Does Cymbalta cause orthostatic hypotension?(+5 factors)

In this article, we will discuss the orthostatic hypotension caused by Cymbalta. We will also discuss the research studies suggesting a link between the use of Cymbalta and orthostatic hypotension. Additionally, we will explore the risk factors for Cymbalta-induced orthostatic hypotension and its management. 

Does Cymbalta cause orthostatic hypotension?

Yes, Cymbalta can cause orthostatic hypotension. While orthostatic hypotension is not a frequently reported side effect of Cymbalta, research studies have demonstrated that it occurred in some individuals taking this medication for depression.

Cymbalta is an antidepressant medication, which is commonly known as duloxetine. It works by increasing the levels of serotonin and norepinephrine in the brain. The elevated levels of these neurotransmitters are responsible for the therapeutic benefits of Cymbalta. It is frequently prescribed in the management of depression, anxiety, fibromyalgia, and pain (1). 

While Cymbalta is generally considered a well-tolerated and safe medication, with a lower incidence of serious side effects reported in clinical settings, it can cause some adverse effects such as nausea, vomiting, dizziness, fatigue, and cardiovascular complications in some individuals (1).

What does research suggest?

According to research, Cymbalta has the potential to induce orthostatic hypotension in susceptible individuals. A study revealed that 6% of patients experienced this side effect after taking Cymbalta for depression (3).

In a research study conducted on geriatric patients, Cymbalta was administered at a dosage of 60mg for the management of depression. The findings revealed that Cymbalta was generally well-tolerated, with a lower incidence of serious side effects observed among the patients. However, it was noted that 16% of the participants experienced orthostatic hypotension (2).

Another study indicates a potential association between Cymbalta and orthostatic hypotension in older adults with Major Depressive Disorder. The observation was made over a 6-month study, suggesting a need for attention to this cardiovascular effect during Cymbalta treatment in the geriatric population (3).

What factors can influence Cymbalta-induced orthostatic hypotension?

Several factors may increase the risk of orthostatic hypotension while taking Cymbalta. These factors may include:

Individual sensitivity: Individual responses to medications like Cymbalta, may differ from one person to another. Individual sensitivity to Cmbalta may increase the risk of occurrence of various side effects of this medication, including orthostatic hypotension. 

Underlying cardiovascular disorders: Individuals with underlying cardiovascular diseases such as arrhythmias, bradycardia, and heart failure may experience difficulties in maintaining adequate blood pressure upon standing. These medical conditions increase the risk of orthostatic hypotension in individuals taking Cymbalta.

Concurrent medications: Concomitant use of medications such as beta-blockers, diuretics, or certain antidepressants with Cymbalta doubles the risk of developing orthostatic hypotension. This heightened risk is attributed to the fact that these medications themselves can potentially induce orthostatic hypotension as a side effect.

High dosage: A low dosage of Cymbalta is less likely to induce side effects in individuals as compared to a higher dosage which increases the likelihood of experiencing several side effects of Cymbalta, including orthostatic hypotension.

Physical activity: Physical activity involves changes in body position, including standing up, walking, and exercising. These movements can potentially exacerbate the blood pressure-lowering effects of medications, increasing the likelihood of orthostatic hypotension.

What to do if Cymbalta causes orthostatic hypotension?

If you experience unusual sudden lightheadedness or near-fainting episodes upon standing up after taking Cymbalta, consult your healthcare provider. Your healthcare provider may analyze your symptoms and check your blood pressure to diagnose orthostatic hypotension. 

Your healthcare provider may identify any risk factors that could be causing your orthostatic hypotension. If it is determined that the side effects of Cymbalta are causing your symptoms, your healthcare provider may recommend adjusting your dosage to reduce the incidence of these side effects.

If there are risk factors present such as drug interactions or underlying medical conditions, your healthcare provider may prescribe an alternative medication or treat the medical conditions first to remove these factors.

If Cymbalta is the only cause of severe and persistent orthostatic hypotension, your healthcare provider may suggest discontinuing the medication and prescribing an alternative that is less likely to cause orthostatic hypotension.

However, it is important to understand that the decision to discontinue Cymbalta should only be made by your healthcare provider. You should not stop taking this medication suddenly without consulting your doctor because abrupt discontinuation of Cymbalta can lead to discontinuation syndrome that may have potentially serious adverse effects.

What are alternatives to Cymbalta if it causes orthostatic hypotension?

Alternatives to Cymbalta that have a lower risk of causing orthostatic hypotension in individuals with underlying risk factors may include (4,5,6):

• fluoxetine
• nortriptyline 
• amitriptyline 

 However, it is essential to note that, although these medications are less likely to cause orthostatic hypotension compared to Cymbalta, they are associated with other side effects that can be more serious than orthostatic hypotension.

In my opinion, the decision to opt for an alternative medication should be based on a careful evaluation of the risks and benefits of therapy. If the benefits of treatment with Cymbalta outweigh its risks, it is recommended to continue the medication and manage adverse effects symptomatically.

References