Does Cymbalta cause liver problems? (+5 factors)
By
Ivan Kahwa
Author bio
Mr Ivan Kahwa is a chemist and phytopharmaceutical scientist with expertise in chemistry, pharmacology, phytochemistry, and Nanobiotechnology. He writes and reviews content on these topics.
Mr Ivan Kahwa’s Highlights:
Guest Researcher at the University of Leipzig, Senior Research Fellow/Scientist, and Lecturer at the Department of Pharmacy, Faculty of Medicine, Mbarara University of Science and Technology.
Professional Experience:
Mr Ivan joined PHARMBIOTRAC as a research fellow/scientist during his master of science tenure. He contributed to the development of most of the phytopharmaceutical products in the project. Furthermore, he participated in carrying out the pharmacological activities of the developed products in laboratory animals such as mice and rats in order to develop proper doses hence leading to pre-clinical studies.
With the above relevant research experience, Ivan started to work with the University of Leipzig on collaborative projects with Mbarara University to develop the chemistry of Ugandan Medicinal plants and their pharmacological activities. This was coupled with several consultative positions by different German NGOs. Mr. Kahwa is also a supporting in the teaching and learning at the Departments of Pharmacy and Pharmaceutical Sciences, Faculty of Medicine, Mbarara University of Science and Technology.
With the increase in antimicrobial resistance globally, Ivan retooled his thinking towards developing new naturally derived antibiotic regimens from Ugandan propolis with the assistance of nanotechnology to improve their delivery to microbial cells. Kahwa has also published over 28 articles in peer-reviewed journals and he is currently reviewing for many journals.
Education:
2023-2027: PhD in Pharmaceutical Sciences (ongoing) with a focus on Pharmaceutical Microbiology and Nanobiology at Mbarara University of Science and Technology.
2022: 2Msc. in Pharmacognosy and Natural Medicine Science at Mbarara University of Science and Technology.
2018: Bachelor of Science (Chemistry) at Mbarara University of Science and Technology.
Publications:
▪ Iqbal, S., Jabeen, F., Kahwa, I., & Omara, T. 2023. Suberosin Alleviates Thiazolidinedione-Induced Cardiomyopathy in Diabetic Rats by Inhibiting Ferroptosis via Modulation of ACSL4-LPCAT3 and PI3K-AKT Signaling Pathways. Cardiovascular Toxicology. https://doi.org/10.1007/s12012-023-09804-7
▪ Gupta, A. K., Yadav, R., Sharma, S., Sawale, J., & Kahwa, I. 2023. Anti-ageing Activity and Antioxidant Activity of Methanol Extracts of Leaves and Flowers of Salvia officinalis and Rosmarinus officinalis. Journal of Young Pharmacists, 15(3), 448–455. https://doi.org/10.5530/jyp.2023.15.60
▪ Tolo, C.U., Kahwa, I., Nuwagira, U., Weisheit, A. and Ikiriza, H., 2023. Medicinal plants used in treatment of various diseases in the Rwenzori Region, Western Uganda. Ethnobotany Research and Applications, 25, pp.1-16.
https://ethnobotanyjournal.org/index.php/era/article/view/4683
▪ Kahwa, I., Ajayi, C.O., Yadav, R., Chauhan, N.S., Shah, K., Abdelgadir, A.A., Shegena, E.A., Daniel, S., Omara, T., Asiimwe, J.B. and Ikiriza, H., 2023. Pharmacognostic and phytochemical studies as an invaluable approach for correct identification of medicinal plants: The case of Artemisia vulgaris L. substituted for Artemisia annua L. in Western Uganda. TMR Integr Med, 7, p.e23004.
https://doi.org/10.53388/TMRIM202307004
▪ Nalimu, F., Oloro, J., Kahwa, I. and Ogwang, P.E., 2021. Review on the phytochemistry and toxicological profiles of Aloe vera and Aloe ferox. Future Journal of Pharmaceutical Sciences, 7, pp.1-21.
https://doi.org/10.1186/s43094-021-00296-2
▪ Elamin, O.H.S., Ali, M.A., Elgezuli, I.A.A., Bashir, M.A. and Kahwa, I., 2021. Diagnosis of pre-and post-treatment of echinococcus granulosus with counter current immune electrophoresis and bacterial co-agglutination. Journal of Microbiology and Infectious Diseases, 11(02), pp.88-94.
https://doi.org/10.5799/jmid.951600
Published book Chapter
▪ Kahwa, I., Ayesiga, I., Nakalema, S., Alinaiswe, R., Mbabazi, R. and Iqbal, S., 2023. Natural products in the management of onchocerciasis. In Natural Products in Vector-Borne Disease Management (pp. 63-80). Academic Press. Book Chapter.
https://doi.org/10.1016/B978-0-323-91942-5.00012-4
Submitted manuscripts Under Review:
▪ Comparison of the Wound Healing Activity of the Leaf and Leaf Ash Extracts of Vernonia amygdalina in Rats. Journal name: Clinical Phytoscience
▪ Ethnobotanical Survey of Medicinal plants used in the management of cancer in Uganda. Journal name: Journal of Herbal Medicine
▪ Ethnobotanical survey and phytochemical screening of medicinal plants used in treatment of epilepsy by PROMETRA-Uganda Traditional Health Practitioners in Mpigi District, Uganda. Journal name: Journal of Ethnopharmacology
Submitted book chapters under review
1.Book title: Algae as a Natural Solution for Water-Food-Energy Nexus, Section 4: Microalgae and cyanobacteria for food applications, Chapter 4.6: Safety, toxicological and allergenic aspects of using algae for food. Authors: Christine Kyarimpa, Tom Omute, Caroline K. Nakiguli, Alice V. Khanakwa4, Christopher Angiro, Ivan Kahwa, Fortunate Ahumuza, Timothy Omara*. Publisher: Springer Nature Singapore Pte Ltd. 152 Beach Road, #21-01/04 Gateway East, Singapore 189721, Singapore.
2.Book title: Nutraceuticals Inspiring the Contemporary Therapy for Lifestyle Diseases. Chapter: Nutraceutical applications of Seaweeds and their Phytocompounds in Nutrition and Treatment of Diseases. Authors: Ivan Kahwa, Timothy Omara , Innocent Ayesiga , Gael Noel Neh Neba Ambe , Zehbanaz Javidbhai Panwala , Rachel Mbabazi , Shabnoor Iqbal , Christine Kyarimpa , Christine Betty Nagawa , Kamal Shah ,Nagendra Singh Chauhan* Publisher: CRC Press
You can view my works on the following professional sites:
Research Gate: https://www.researchgate.net/profile/Ivan-Kahwa
Google Scholar: https://scholar.google.com/citations?user=tOwrvqoAAAAJ&hl=en
ORCID: https://orcid.org/0000-0002-6440-3437
Linkedin: https://de.linkedin.com/in/ivan-kahwa-865450159
In this article, we will discuss whether Cymbalta causes liver problems. We will also explore research studies linking the use of Cymbalta to the occurrence of liver issues. Additionally, we will discuss the factors that may increase the risk of liver problems while taking Cymbalta and explore alternatives to Cymbalta if it does cause liver problems.
Does Cymbalta cause liver problems?
Yes, Cymbalta can cause liver problems. However, the risk of liver issues is higher with a high dosage of Cymbalta and in the presence of underlying liver diseases. Cymbalta is metabolized by the liver, which may increase the burden on the organ; however, the exact mechanism of liver injury caused by Cymbalta is unknown.
Cymbalta is an antidepressant medication frequently employed in the management of various health conditions. It is used to treat fibromyalgia, depression, anxiety, and its associated symptoms. The mechanism behind its therapeutic effects may involve its interference with serotonin and norepinephrine in the brain (1).
While the side effects of Cymbalta are not typically serious, it may cause certain side effects in the initial phase of treatment, including headaches, drowsiness, sleep disturbances, gastrointestinal discomfort, and fatigue (1).
What does research suggest?
According to research, Cymbalta is most likely to cause liver injury in patients with underlying risk factors such as a higher dosage of Cymbalta and underlying liver diseases.
A research study reported that the use of Cymbalta in patients with pre-existing liver diseases resulted in liver problems in more than 80% of patients, including jaundice and elevated levels of liver enzymes (2).
Another research study found that liver problems occurred in a patient when the dosage of Cymbalta was increased from 30 mg daily to 60 mg daily. In this case, the patient was advised to stop taking the medication, and Effexor was prescribed. After the discontinuation of Cymbalta, the liver functions returned to normal after a few months (3).
However, the same research study reported another case where jaundice occurred in a patient with no history of liver diseases who was using Cymbalta (3).
What factors may increase the risk of Cymbalta-induced liver problems?
Several factors may increase the risk of liver problems while taking Cymbalta. These factors may include:
History of liver diseases: Pre-existing liver diseases in individuals, such as jaundice, hepatitis, and cirrhosis, elevate the risk of hepatic injury when using Cymbalta. Healthcare providers generally avoid prescribing Cymbalta to individuals with underlying liver diseases.
Higher dosage: The risk of liver injury with Cymbalta is also higher with increased medication dosage, as reported in research studies where the higher dosage of Cymbalta induced liver problems in individuals (3).
Concurrent medications: Concurrently using Cymbalta with medications known to potentially cause liver injury, such as isoniazid, sulphonamides, and metronidazole, raises the risk of serious liver problems (4).
Use of alcohol: Consuming alcohol with Cymbalta is likely to amplify the medication’s side effects, including liver injury, as both alcohol and Cymbalta can burden the liver and contribute to subsequent liver injury.
Individual factors: Individuals vary in their sensitivity to Cymbalta, increasing the risk of side effects, including liver problems, in certain cases. Genetic factors and old age are also potential contributors to an elevated risk of these side effects.
What to do if Cymbalta causes liver problems?
If you experience any symptoms of liver problems such as dark urine or abdominal pain after using Cymbalta, it is crucial to consult your healthcare provider immediately.
They will assess your condition and may recommend liver function tests to determine the cause of your symptoms. If the liver injury is associated with underlying risk factors, your healthcare provider will work to address these factors first.
If the current dosage of Cymbalta is deemed likely to cause severe liver injury, your healthcare provider may adjust the dosage to prevent the worsening of symptoms. In cases where even the lower dosage of Cymbalta causes liver problems, your healthcare provider may suggest discontinuing the medication and switching to another antidepressant that is less likely to cause liver problems.
However, it’s important to note that the discontinuation of Cymbalta should be done only under the guidance of your healthcare provider, as a sudden discontinuation of medications like Cymbalta may lead to withdrawal effects.
What are the alternatives to Cymbalta if it causes liver problems?
Alternatives to Cymbalta are prescribed in conditions where Cymbalta causes severe and unbearable side effects in individuals, including liver damage. Medications with a lower risk of causing liver damage compared to Cymbalta may include (5):
- fluoxetine
- desvenlafaxine
- sertraline
- citalopram
- escitalopram
However, the selection of an appropriate medication should be based on the individual’s overall health status and underlying medical conditions. It’s important not to make a decision to switch medications without consulting your healthcare provider, as it may worsen your symptoms.
In my opinion, Cymbalta is more likely to cause liver problems in individuals with a history of liver disease or when combined with other medications that affect the liver. However, in any case, if you experience any symptoms of liver problems, you should consult your healthcare provider to prevent the worsening of your condition.
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References
1.-
Dhaliwal JS, Spurling BC, Molla M. Duloxetine. [Updated 2023 May 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK549806/
2.-
Vuppalanchi R, Hayashi PH, Chalasani N, Fontana RJ, Bonkovsky H, Saxena R, Kleiner D, Hoofnagle JH; Drug-Induced Liver Injury Network (DILIN). Duloxetine hepatotoxicity: a case-series from the drug-induced liver injury network. Aliment Pharmacol Ther. 2010 Nov;32(9):1174-83. doi: 10.1111/j.1365-2036.2010.04449.x. Epub 2010 Sep 3. PMID: 20815829; PMCID: PMC3773985. https://pubmed.ncbi.nlm.nih.gov/20815829/
3.-
Kang SG, Park YM, Lee HJ, Yoon B. Duloxetine-induced liver injury in patients with major depressive disorder. Psychiatry Investig. 2011 Sep;8(3):269-71. doi: 10.4306/pi.2011.8.3.269. Epub 2011 Aug 10. PMID: 21994516; PMCID: PMC3182394. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3182394/
4.-
Francis P, Navarro VJ. Drug-Induced Hepatotoxicity. [Updated 2022 Nov 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557535/
5.-
Menon V, Ransing R, Praharaj SK. Management of Psychiatric Disorders in Patients with Hepatic and Gastrointestinal Diseases. Indian J Psychiatry. 2022 Mar;64(Suppl 2):S379-S393. doi: 10.4103/indianjpsychiatry.indianjpsychiatry_18_22. Epub 2022 Mar 23. PMID: 35602369; PMCID: PMC9122174. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9122174/
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