Debbie asked
What is a safe natural sleep aid to take with Cymbalta?
At a glance
- Most natural sleep aids aren't known to interact with Cymbalta (duloxetine).
- However, since Cymbalta can cause sedation and dizziness on its own, combining it with a sleep aid can enhance these effects.
- One well-documented interaction with Cymbalta is with L-tryptophan, a serotonin precursor. Taking L-tryptophan with Cymbalta increases the risk of a rare, but serious condition known as serotonin syndrome.
Answer
There is such a variety of 'natural' sleep aids over the counter that it is difficult to give a definitive statement regarding which are safe to take with Cymbalta (duloxetine) and which are not.
Additionally, since so many products marketed for sleep contain more than one ingredient, it can be a challenge to discern the overall safety of a particular product.
What we can do, however, is take a look at a few specific herbals and other 'natural' over the counter products and see if they are known to interact with Cymbalta.
Overall, most appear to be relatively safe to use, but it is important to point out that Cymbalta itself can have side sedative side effects. It is also known to cause dizziness and difficulty concentrating.
Therefore, mixing Cymbalta with a product intended to make you tired can have additive effects in this regard, so it is important to keep this in mind.
Below, I take a look at some of the top-selling 'natural' products for sleep and whether or not they are known to interact with Cymbalta. These products include:
- Valerian
- L-tryptophan
- Melatonin
- Lemon Balm
- Kava
Valerian
Valerian is one of the top-selling natural supplements in the United States, consistently ranking in the top 10 in terms of sales.
While it has a variety of purported effects, it is often used for the treatment of anxiety symptoms and insomnia.
How valerian works isn't completely understood, but its relaxation effects are thought to be due to it acting as an agonist on GABA receptors.
GABA is an inhibitory neurotransmitter and when bound to GABA receptors, produces a variety of effects, including sedation and relaxation.
There are a variety of prescription drugs that work on GABA receptors, including:
- Benzodiazepines (e.g. diazepam, lorazepam)
- Topamax (topiramate)
- Ambien (zolpidem)
- Lunesta (eszopiclone)
Valerian is not known to interact with Cymbalta, aside from the fact that both can cause sedation and drowsiness.
Valerian may have some effect on certain serotonin receptors (5-HT1), but this isn't thought to be overly significant.
Even though Cymbalta can increase serotonin concentrations, there likely isn't any significant interaction here. Valerian has not been reported to interact with other drugs that affect serotonin.
L-Tryptophan
L-tryptophan is widely used as a natural sleep aid. It is an essential amino acid (meaning we need to consume via our diet) and is commonly associated as the compound in turkey that makes people tired.
The purported sedative effects of l-tryptophan aren't simply anecdotal. Studies show that L-tryptophan may decrease sleep latency (i.e. time it takes to fall asleep), but more studies are needed to fully elucidate its effects.
In terms of taking L-tryptophan with Cymbalta, there is a potentially dangerous interaction here, and they shouldn't be used together in most cases since L-tryptophan is a serotonin precursor.
Our body absorbs tryptophan from dietary sources (including supplementation), converts it to 5-hydroxytryptophan (5-HTP), and then to serotonin (5-hydroxytryptamine).
Cymbalta, an SNRI (serotonin-norepinephrine reuptake inhibitor), works partly by increasing serotonin concentrations in the brain.
The prescribing information for Cymbalta warns against its use with other serotonergic agents and specifically, tryptophan:
References
- Cymbalta Prescribing Information. AccessFDA
- Mediterranean Journal of Nutrition and Metabolism. Springer
- Kava Health Information. NIH
- Valerian for Sleep: A Systematic Review and Meta-Analysis. PubMed
- Sales of Herbal Dietary Supplements in US Increased 7.5% in 2015 Consumers spent $6.92 billion on herbal supplements in 2015, marking the 12th consecutive year of growth. HerbalGram
- L-Tryptophan: Basic Metabolic Functions, Behavioral Research and Therapeutic Indications. PubMed
- Influence of Tryptophan and Serotonin on Mood and Cognition with a Possible Role of the Gut-Brain Axis. PubMed
- Melatonin for Treatment of Sleep Disorders: Summary. NIH
- Melatonin: In Depth. NIH
- Kava for the treatment of generalised anxiety disorder (K-GAD): study protocol for a randomised controlled trial. PubMed
