultaneously. Your doctor may prescribe this combination only in conditions where the benefits outweigh the risks.

Cymbalta (Duloxetine) is an antidepressant belonging to the class of serotonin and norepinephrine reuptake inhibitors (SNRIs) used for depressive illnesses, fibromyalgia, and chronic pain conditions (1).

Strattera (Atomoxetine) is a selective norepinephrine reuptake inhibitor (NRI). It has been approved by the FDA for the treatment of attention deficit hyperactivity disorder (ADHD). It has also been used ‘off-label’ for the treatment of neurogenic orthostatic hypotension and treatment-resistant depression in adults (2,3).

What does research suggest?

Not many research studies have been published assessing the concurrent use of Cymbalta and Strattera. However, the very few that have been published have mixed reviews on this combination.

A case study of a teenager who was prescribed Atomoxetine and Duloxetine for the treatment of ADHD with generalised anxiety disorder (GAD), reported the development of takotsubo cardiomyopathy (broken heart syndrome) due to the potential interactions between both medications (4).

Another study assessed the drug-drug interactions between medications used for ADHD and found a potential interaction between Atomoxetine and Duloxetine. The metabolism of Atomoxetine is through the CYP2D6 enzymatic pathway whereas Duloxetine is a moderate inhibitor of the same enzyme. This increased the response of Atomoxetine but also increased the possibility of adverse events (5).

What are the benefits of using Cymbalta and Strattera together?

Combining Cymbalta and Strattera may have the following potential benefits:

Enhanced efficacy

Using both medications together can increase the efficacy of both agents. Duloxetine is an inhibitor of the enzyme responsible for the metabolism of Atomoxetine. When used together the concentration of Atomoxetine increases which can lead to enhanced efficacy of the medication.

Diverse action on symptoms

Cymbalta and Strattera both impact neurotransmitters. When combined they can cause a more diverse action on symptoms and in turn help with the depressive illness under treatment.

What are the potential risks of combining Cymbalta and Strattera?

Cymbalta and Strattera can be used in combination but their concurrent use requires intense monitoring. This is due to the reason that the combination can cause the following side effects:

Serotonin Syndrome

Although Strattera has more selectivity for the presynaptic norepinephrine transporter it also has a weak affinity for the serotonin transporter. When it is combined with Cymbalta, there is a risk of the individual developing serotonin syndrome. You should watch out for side effects like agitation, confusion, restlessness, insomnia, dilated pupils and changes in heart rate and blood pressure.

If you are taking both Cymbalta and Strattera, and you experience any of these side effects make sure to contact your healthcare provider regarding your symptoms.

Elevated blood pressure and heart rate

Both Cymbalta and Strattera cause an increase in blood pressure and heart rate. If these medications are prescribed simultaneously, the elevation in heart rate and blood pressure can be so intense that they may require external intervention to bring it down to a normal level.

If your healthcare provider has prescribed both Cymbalta and Strattera, you will be advised to keep a check on your blood pressure and heart rate and ask for medical assistance if it increases above a certain level.

Increased effects on the central nervous system

Both medications act on the central nervous system (CNS) to produce their desired responses. This mechanism is in favour of the individual receiving treatment. However, sometimes the effects of the CNS increase to such an extent that they may cause a problem in day-to-day activities.

Cymbalta and Strattera both tend to cause sedation and drowsiness which may become uncomfortable for the patient receiving concurrent therapy for their condition.

Increased side effects of Strattera

As Cymbalta inhibits the enzyme responsible for the metabolism of Strattera, the concentration of Strattera can increase within the body. This has a beneficial effect on the illness being treated and it also can cause the side effects of the medication to increase.

How to ensure safe and effective use of Cymbalta and Strattera?

When using Cymbalta and Strattera together, you can ensure the safe and effective use of both medications by considering the following points:

Take medications as prescribed

You should take the same medications, in the same dosages and for the same time duration as prescribed by your healthcare provider. Making changes to your prescription can cause harmful effects.

Monitor your symptoms

When using the combination of Cymbalta and Strattera together, you should keep a close check on your symptoms and look out for any emerging side effects.

Go for follow-ups

Do not miss any regular follow-ups with your healthcare provider. These routine check-ups are necessary to monitor your condition and symptoms.

Avoid alcohol

Alcohol tends to increase the side effects of both Cymbalta and Strattera. So, it is advised to limit your intake or completely avoid alcohol while taking Cymbalta and Strattera.

What to do if Cymbalta and Strattera cause side effects?

If the combination of Cymbalta and Strattera causes side effects and does not help your condition you can do the following things:

Consult your healthcare provider

First and foremost, you should consult your healthcare provider regarding your condition. You should tell your doctor about all your symptoms. Your doctor will assess your situation, find out the underlying cause of your symptoms and advise a proper management strategy.

Alternative treatment options

Many other medications can be used to help with depressive illnesses. Antidepressants like other SNRIs, selective serotonin reuptake inhibitors (SSRIs), and tricyclic antidepressants (TCAs) can help with depression while stimulants can help with ADHD.

You can discuss treatment alternatives for one or both the agents with your healthcare provider and your doctor will prescribe you the best alternative option to manage your condition.

According to the research studies and the information available, the combination of Cymbalta and Strattera is beneficial when it has enhanced efficacy and better management and coverage of the symptom range. But it also comes with potential risks and enhanced side effects.

In my opinion, the combination should be used only on the advice of and under strict supervision of a healthcare provider. Any side effects or changes experienced during the concurrent use should be immediately conveyed to your doctor for proper assessment.

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