Stacey Berger
Cymbalta is a serotonin-norepinephrine reuptake inhibitor (SNRI) drug used to treat anxiety and depression, as well as chronic pain. It is FDA-approved and commonly prescribed to women of childbearing age. However, there is limited information regarding its safety during pregnancy.
While some studies suggest that Cymbalta does not increase the rate of major malformations, others indicate potential adverse effects, including an increased risk of spontaneous abortion and congenital malformations. The FDA categorises Cymbalta as a Category C drug, meaning that it has shown adverse effects in animal studies, but there is a lack of adequate research on its impact on human pregnancies.
Due to the potential risks and limited data, the decision to take Cymbalta during pregnancy is typically made on a case-by-case basis, weighing the benefits against the potential harm to the foetus. It is generally recommended to consult with a healthcare professional to determine the best course of action for managing mental health and pregnancy.
| Characteristics | Values |
|---|---|
| Brand Name | Cymbalta |
| Generic Name | Duloxetine |
| Type of Drug | Serotonin-Norepinephrine Reuptake Inhibitor (SNRI) |
| Used to Treat | Anxiety, Depression, Chronic Pain |
| Pregnancy Safety Rating | Category C |
| Side Effects | Nausea, Dry Mouth, Sleepiness, Fatigue, Constipation, Excessive Sweating, Decreased Appetite |
| Rare but serious side effects: Increased Heart Rate, Irregular Menstrual Cycle, Eye Pain, Severely Elevated Blood Pressure, Difficulty Urinating, Heart Attack | |
| Risk of Birth Defects | 3% chance for all pregnant women |
| Miscarriage Risk | 18% for those taking Cymbalta, 12%-15% for the general population |
| Congenital Malformations | Urinary Tract System, Kidney and Urinary Issues, Clubfoot, Cardiovascular Abnormalities |
| Preeclampsia Risk | 1.12 to 1.67 times more likely for those taking Cymbalta |
| Postpartum Hemorrhage Risk | Slightly higher for those exposed to Cymbalta |
| Neonatal Adverse Reactions | Constant Crying, Feeding Difficulty, Hyperreflexia, Irritability |
| Breastfeeding | Less than 1% of duloxetine is transferred to the infant through breast milk |
What You'll Learn
Cymbalta's effects on fetal development
Cymbalta (duloxetine) is a serotonin-norepinephrine reuptake inhibitor (SNRI) drug used to treat anxiety and depression, and chronic pain. It is not recommended to take Cymbalta during pregnancy as it is not fully known what effects the drug may have, but it may cause harm to a fetus.
There is limited data on the effects of Cymbalta on fetal development. However, some studies have found that Cymbalta may increase the risk of certain adverse effects for both the mother and fetus.
Spontaneous Abortion
Several studies suggest that Cymbalta may increase the risk of spontaneous abortion. The risk of spontaneous abortion was about 18% among women taking Cymbalta, which is higher than the 12%-15% risk seen in the general population.
Congenital Malformations
Cymbalta has been linked to a slightly higher risk of congenital malformations, particularly related to the urinary tract system. Some other malformations noted were clubfoot and cardiovascular abnormalities. However, the rate of congenital malformations in women taking Cymbalta was similar to that of the general population.
Preterm Birth and Low Birth Weight
Cymbalta use has been associated with a slightly higher risk of preterm births and lower than usual birth weights.
Respiratory Distress and Other Side Effects
Clinical findings have reported that taking Cymbalta in the third trimester of pregnancy could lead to the development of respiratory distress, constant crying, seizures, and more in the infant.
Persistent Pulmonary Hypertension of the Newborn (PPHN)
Cymbalta might slightly increase the risk of this rare but often fatal condition.
Neonatal Abstinence Syndrome (NAS)
NAS is a condition where a baby withdraws from a substance the mother was taking during pregnancy. While rare, NAS can occur in babies exposed to Cymbalta in utero, with symptoms such as hyperactive reflexes, yawning, excessive high-pitched crying, and stuffy nose or sneezing.
While the data on Cymbalta's effects on fetal development is limited, it appears that Cymbalta may increase the risk of certain adverse effects. It is important for pregnant women taking Cymbalta to consult with their doctor to weigh the risks and benefits of continuing the medication.
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Pregnancy complications
One potential complication is preeclampsia, a dangerous condition characterised by abnormally high blood pressure that can damage the liver or blood cells and cause stillbirths or even be fatal to the mother. Women who take Cymbalta are around 1.12 to 1.67 times more likely to experience preeclampsia. Another potential issue is postpartum hemorrhage, or excessive bleeding following childbirth, which can be life-threatening, especially if the mother has preexisting health conditions.
In addition, Cymbalta may also affect fetal development. The rate of spontaneous miscarriage for those taking Cymbalta is around 18%, 3% higher than the general population. Even if the pregnancy is successful, Cymbalta use has been linked to a slightly higher risk of preterm births and lower birth weights. Furthermore, successful pregnancies following Cymbalta exposure showed slightly higher rates of congenital malformations, particularly related to the urinary tract system, with some children experiencing kidney and urinary issues. Other malformations noted were clubfoot and cardiovascular abnormalities.
It is important to note that the exact effects of Cymbalta on pregnancy are still unknown, as clinical trials have not been conducted due to ethical and legal limitations. The available data suggests that the frequency of abnormal outcomes is generally consistent with the historic control rates in the general population, and the risk of adverse birth outcomes is low compared to the general population. However, more research is needed to fully understand the potential risks.
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Breastfeeding
The US Food and Drug Administration (FDA) has not assigned Cymbalta a lactation risk category. However, it is known that antidepressants can enter breast milk. Research has shown that less than 1% of duloxetine (the generic version of Cymbalta) is transferred from breast milk to an infant.
The Cymbalta Pregnancy Registry is designed to collect prospective data about potential risks of duloxetine exposure during pregnancy.
If you are currently taking Cymbalta and breastfeeding, or planning to do so, you should speak with your healthcare provider as soon as possible. It is generally not recommended to start taking Cymbalta for the first time while breastfeeding.
If you are taking Cymbalta during pregnancy, it is typically fine to continue during breastfeeding, particularly if the mother is doing well with the medication. It is important to monitor the infant for drowsiness and adequate feeding, weight gain, and developmental milestones, especially if they are exclusively breastfed. Consult your doctor if you have any concerns.
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Cymbalta dosage during pregnancy
If you are taking Cymbalta and become pregnant, it is important to consult a doctor as soon as possible to discuss how your medication may affect your pregnancy. Cymbalta is not recommended for use during pregnancy unless the benefits are considered to outweigh the risks to the foetus.
Cymbalta is a serotonin-norepinephrine reuptake inhibitor (SNRI) used to treat anxiety and depression, as well as chronic nerve pain caused by conditions like fibromyalgia, arthritis, or diabetes. It is not known exactly how Cymbalta affects pregnancy, as pregnant women are typically excluded from prescription drug trials for ethical and legal reasons. However, some studies have indicated that Cymbalta may increase the risk of certain adverse effects for pregnant women, including preeclampsia and postpartum hemorrhage.
Data suggests that the rate of spontaneous miscarriage is around 18% for those taking Cymbalta, compared to 12%-15% in the general population. Successful pregnancies may also be affected, with slightly higher risks of preterm births, lower birth weights, and congenital malformations. However, it is hard to know whether these issues are caused by the medication, underlying conditions, or other factors.
If you are taking Cymbalta and become pregnant, your doctor may suggest tapering off the medication or continuing to take it, depending on your individual circumstances. Stopping Cymbalta suddenly can cause withdrawal symptoms, and discontinuing antidepressant use during pregnancy may increase the risk of sinking back into depression or experiencing heightened anxiety.
If you are taking Cymbalta and are planning to become pregnant, it may be a good idea to consult your doctor beforehand to discuss whether you should discontinue usage. This will help to prevent any issues during the early stages of pregnancy, when a woman may not yet be aware that she has conceived.
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Alternatives to Cymbalta during pregnancy
If you are taking Cymbalta and are pregnant or planning to become pregnant, it is important to consult your doctor. Cymbalta is not the first medication doctors recommend for pregnant women experiencing symptoms of depression.
Selective serotonin reuptake inhibitors (SSRIs) like Zoloft or Celexa are more commonly prescribed because there is more research demonstrating their safety. Cymbalta is generally not used during pregnancy unless the benefits greatly outweigh the risks to the foetus.
If you are taking Cymbalta for a mental health condition, your doctor may recommend switching to an SSRI. While these medications can cause premature birth and maternal birth changes, they do not cause birth defects.
If medication is not an option, your doctor may recommend treating anxiety and depression with counselling and therapy.
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Frequently asked questions
Cymbalta is a serotonin-norepinephrine reuptake inhibitor (SNRI) drug used to treat anxiety and depression, and chronic pain.
Cymbalta is labelled by the FDA as a Category C risk category medication, meaning that there haven't been enough high-quality studies in humans, but potential risks can't be ruled out because controlled studies on animals have shown that there may be a risk to a fetus. Some studies have found that infants exposed to SNRIs in the third trimester could experience side effects such as cyanosis, apnea, respiratory distress, seizures, temperature instability, feeding difficulty, hypoglycemia, jitteriness, irritability, constant crying, or tremors.
If you use Cymbalta and have just realized that you are pregnant, it is not a good idea to abruptly discontinue use without talking to your doctor. Stopping Cymbalta suddenly can cause withdrawal symptoms, and discontinuing antidepressant use suddenly can cause a relapse of depression, anxiety, and other symptoms.
