Duloxetine is a prescription-only medication first used to treat depression. But we also use duloxetine for chronic pain, including musculoskeletal pain such as osteoarthritis. So what’s the evidence for using duloxetine for arthritis and chronic pain, and how should it be used?
How does duloxetine work for pain?
Duloxetine is a selective serotonin and noradrenaline reuptake inhibitor (SNRI). It increases the levels of two chemical messengers — serotonin and noradrenaline — which produces pain-relieving effects, focused on the pain-carrying nerves in the body.
What conditions does duloxetine treat?
Duloxetine was first marketed as an antidepressant, for its effects on major depression and anxiety. It was later found to be effective in pain conditions such as nerve pain and fibromyalgia, and it also helps musculoskeletal conditions such as knee osteoarthritis and lower back pain.
Duloxetine for osteoarthritis: what is the evidence?
Studies show that duloxetine improves pain from musculoskeletal conditions such as chronic low back pain, knee osteoarthritis, fibromyalgia, and neuropathic (nerve) pain.
A recent review found duloxetine effective for chronic low back pain and osteoarthritis. The optimal dose was 60 mg per day; increasing it to 120 mg per day was associated with more side effects without further benefit.
Compared with other nerve drugs — amitriptyline, pregabalin, or gabapentin — duloxetine was more effective, with a similar or lower side-effect profile. Another study found duloxetine effective for knee, but not hip, osteoarthritis.
Duloxetine doesn’t treat the underlying inflammation — it reduces the sensation of pain. So for a greater effect, it can be combined with anti-inflammatory medications such as ibuprofen or Celebrex.
Side effects of duloxetine for osteoarthritis
Like all medications, duloxetine has side effects, some more common than others.
The more common side effects are gastrointestinal — nausea, dry mouth, reduced appetite, and constipation. Duloxetine can also make you feel anxious or sleepy.
Less common side effects include headaches, dizziness, tiredness, reduced sexual function, and muscle pain or cramping.
These side effects are generally mild and often settle within a few days of starting the medication.
Possible interactions
Some medications can increase or decrease the effect of duloxetine. Speak to your doctor if you take any of the following:
- Blood thinners such as warfarin or aspirin
- Quinolone antibiotics, including ciprofloxacin
- Pain medications such as codeine or morphine
You should also limit alcohol, as studies show combining alcohol with duloxetine can increase the risk of liver damage.
How to take duloxetine for osteoarthritis and other pain
Duloxetine comes as a delayed-release capsule. We usually start with a 30 mg capsule in the morning, then increase to 60 mg if needed.
Avoid chewing, crushing, or opening the capsule, and take it with food to prevent stomach upset.
Frequently asked questions about cymbalta for arthritis
How long does Cymbalta (duloxetine) for arthritis take to work?
Like other nerve drugs, duloxetine doesn’t work immediately. Most people notice a benefit after 2–4 weeks.
How long can you take duloxetine for nerve pain?
We generally recommend taking duloxetine for 3–6 months to treat nerve pain. If it’s helping, it can sometimes be taken for longer, under your doctor’s guidance.
Celebrex vs duloxetine: which is better?
Celebrex is an NSAID — a class of drugs that reduces inflammation — so it’s best used as an anti-inflammatory. Duloxetine, by contrast, reduces the sensitivity of the pain nerves and takes a few weeks to work. The two can be used together to treat musculoskeletal pain.
Can you drink alcohol with duloxetine?
We suggest limiting or stopping alcohol while taking duloxetine, as combining the two may increase the risk of liver damage.
Can you stop duloxetine suddenly?
We advise against stopping suddenly. Stopping abruptly can cause withdrawal effects such as dizziness, nausea, headache, and tiredness. Speak to your doctor about how to reduce and stop the medication safely.
Can I take Tylenol (paracetamol) with Cymbalta for arthritis?
Yes. Tylenol (paracetamol) and Cymbalta (duloxetine) relieve pain through different mechanisms and work well together, so it’s safe to take them at the same time.
Can you combine duloxetine with a knee joint injection for knee arthritis?
Yes. A recent study found that combining duloxetine with a knee injection (cortisone and hyaluronic acid) was more effective than the injection alone.
Final word from Sport Doctor London about Cymbalta for arthritis
Duloxetine is used to treat chronic musculoskeletal conditions such as chronic low back pain, nerve pain, and knee osteoarthritis. It’s generally well tolerated — but as a prescription-only medication, you should always speak to your doctor about adding it to your treatment plan.
If you have arthritis or chronic pain and want to discuss your treatment options, Dr Masci can assess you in London. Contact the team here or call +44 (0) 203 488 0350.
This page is for general information and isn’t a substitute for personal medical advice. Never start, stop, or change a prescribed medication without speaking to your doctor.
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