Can Cymbalta And Amitriptyline Be Taken Together?

Posted on Wed, 15 Mar 2017

Question: This message is for Dr. XXXXXXX Hi Dr XXXXXXX hope this finds you well. OK, so first, my psychiatrist started me on Cymbalta. It was working great up until three days ago when my Spine specialist put me on Voltaren for the pain. The pain is gone. He said if it doesn't help to call and we could try amtriptaline. Well, I'm really sensitive to meds and I feel somewhat more depressed since I started taking the Volateran. And I know Amtriptaline with Cymbalta could cause the serotonin syndrome. They are going to get me a back brace and I have an appointment with physical therapy. I know you're not a therapist, but I can't take all of this medicine for the rest of my life and I can't live with the pain! No matter what I do I either live with the pain or I live with the depression. I know they have to do all of this as to avoid surgery but I feel they are prolonging the inevitable. I would so appreciate your advice. Thanks for listening.

Answered by Dr. Dr. Ashok Kumar Choudhary (2 hours later)

Brief Answer:
Cymbals is as effective as amitryptiline for pain

Detailed Answer:
Hello,
Thanks for posting again at HCM.

I do not think this should be a point of worry as cymbalta is as effective as amitryptiline when it comes to pain. I also like to assure you that chance of serotonin syndrome is extremely rare with combination of amytryptiline and duloxetine when the titration is done slowly and there are no acute changes in the prescribed dose.

In my experience of 10 years in psychiatry I rarely encountered a person with serotonin syndrome while doing rational prescribing.

As you understand that the brace and physical therapy are good alternative to surgery and sufficient for 90% of patients with spine issues. I mean to say that it does not mean that they want to prolong inevitable but it can be stated that they are first trying less invasive treatment which has proven results.

I hope this helps you.
Thanks and regards.

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Dr. Ashok Kumar Choudhary (11 minutes later)

Thank you Dr. XXXXXXX just one more thing, since the Voltaren is causing me mood problems would there be any problem taking naproxin or ibuprofen? Or tramadol? The pharmacist seems to think I shouldn't take Tramadol. Thank you so much

Answered by Dr. Dr. Ashok Kumar Choudhary (25 minutes later)

Brief Answer:
Follow up

Detailed Answer:
Dear XXXXXXX
Thanks for follow up.

If you are having adequate pain control with voltaren I do not think tramadol should be used. The naproxen, ibuprofen and voltaren are equally effective and can be interchanged if there are any issues with voltaren.

I hope this assists you further.
In future if you need to ask more questions please use my url as it ensures continuity of care.

http://doctor.healthcaremagic.com/doctors/dr-ashok-kumar/67386

Thanks and regards.

Note: For further guidance on mental health, Click here.

Above answer was peer-reviewed by : Dr. Remy Koshy