Duloxetine Interactions

Duloxetine is a serotonin-norepinephrine reuptake inhibitor (SNRI), and St. John's wort independently raises central serotonin through reuptake inhibition. Combined use can precipitate serotonin syndrome, and St. John's wort induction of CYP3A4 and P-glycoprotein may also alter duloxetine exposure.

Duloxetine (Cymbalta) and heavy alcohol use both can damage the liver. The FDA-approved label explicitly states that Cymbalta should not be prescribed to patients with substantial alcohol use because the combination has been linked to severe, sometimes fatal, hepatotoxicity in clinical trial data.