Symbal 60mg (Duloxetine)

Symbal general information

What is Symbal used for?

Symbal tablets 60mg (generic Cymbalta) are used to treat major depressive disorder, to relieve symptoms of depressive illness, including anxiety, loss of interest in usual activities, disturbed sleep, change in appetite, fatigue, feelings of worthlessness or guilt, difficulty thinking or concentrating, and recurrent thoughts of suicide.  Symbal tablets 60mg are also used to treat generalised anxiety disorder, a mood disorders that affect daily activities and relationships with others.  Symbal 60 is also effective for pain relief and are used to treat pain caused by nerve damage in diabetes (diabetic neuropathy) and the chronic pain disorder called fibromyalgia. 

How does Symbal work?

Symbal tablets 60mg contain duloxetine which is an antidepressant belonging to the class of drugs known as selective Serotonin-Noradrenaline Reuptake Inhibitors (SSNRIs).  Duloxetine in Symbal tablets 60mg acts in the brain to correct the chemical imbalance caused by a lack of certain neurotransmitters (brain chemical that allows nerve cells to communicate) that is thought to be one of the major causes of depression and other mood disorders, particularly a lack of serotonin, which controls many body activities, including regulating mood.  Duloxetine is a potent inhibitor of the reuptake of serotonin and noradrenaline, and also weakly inhibits dopamine reuptake, which means that it blocks the re-uptake of serotonin and noradrenaline from the synapse (the gap between nerve cells across which chemical messages are sent from one nerve cell to another).  If the re-uptake of serotonin and noradrenaline by the first nerve cell (pre-synaptic) is blocked, this means that there is more neurotransmitter remaining for the receiving nerve cell (post-synaptic), which allows nerve cells to communicate with each other for longer.  The action of Symbal 60 helps relieve symptoms of depression and other mood disorders by increasing the amount of serotonin and noradrenaline in the brain, which in turn increases stimulation of nerve pathways that control mood.  The pain inhibitory actions of Symbal tablets 60mg are also thought to be due to the effects of duloxetine on increasing serotonin and noradrenaline (serotonergic and noradrenergic activity) in the central nervous system.

What does Symbal contain?

Symbal tablets 60mg contain the active ingredient duloxetine, an antidepressant belonging to the class of drugs known as Serotonin-Noradrenaline Reuptake Inhibitors (SNRIs) used to treat depression, anxiety and some pain disorders. 

What doses of Symbal are available?

Symbal tablets are available to buy from Inhouse Pharmacy in 3 different doses: 20mg 30mg and 60mg.

Treating depression with Symbal

Symbal tablets 60mg contain duloxetine which is an antidepressant belonging to the class of drugs known as Serotonin-Noradrenaline Reuptake Inhibitors (SSNRIs), used to treat symptoms of depression, including anxiety, loss of interest in usual activities, disturbed sleep, change in appetite, fatigue, feelings of worthlessness or guilt, difficulty thinking or concentrating and recurrent thoughts of suicide.  One of the major causes of depression is thought to be an imbalance of neurotransmitters (brain chemicals that allows nerve cells to communicate), particularly a lack of serotonin that controls mood.  Symbal 60 \works by specifically blocking the reuptake of serotonin and noradrenaline from the synapse, or gap between nerve cells across which chemical messages are sent to allow nerve cell to communicate with each other.  By preventing the reuptake of serotonin and noradrenaline by the first nerve cell (pre-synaptic) there is more neurotransmitter remaining for the receiving nerve cell (post-synaptic), so that nerve cells can communicate with each other for longer which increases stimulation of nerve pathways that control mood changes, relieving symptoms of depression. 

Symbal for anxiety

Symbal tablets 60mg contain duloxetine which is an antidepressant belonging to the class of drugs known as selective Serotonin-Noradrenaline Reuptake Inhibitors (SSNRIs), used to treat generalised anxiety disorder, where excessive anxiety causes constant and uncontrollable feelings of worry and distress, making you feel irritable, and have difficulty thinking and sleeping.  Other common symptoms associated with anxiety may include muscle tension, dry mouth, a lump in the throat, cold clammy hands, diarrhoea and nausea.  One of the major causes of anxiety is thought to be an imbalance of neurotransmitters (brain chemicals that allows nerve cells to communicate), particularly a lack of serotonin that controls mood and noradrenaline that is related to drive and motivation.  If there is a lack of serotonin, the brain cells involved in nerve pathways that control mood changes generate feelings of anxiety and panic instead of well-being, which is associated with high levels of serotonin.  Symbal tablets 60mg works by specifically blocking the reuptake of serotonin and noradrenaline from the synapse, or gap between nerve cells across which chemical messages are sent to allow nerve cell to communicate with each other.  By preventing the reuptake of serotonin and noradrenaline by the first nerve cell (pre-synaptic) there is more neurotransmitter remaining for the receiving nerve cell (post-synaptic), so that nerve cells can communicate with each other for longer which increases stimulation of nerve pathways that control mood changes, relieving symptoms of anxiety. 

What are the side effects of Symbal?

The most commonly reported side effects when taking Symbal 60 include: nausea, dry mouth, constipation, decreased appetite, fatigue, drowsiness, dizziness, increased sweating, sexual problems.

When should Symbal not be used?

You should not use Symbal tablets 60mg if you:

• are allergic to duloxetine or any of the ingredients in Symbal 60
• are pregnant, plan to become pregnant or are breastfeeding
• have liver disease, a recent history of myocardial infarction or unstable heart disease
• have glaucoma or are at risk of glaucoma (increased eye pressure)
• taking any monoamine oxidase inhibitor medications (such as phenelzine and tranylcypromine) as these can cause serious reactions if taken with Symbal or within 5 days
• taking other medication that interacts with Symbal, including, monoamine oxidase inhibitors (MAOIs) for depression, other antidepressants, the analgesic tramadol, migraine medicines like sumatriptan, antipsychotics like chlorpromazine or thioridazine, herbal remedies containing St. John´s Wort, the antifungal ketoconazole, the antibiotic ciprofloxacin, clozapine for schizophrenia
• are taking medication that affects blood clotting as these may increase risk of bleeding if taken with Symbal

What medications interact with Symbal?

Several medications interact with Symbal 60 and should either not be taken while you are taking Symbal or only after discussion and instruction from your doctor:

• Drugs that cause a serious reaction with Symbal: monoamine oxidase inhibitors (MAOIs) for depression; medication that affects blood clotting like warfarin, as these may increase risk of bleeding if taken with Symbal
• Drugs that affect Symbal: tramadol (analgesic); the antidepressant fluvoxamine; sumatriptan for migraine; St John's wort, a herbal remedy used to treat mood disorders; cimetidine for reflux and ulcers; the antibiotic ciprofloxacin
• Drugs that are affected by Symbal: lithium and Imipramine (mood disorders); clozapine for schizophrenia; the anticoagulant warfarin; other antidepressants like nortriptyline

How should Symbal be taken?

You should take your Symbal tablets 60mg with a glass of water, with food once a day, at the same time each day, for several weeks or months, depending on your condition and your doctor’s recommendations.  Your doctor may increase your dose, depending on what you are being treated for. 

How long should you take Symbal?

You should take your Symbal tablets 60mg regularly for as long as recommended by your doctor, usually for several weeks or months and you should continue your medication even if you feel well.

Missed dose of Symbal

If you miss a dose of Symbal tablets 60mg take it as soon as you remember, unless it is time to take the next dose, then skip the missed dose.  Do not take a double dose.

How should Symbal be stored?

You should store your Symbal tablets 60mg below 25°C in a cool dry place.