Does Trazodone interact with Cymbalta? (3+ precaution)
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 the interaction between Trazodone and Cymbalta. We will also discuss the research studies on the use of Trazodone and Cymbalta together. Additionally, we will talk about the side effects associated with the use of this combination and how to use Trazodone and Cymbalta safely and effectively.
Does Trazodone interact with Cymbalta?
Yes, Trazodone can interact with Cymbalta. Trazodone and Cymbalta are the antidepressants which act by increasing the levels of serotonin in the body. A high dose of this drug combination can cause serotonin syndrome. (1,2)
Serotonin syndrome is a life-threatening condition, and its symptoms can vary from mild (nausea, vomiting) to severe (seizures, high blood pressure, etc). (3) Trazodone is used in combination to treat insomnia caused by Cymbalta, and a high dose of Trazodone can cause an increase in the levels of serotonin.
If you notice any negative changes in your behaviour, altered mental status, tremors, seizures, nausea, vomiting, etc., consult your physician for proper management and do not stop taking the medication suddenly, as it can cause withdrawal symptoms.
What does the research suggest?
Serotonin syndrome was reported in a 59-year-old patient who was being treated with Trazodone 100 mg for insomnia and Cymbalta 60mg for depression. She underwent a liver biopsy procedure for hepatitis. After 10 minutes of the procedure, she developed abdominal and chest pain, following which she was administered fentanyl. (4)
After 5 minutes of receiving fentanyl, she became agitated and hypertensive. She was admitted to the intensive care unit for observation. When a thorough assessment was made, the physicians found a possible interaction between fentanyl, duloxetine and trazodone, which led to serotonin syndrome. (4)
What are the benefits of taking Trazodone with Cymbalta?
Trazodone is an antidepressant which is used to treat depression, anxiety, insomnia and other sleep-related disorders. Cymbalta is also an antidepressant of class serotonin-norepinephrine reuptake inhibitor (SNRI), which helps treat symptoms of depression, anxiety, fibromyalgia and chronic pain. (1,2)
The use of Cymbalta is associated with the side effect of insomnia (reduced sleep), and Trazodone is prescribed to help manage insomnia associated with the use of Cymbalta. In addition to that, Trazodone can also help treat symptoms of depression and gives an additive effect in managing mood-related symptoms and anxiety. (1,2)
Taking this combination comes with a risk, as an increased dose of these antidepressants can put you at risk of serotonin syndrome. Hence, it is important to follow your healthcare provider’s instructions and take the medication as prescribed. If you want to stop taking the drug, make sure you consult your physician, as drugs like Trazodone and Cymbalta require careful tapering before discontinuation.
What are the alternatives to Trazodone and Cymbalta?
Suppose you are experiencing any unwanted changes after taking Trazodone and Cymbalta together, which is affecting your day-to-day activities. In that case, you can choose to switch to other antidepressants, such as:
- SSRIs: citalopram, escitalopram, fluoxetine, paroxetine, sertraline.
- SNRIs: venlafaxine, milnacipran, desvenlafaxine, levomilnacipran
- Tricyclic antidepressants: amitriptyline, amoxapine, nortriptyline, imipramine.
- Atypical antidepressants: bupropion, mirtazapine.
- Monoamine oxidase inhibitors (MAOIs): isocarboxazid, selegiline.
If you have been prescribed Trazodone to manage insomnia, you can choose other drugs which help treat insomnia, such as benzodiazepines (triazolam, estazolam, temazepam), Non-benzodiazepines (zolpidem, zaleplon), melatonin agonist (ramelteon), orexin receptor antagonist (suvorexant), antihistamine (diphenhydramine).
How to use Trazodone and Cymbalta safely and effectively?
There are a few measures to follow in order to use Trazodone and Cymbalta safely and effectively, such as
- If you have been prescribed Cymbalta and Trazodone together, take Cymbalta in the morning and Trazodone in the evening.
- If you forgot to take a dose of the drug, take it as soon as you remember, only if the time gap between the next dose is more.
- Do not take a double dose of the drug, as it can cause overdose and increase the risk of serotonin syndrome.
- Look out for any unwanted changes in your behaviour, as Trazodone can increase suicidal thoughts.
- Monitor for any unwanted side effects while consuming Trazodone and Cymbalta.
- Do not miss a dose or stop taking the drug suddenly, as it can cause withdrawal symptoms and worsen your condition.
- If you accidentally take Trazodone in the morning, don’t engage in any activities such as driving, handling heavy machinery, etc.
In my opinion, as a pharmacist, taking Trazodone and Cymbalta together can be beneficial if you have antidepressant-induced insomnia. However, the dose of these drugs should be managed carefully in order to avoid serotonin syndrome. If you are experiencing any unwanted side effects, make sure you consult your physician.
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References
1.-
Shin JJ, Saadabadi A. Trazodone. [Updated 2022 Jul 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470560/
2.-
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/
3.-
Simon LV, Keenaghan M. Serotonin Syndrome. [Updated 2023 Jul 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482377/
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