Interaction Between Cymbalta (Duloxetine) & Elavil (Amitriptyline)

In our latest question and answer, our pharmacist discusses the potential interaction between Cymbalta (duloxetine) & Elavil (amitriptyline).

Nov 28, 2017

Kimmy6i asked

Can I safely take Cymbalta 60mg, gabapentin 1800 mg, Norco 7.25 3.25mg, Lyrica 225mg and generic Elavill 25mg as prescribed for fibromyalgia gad panic disorder and depression?


There are a few drug interactions that you should be aware of regarding your medication list.

The first, and most serious, is the interaction between Cymbalta (duloxetine) & Elavil (Amitriptyline). Both of these drugs can increase the neurotransmitter serotonin, potentially causing serotonin syndrome. While rare, serotonin syndrome is serious and is characterized by a variety of symptoms including an increase in blood pressure, rigidity, mental status changes and hyperthermia. You are taking a relatively low dose of Elavil  but the risk is there and is important to be aware of. It isn't necessarily uncommon to take this combination of drugs, but is good to know so you can avoid other serotonergic drugs such as the popular over the counter cough medicine dextromethorphan.

The other major concern is the potential sedation caused by all of these medications. Cymbalta, gabapentin, Norco (hydrocodone/acetaminophen), Lyrica and Elavil are all associated with sedation and CNS depression. If these are all new medications, you may experience pronounced sedation and you need to be aware of how these medications may affect you. 

The symptoms of fibromyalgia are often extremely difficult to live with and a combination of medication is often used for treatment, so your situation is fairly common. If you feel you are experiencing any negative side effects, be sure to speak with your doctor. In addition, always be sure to check with your pharmacist or doctor before adding on any over the counter medications.

Lastly, if these medications are prescribed by different doctors, make sure they all have an up to date list of your medications so they can adjust your therapy as needed.

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