Sandra asked
I am taking Cymbalta 30 mg due to sciatica in the morning. I have been on Elavil 50 mg at night for tinnitus, is this safe?
Answer
Cymbalta (duloxetine) and Elavil (amitriptyline) do have a major drug interaction and should be used together with extreme caution. Although not contraindicated to take together, taking Elavil and Cymbalta increases the risk of serotonin syndrome.
Serotonin syndrome is the name given to a certain group of symptoms that can occur with the use of serotonergic drugs (i.e. drugs that increase serotonin). The symptoms can range from mild to severe and include but are not limited to the following:
- Hyperthermia
- Shaking/tremors
- Nausea
- Vomiting
- Agitation
- Delirium
- Confusion
- Rapid heart rate
- Coma
In addition to the risk of serotonin syndrome, Cymbalta is an inhibitor of the metabolizing enzyme CYP2D6, which metabolizes Elavil. Therefore, Elavil concentrations can be increased when taken with Cymbalta, increasing the risk of side effects.
It should be noted that sometimes Elavil is given in a low does for treatments other than depression (such as for insomnia and tinnitus). The risk of the interaction with Cymbalta is certainly lower when taken with low doses of Elavil but not eliminated. It is important to be aware of the risks of taking the drugs together as well as the side effects to look out for. Be sure to report any adverse effects to your doctor.
