Cymbalta (Duloxetine) Overdose: Signs, Precautions, & Treatment

Symptoms of a Cymbalta Overdose

The amount of Cymbalta required to overdose may vary depending on an individual’s weight, age, and overall health, with any amount over the prescribed amount increases the risk of an overdose. Overdose symptoms can present in the form of many different side effects to watch out for.

Early signs may include sudden dizziness or lightheadedness, nausea, vomiting, excessive sweating, and a rapid heartbeat. These can quickly progress into more severe symptoms including but not limited to difficulty breathing, seizures, loss of consciousness, or a serious condition known as serotonin syndrome. Initial symptoms may present quickly and should be treated as soon as possible with severe symptoms setting in after only a couple of hours.²

Some common signs and symptoms of a Cymbalta overdose may include: 1

• Dizziness or lightheadedness
• Drowsiness
• Nausea or vomiting
• Rapid heart rate or palpitations
• Agitation
• Confusion
• Sweating
• Tremors

Serious symptoms of a Cymbalta overdose may include: 1

• Seizures or convulsions
• Loss of consciousness or coma
• Respiratory depression or difficulty breathing
• Cardiac arrhythmias or irregular heart rhythms
• Serotonin Syndrome
• Hallucinations or delirium
• Severe gastrointestinal distress

What Can Cause a Cymbalta Overdose?

A Cymbalta overdose can occur when an individual takes a dose of the medication that is harmful to the body. This may happen either slowly over time or quickly by taking too much of the drug or by taking it in combination with other substances that can interact with it.

Taking More Than the Prescribed Dosage

This can happen accidentally, for example, if an individual simply forgets they have already taken their daily dose and takes another. Alternatively, an overdose may also be intentional, such as when someone feels that their symptoms are not improving fast enough and takes more than the prescribed amount. Or when someone is misusing or abusing a medication with the intention of causing self-harm.

Taking Cymbalta with Other Substances

Taking Cymbalta with other substances, such as alcohol or other medications that can affect serotonin levels, can increase the risk of overdose and result in rare but serious health complications. Substances and medications may affect how your body processes Cymbalta, potentially causing an increased effect, resulting in an overdose. These can manifest in the form of Serotonin Syndrome with other antidepressants and pain medications that alter serotonin or potential liver damage when paired with alcohol.¹

Cymbalta and alcohol are both potential depressants that may affect the central nervous system and increase depression symptoms. This combination may also result in liver damage, as both Cymbalta and alcohol are processed in the liver.

Taking Cymbalta with Other Medications

Taking Cymbalta with other medications can increase the risk of serious side effects. It is important to discuss all medications and substances they may be taking with their provider before taking Cymbalta to ensure safe and effective use.

These also include other prescriptions, herbal or supplement products, and other over-the-counter medications. A provider may need to adjust the dose of Cymbalta or other medications for an individual’s safety or even switch to a different medication altogether.

Medications that can increase the risk of a Cymbalta overdose when taken together include:¹

• Pain medications including opioids and tramadol: Medications that affect the reuptake of serotonin, such as pain medications, can increase the risk of serotonin syndrome, a rare but potentially life-threatening condition. Opioids can also increase sedation and lead to respiratory depression.
• Migraine medications: Medications such as triptans, often used for the treatment of chronic and acute migraines may also increase the risk of serotonin syndrome by increasing serotonin.
• Benzodiazepines: Benzodiazepines like Lorazepam paired with Cymbalta may also increase sedation, drowsiness, and confusion, leading to respiratory depression.
• Monoamine oxidase inhibitors: MAOIs and Cymbalta both work to increase the amount of serotonin available, resulting in an increased risk of serotonin syndrome. The use of duloxetine within 14 days of an MAOI is contraindicated.
• Other antidepressant medications: Doubling up on medications that affect serotonin levels, such as antidepressants, can also increase the risk of serotonin syndrome due to excess serotonin. These include selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and tricyclic antidepressants (TCAs).

Can a Cymbalta Overdose Cause Complications?

A Cymbalta overdose is often rare, with the max daily dose of 120 mg being far below the average amount needed for an overdose to occur.¹ But through the combination of other substances it may be more likely to occur. While overdose is rare with this medication, recovery is expected with proper medical treatment as long as it is sought out as soon as the overdose may be expected. Recovery primarily depends on quick access to treatments that may include the use of temperature control intubation, oxygenation, ventilation, monitoring of cardiac and other vital signs, gastric lavage, and giving activated charcoal.¹

Serotonin Syndrome

Overdosing on Cymbalta can lead to a buildup of serotonin in the form of a condition known as serotonin syndrome. Serotonin syndrome can be a severe side effect of Cymbalta and can be fatal in some cases. The severity and duration of serotonin syndrome can depend on various factors. With symptoms appearing within a few hours and lasting from 24 hours to several days.²

Symptoms of serotonin syndrome include:³

• Hallucinations
• Agitation
• Fast heart rate
• Heavy sweating
• Muscle spasms and rigidity
• Overactive reflexes
• Vomiting
• Fever
• Coma
• Seizures

Cymbalta Overdose Symptoms Vs. Side Effects

It can be challenging to distinguish between an overdose and side effects from Cymbalta. Cymbalta can cause side effects even at safe doses, and these side effects can be mild to severe. Side effects usually appear within the first few weeks of treatment and can last for several weeks.

In contrast, symptoms of an overdose usually appear within a few hours of ingestion and can be more severe and life-threatening. If you experience side effects that do not go away, it is essential to discuss them with your healthcare provider.

Common Side Effects of Cymbalta

Cymbalta is a medication commonly prescribed to treat symptoms of anxiety and depressive disorders. At clinical doses, Cymbalta has been shown to effectively improve depression and anxiety symptoms for many individuals. However, like many medications, it can cause side effects, which are not necessarily a sign of overdose. While not severe, these side effects may still require medical attention.

Common side effects of Cymbalta include:¹

• Nausea
• Dry mouth
• Dizziness
• Headaches
• Drowsiness
• Fatigue
• Constipation
• Loss of appetite

Seeking Professional Help for a Cymbalta Overdose

If you suspect that you or someone you know has overdosed on Cymbalta, it’s crucial to seek emergency medical attention immediately. For overdoses, the National Poison Control Center can provide assistance and guidance 24 hours a day, seven days a week, and can be reached at 1-800-222-1222. They can offer advice on what steps to take, including whether medical attention is necessary, and what steps to take while waiting for emergency services to arrive.

In the case of a severe Cymbalta overdose, calling 911 or your local emergency services is essential. The emergency responders can provide life-saving care on the way to the hospital if needed. It’s crucial to provide them with as much information as possible, including the amount ingested, and any other medications or substances taken to ensure that they can provide the most effective care.

Here is information important to share when seeking treatment for a Cymbalta overdose:

• Individual’s name and age
• Location of the person affected
• What the normal dose of their medication is
• What substances they have taken in addition to Duloxetine
• What doses of each they have taken
• What side effects and symptoms they are exhibiting
• Any other prescribed medications the individual takes regularly
• If possible, information on allergies they have and their blood type

Cymbalta Overdose Treatment

If someone has overdosed on Cymbalta, emergency treatment will depend on the severity of the symptoms and what symptoms are present. Once at the emergency room, doctors might administer activated charcoal to absorb any remaining medication in the digestive tract and may provide medications to counteract other side effects. They will also monitor vital signs, provide intravenous fluids to keep them hydrated, and keep them under observation until their condition stabilizes.¹

It’s important to note that in the case of a suspected overdose, seeking emergency medical attention is always the safest option. Poison control may be able to offer guidance, but ultimately, the decision on whether to seek medical attention should be made based on the severity of the symptoms. The length of stay in the hospital will depend on the severity of the overdose and how long it takes for the individual’s symptoms to subside.²

Emergency treatment for an overdose on Cymbalta might include:¹

• Use of activated charcoal up to 6 hours after ingestion to absorb ingested toxins within the gastrointestinal tract preventing the systemic absorption of that toxin⁴
• Use of cyproheptadine for the treatment of nausea, vomiting, and dizziness in serotonin syndrome
• Temperature control intubation to maintain a specific body temperature for recovery in serotonin syndrome
• Oxygenation and ventilation to maintain airways safely
• Monitoring of cardiac and other vital signs for any changes or developments
• Use of a gastric lavage to empty the stomach and decontaminate the gastrointestinal tract

Next Steps After an Overdose

After receiving treatment for an overdose, it’s crucial to follow up with a healthcare provider to monitor any lasting effects and prevent future overdoses. It’s important to discuss any concerns or questions with a healthcare provider, such as changing the medication or dosage. Patients should not suddenly stop Cymbalta, and instead, taper off the medication if needed.

For preventing future overdoses, additional precautions may be necessary, such as keeping medication in a secure location and avoiding the use of other interacting substances. For those who intentionally overdosed, the provider may recommend therapy or counseling to address underlying mental health concerns and reduce the risk of future attempts. It’s essential to seek help and support to prevent future overdoses and address any underlying issues.

If the Overdose on Cymbalta was Unintentional

Recovery from an overdose often involves consulting with a provider about how to proceed with a medication and monitoring for potential complications. It is not recommended to abruptly discontinue Cymbalta. In the event of an unintentional overdose, the patient should slowly taper off the medication in favor of another alternative or continue the Cymbalta at a lower dose under the guidance of a physician. Safe alternatives may include SSRIs for depression and anxiety or Gabapentin for neuropathy.⁵

Next steps to consider after an unintentional Cymbalta overdose include:

• Take medication as prescribed: It is essential to follow the prescription directions, attend follow-up appointments and report any concerning symptoms.
• Consult with your psychiatrist: Dealing with the aftermath of an unintentional overdose may be challenging. Consult with your psychiatrist and seek counseling for help coping with your experience.
• Consider alternative treatments: If Cymbalta is not suitable for you due to a history of overdose or other concerns, alternative treatments such as therapy or other medications may be considered.
• Avoid other medications or substances that may cause an overdose: It is crucial to avoid other medications and substances that may contribute to Cymbalta overdose such as alcohol, opioids, or other antidepressants.

If the Overdose of Cymbalta Was Intentional

In the event of an intentional overdose, additional intervention may be needed to assist the individual. Underlying mental health concerns may require the patient to seek additional help or adjust their medication to an option that may be safer for them based on their history. Alternative therapy options such as cognitive behavioral therapy or non-drug therapy options may be recommended to help manage their depression or anxiety.

Next steps to consider after an intentional Cymbalta overdose include:

• Seek psychotherapy: Since intentional overdoses may be associated with underlying mental health issues, it’s essential to seek support in treating symptoms that may trigger suicidal thoughts or self-harming behaviors.
• Consult your provider or psychiatrist: It’s important to follow the medical advice given by healthcare professionals, which may include hospitalization, monitoring, and other treatments to best aid the individual.
• Avoid drug and alcohol use: It is crucial to avoid other medications and substances that may contribute to Cymbalta overdose such as alcohol, opioids or other antidepressants.
• Consider alternative treatments: If Cymbalta is not suitable for the individual due to a history of overdose or other concerns, alternative treatments such as therapy or other medications may be considered.

In My Experience

In my personal experience as a pharmacist, it’s important for individuals to always be aware of their medications and involved in their own health. Being knowledgeable of each prescribed medication, how much you are taking, and how often you take it goes a long way in safe medication use and preventing overdoses. When an individual knows their medications inside and out, there is much less concern for accidental overdoses or dangerous combinations leading to one.

In the case of Cymbalta specifically, there is concern for the potential of serotonin syndrome, which is a rare but important condition to be knowledgeable of with the increasing prevalence of medications that affect serotonin levels. It’s also very important to follow your doctor’s recommendations and guidance in the event of any changes to your regimen. When an overdose does present itself, it is always best to err on the side of caution and seek help immediately if you or someone else notices something doesn’t seem right.

For Further Reading

• Cymbalta (Duloxetine) Withdrawal: Symptoms, Duration, & How to Cope
• Cymbalta For Anxiety: Effectiveness, Dosage, & More
• Mayo Clinic: Serotonin Syndrome
• National Poison Control Center
• CDC: Drug Overdose