Cymbalta, the brand name of duloxetine, is a prescription drug classified as an antidepressant. It belongs in the drug category called the serotonin norepinephrine reuptake inhibitors because it actively works on serotonin and norepinephrine, which are chemicals found in the brain. The medication prevents these chemicals from being reabsorbed and allows them to continue to work in the brain. Cymbalta is used to treat major depressive disorder, generalized anxiety disorder, management of fibromyalgia and diabetic neuropathic pain. Pregnant patients should discuss the use of Cymbalta with a physician prior to therapy.
Categorization
Cymbalta is classified as pregnancy category C due to the effects seen in animal studies. The "Drug Information Handbook" states that these adverse effects include decreased fetal weight and behavioral effects, such as an increase in the startle response to noise. Adequate and well-controlled studies in pregnant women have not been performed; use during pregnancy is recommended only when benefits outweigh the risks.
Use During Third Trimester
The use of selective norepinephrine reuptake inhibitors, such as Cymbalta, late in the third trimester may lead to side effects on the baby. According to RxList.com, clinical findings indicate that the side effects on the baby may include difficulty breathing, difficulty feeding, seizures, vomiting, tremor, jitteriness, irritability and constant crying. These may be due to toxic effects or to drug discontinuation symptoms. The patient should be tapered off the medication during the third trimester.
Discontinuing Therapy
Women who plan to get pregnant may discontinue the medication if they have mild or no symptoms for six months or longer. Those with a history of severe, recurrent depression should continue therapy. Pregnant women who are not experiencing symptoms of depression may stop the medication after a consultation with a psychiatrist, states the American Congress of Obstetricians and Gynecologists. Women with a history of recurrent depression are at a high risk of relapse and should discuss benefits versus risks with a health care professional. Pregnant women with severe depression should not stop the medication.
Delivery
The effects of Cymbalta on delivery in humans are not known. Although the medication may cause side effects in the baby, the medication may be used during labor or delivery if the benefits outweigh the risks to the baby.
Breast-Feeding
Cymbalta enters breast milk and may be passed on to the baby. According to the "Drug Information Handbook," the safety of the drug in infants is unknown and, therefore, women should not breastfeed while on the medication. However, if the patient must continue therapy, she does not require a dosage adjustment because breastfeeding does not change the effects of the medication. The patient may choose to not breastfeed to avoid toxicity effects or side effects in the baby.
References
- "Drug Information Handbook"; Charles F. Lacy, Lora L. Armstrong, et al.; 2009
- RxList.com: Cymbalta
- American Congress of Obstetrcians and Gynecologists: Depression During Pregnancy--Treatment Recommendations
