Does Cymbalta cause blood thinning? (+5 factors)

This article will discuss whether Cymbalta causes blood thinning. Moreover, in this article, we will explore Cymbalta’s effects on blood clotting and what factors can contribute to Cymbalta’s effects on blood thinning. We will also mention the precautions that should be taken while using Cymbalta and available alternatives to Cymbalta if it causes blood thinning.

Does Cymbalta cause blood thinning?

Yes, Cymbalta may cause blood thinning and increase the risk of bleeding. While Cymbalta is not classified as a traditional blood thinner like aspirin and warfarin, it can slightly increase the risk of bleeding.

Cymbalta is not typically associated with blood-thinning effects and bleeding risk is considered low for most individuals. However, individual responses to Cymbalta can vary widely.

Cymbalta is an antidepressant that belongs to the class of serotonin-norepinephrine reuptake inhibitors (SNRIs). It primarily affects serotonin and norepinephrine levels in the brain to alleviate symptoms of depression and anxiety. Cymbalta doesn’t directly thin blood, but it can indirectly increase the risk of bleeding through different mechanisms.

Cymbalta’s minor effects on blood thinning can be desirable in certain situations, as it helps prevent dangerous blood clots from forming. However, Cymbalta can interact with blood-thinning medications and increase the risk of bleeding. (1)

It’s important to always inform your doctor about all the medications you take, including over-the-counter drugs and supplements. Your doctor can assess your situation, considering your individual risk factors and other medications, including blood thinners, to determine if Cymbalta is safe for you to take.


How does Cymbalta impact blood clotting?

Cymbalta can impact blood clotting factors through complex and indirect pathways. While it doesn’t significantly alter the levels of these factors themselves, it can slightly influence the process of platelet aggregation, potentially increasing the risk of minor bleeding in some individuals.

Here is a breakdown of how Cymbalta may affect blood clotting (2,3):

Platelet aggregation 

Cymbalta can weakly inhibit the clumping of platelets, which are tiny blood cells crucial for clot formation. As an SNRI, Cymbalta can reduce platelets’ ability to stick to both collagen and fibrinogen, blood clotting factors. This can slightly hinder the platelets’ ability to seal wounds and stop minor bleeding, leading to potential increased risks of:

  • Bruising
  • Nosebleeds
  • Cuts and scrapes take longer to heal
  • Gum bleeding

Neurotransmitter interactions

Cymbalta increases the levels of serotonin and norepinephrine in the brain and increases their availability in the synapse. While the exact mechanisms are still being researched, these two neurotransmitters can influence platelet activation and blood vessel tone, contributing to a higher risk of bleeding. 

Studies indicate that decreased intracellular serotonin is a main contributing factor for increasing the risk of bleeding in some individuals taking antidepressants. This neurotransmitter interaction can cause a widening in blood vessels, increasing the bleeding risk from injuries. 

Medication interactions

Combining Cymbalta with other blood thinners or medications affecting platelet function, such as non-steroidal anti-inflammatory drugs (NSAIDs), can significantly increase the bleeding risk. These medications work together synergistically, amplifying the overall impact on platelet function and clot formation.

When NSAIDs and Cymbalta are taken together, the risk of gastrointestinal bleeding is significantly increased.

 In addition to direct blood thinners, even certain antibiotics, antifungals and herbal supplements can interact with Cymbalta, either affecting its metabolism or impacting platelet function. While the bleeding risk from these interactions is generally low, it’s still important to be aware of the possibility.


What does the research suggest?

Studies combining and analyzing findings from multiple trials indicate a statistically significant increase in bleeding risk associated with Cymbalta. While less common, individual cases of more serious bleeding complications with Cymbalta have been reported.

A study of 170 post-marketing cases reported bleeding during Cymbalta therapy. Gastrointestinal bleeding was the most common location, but bleeding also occurred in other parts of the body, ranging from minor bruising to fatal gastrointestinal hemorrhage.

In addition, among 51 hospitalizations linked to Cymbalta therapy, 33 were reportedly due to bleeding events. 12 involved patients were using anticoagulants, aspirin or NSAIDs. The research identified cases of platelet dysfunction, prolonged blood clotting time and thrombocytopenia, suggesting potential hematological complications. (4)

Individual variability in response to medication makes it difficult to predict bleeding risk with absolute certainty. Further research is needed to fully understand the mechanism by which Cymbalta influences bleeding.



What factors can contribute to Cymbalta’s effects on blood thinning?

Cymbalta can increase bleeding risk through several factors. Factors affecting any potential impact of Cymbalta on blood thinning could include the following (3):

  • Dosage: Higher Cymbalta doses lead to increased medication concentration as a result leading to a stronger effect on platelets.


  • Underlying medical conditions: Liver or kidney disease, bleeding disorders, or recent surgery can exacerbate the bleeding risk while taking Cymbalta.


  • Age and gender: Older adults and females might be more susceptible to bleeding complications.


  • Genetic variability: Some individuals possess genetic variations affecting platelet function or drug metabolism, making them more sensitive to Cymbalta’s bleeding effects.


  • Medication interactions: Using Cymbalta concurrently with blood thinners like aspirin, heparin or warfarin, as well as NSAID medications affecting platelets such as ibuprofen, naproxen and celecoxib, or other antidepressants like sertraline and citalopram, may have potential interactions.


  • Lifestyle factors: Alcohol consumption and smoking can significantly impair platelet function and increase the risk of bleeding while using Cymbalta.



What precautions should be taken while using Cymbalta?

To avoid Cymbalta’s blood thinning effects, precautions are vital. Here are some steps you can take to minimize the risk:

  • Open communication with your doctor: Make sure to disclose your complete medical history, including any bleeding disorders, recent surgery, kidney or liver conditions. Report any changes in your health or bleeding episodes you experience to your doctor immediately.


  • Dosage adjustment: Your healthcare provider may start with the lowest effective dose and then adjust the dosage. Higher doses can increase the risk of bleeding.


  • Avoid combining with other blood thinners: Inform your doctor about all the medications you take, especially anticoagulants, NSAIDs or other medications that affect clotting. Your doctor might recommend alternative medications or adjust your Cymbalta dosage.


  • Be mindful of alcohol and smoking: Excessive alcohol can impair platelet function and smoking damages blood vessels, both enhancing bleeding risk with Cymbalta.


  • Monitor for bleeding signs: Potential bleeding symptoms include easy bruising, nosebleeds, gum bleeding, blood in urine or stool, unusual headaches and cuts taking longer to heal.


  •  Stay hydrated: Maintain good hydration to support healthy blood flow and platelet function.


  • Avoid activities with high-risk injury: Be cautious during activities prone to cuts or bruises, like contact sports or vigorous exercise.



What are the alternative antidepressants available if Cymbalta causes blood thinning?

Determining the most suitable antidepressants for avoiding blood thinning problems is challenging, as individual factors and medication interactions play a significant role. While some antidepressants have a lower risk of bleeding compared to others, there is no single universally safe option.

Alternative antidepressant considerations may include:

  • Selective serotonin reuptake inhibitors (SSRIs): They are generally considered to have a low risk of bleeding, with options like sertraline (Zoloft) and escitalopram (Lexapro) potentially showing slightly lower risk compared to others.


  • Tricyclic antidepressants (TCAs): TCAs, such as amitriptyline or nortriptyline, are generally not associated with blood-thinning problems. However, they do have other potential side effects and considerations.


  • Atypical antidepressants: These include bupropion (Wellbutrin) and mirtazapine (Remeron). They can have minimal impact on platelet function and do not directly thin blood. However, they can elevate blood pressure, potentially increasing bleeding risk in some individuals.

Always discuss your individual risk factors and concerns with your healthcare providers. They can assess your situation and recommend the most appropriate antidepressant based on your needs and potential bleeding risks.

It’s important to note that you must avoid switching or stopping medication on your own. Abruptly stopping antidepressants can have more serious consequences. (5)



In summary, Cymbalta can cause blood thinning. Although the risk of bleeding associated with Cymbalta is considered to be low, individual risk factors and medication interactions can exacerbate bleeding side effects. I strongly recommend open communication with your doctor and careful monitoring to ensure the safe and effective use of Cymbalta.


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Perahia DG, Bangs ME, Zhang Q, Cheng Y, Ahl J, Frakes EP, Adams MJ, Martinez JM. The risk of bleeding with duloxetine treatment in patients who use nonsteroidal anti-inflammatory drugs (NSAIDs): analysis of placebo-controlled trials and post-marketing adverse event reports. Drug Healthc Patient Saf. 2013 Nov 25;5:211-9.


Lozano PA, Alarabi AB, Garcia SE, Boakye ET, Kingbong HT, Naddour E, Villalobos-García D, Badejo P, El-Halawany MS, Khasawneh FT, Alshbool FZ. The Antidepressant Duloxetine Inhibits Platelet Function and Protects against Thrombosis. Int J Mol Sci. 2022 Feb 26;23(5)


Clinical Management of Bleeding Risk With Antidepressants, Alexandra L. Bixby, PharmD. Amy VandenBerg, PharmD, BCPP, and Jolene R. Bostwick, PharmD, BCPS, BCPPView all authors and affiliations.Volume 53, Issue 2.

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