Duloxetine Interactions

Duloxetine and St. John's wort both increase serotonergic activity, and combining them can raise serotonin to levels associated with serotonin syndrome.

Duloxetine (Cymbalta) can occasionally cause liver injury, and its FDA label advises against prescribing it to people with substantial or chronic alcohol use or existing liver disease, because both substances stress the liver. Documented cases have generally been reversible after stopping the drug, with no clear pattern of alcohol-linked liver failure in the published case series.