A Risky Combination: The Dangers of Mixing Cymbalta and Metaxalone
Even the most effective and safest prescription medications can lead to a range of side effects that need to be closely monitored and that’s especially the case when it comes to how a medication might interact with other drugs or even over-the-counter herbal supplements. This includes frequently prescribed medications, such as Cymbalta and metaxalone, which can interact in unexpected ways if taken together. Before we explore these medications and how they can lead to problems if taken together, as well as look at the drugs individually, including the risks of withdrawal from Cymbalta, let’s look at what these medications are used for and why they’re prescribed.
Cymbalta is the brand name for a drug called duloxetine, which is most often prescribed as an antidepressant but also can be taken to address nerve pain, such as diabetic neuropathy, fibromyalgia, and pain in the muscles or bones. It is classified as a selective serotonin and norepinephrine reuptake inhibitor, or SNRI, that increases serotonin and norepinephrine neurotransmitters in the brain. Metaxalone, meanwhile, formerly was sold under the brand name Skelaxin and is prescribed as a muscle relaxer to address short-term muscle or bone pain or spasms in addition to rest, exercise, and physical therapy. While both medications are considered relatively safe, they can interact in powerful and potentially dangerous ways, which is why it’s important to understand how these two drugs work together and affect each other.
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Can I Take Metaxalone with Cymbalta?
The neurotransmitter serotonin plays an important role in our moods, sleep, and digestion, and that’s why many types of antidepressant or anti-anxiety medications work by helping us boost the amount of serotonin in our brains. However, it’s dangerous and even potentially life-threatening if too much serotonin builds up in our bodies and that’s a possible risk of the combination of Cymbalta and metaxalone.
Metaxalone can interact with many types of antidepressants, including selective serotonin reuptake inhibitors, or SSRIs, such as Zoloft, as well as tricyclic antidepressants. It can also cause problems if taken with serotonin and norepinephrine reuptake inhibitors, including Cymbalta. This interaction can lead to a condition known as serotonin syndrome, which is rare but can be dangerous as the body has too much serotonin. This condition can cause mild symptoms like tremors or sweating but can also lead to more severe and even potentially life-threatening problems like hallucinations or seizures. That’s why it’s important to follow your doctor’s advice and ensure your prescriber knows about any other medication you’re taking, especially if you’re being prescribed Cymbalta and metaxalone.
What Drugs Interact Badly with Cymbalta?
In addition to the potentially serious serotonin syndrome that can be caused by Cymbalta and metaxalone, other medications can interact poorly with Cymbalta or duloxetine. According to Healthline, using Cymbalta with monoamine oxidase inhibitors (MAOIs), another type of antidepressant, can also cause serotonin syndrome. There are also some reports of liver damage or even liver failure if someone drinks excessively while taking Cymbalta. Cymbalta can even cause side effects if taken with common over-the-counter pain relievers like aspirin or ibuprofen and interact poorly with a whole host of prescription medications, including tramadol, trazodone, Ambien, and blood thinners, in addition to many kinds of mental health medications, including antidepressants and anti-anxiety medications.
Even over-the-counter herbs and supplements can interact with Cymbalta, especially the supplement St. John’s wort. If taken together, users are at a higher risk of serotonin syndrome, which is why many people who are prescribed this medication will be instructed to stop taking St. John’s wort.
Is Metaxalone a Strong Muscle Relaxer?
While metaxalone is considered to be a relatively moderate muscle relaxer that is often better tolerated than other drugs in its category, users can experience side effects from this medication. According to GoodRx, side effects can include:
- Fatigue, drowsiness, or dizziness
- Feeling irritated
- Headaches
- Upset stomach (vomiting or nausea)
However, metaxalone can be addictive if abused or taken too long. It can also rarely lead to more serious and even potentially life-threatening side effects, such as a decrease in certain blood cells. In addition, if it is taken with other substances, it can cause major problems. If combined with alcohol or other things that affect breathing, it can dangerously slow breathing in a user, for example. In addition, it can lead to a buildup of serotonin known as serotonin syndrome in certain interactions with other drugs.
What Drugs Should Not Be Taken with Metaxalone?
While metaxalone is considered to be one of the better-tolerated muscle relaxers available, it can interact poorly with many other drugs and not just the dangerous combination of Cymbalta and metaxalone. Unfortunately, it can raise the risk of serotonin syndrome if taken with other drugs that raise the level of serotonin in the brain, including common antidepressants like SSRIs and SNRIs as well as other substances like migraine medications, the herbal supplement St. John’s wort, and even ecstasy (MDMA).
In addition, metaxalone can interact and cause problems if taken with certain diet pills, attention-deficit/hyperactivity disorder (ADHD) medications, some opioid pain relievers, Parkinson’s disease medications, and supplements. It can cause serious interactions with some drugs like nasal decongestants and stimulants and cause severe high blood pressure, and it can also cause a fatal drug interaction if taken with MAO inhibitors.
Get Help with Avoiding Drug Interactions Like Cymbalta and Metaxalone
While the drugs are considered relatively safe on their own, prescription medications like Cymbalta and metaxalone can cause uncomfortable or even life-threatening problems if combined. That’s why it’s so important to talk with your doctor before beginning any new medication about any other drug you’re taking, including over-the-counter medicine or herbal supplements, to know about the potential risks for interaction and learn how to reduce your chances of problems. Drug interactions can be a major problem for people who are abusing medications, including older adults abusing prescription drugs. If you or a loved one is taking prescription medications recreationally or taking more than the prescribed dose, as well as combining drugs with other substances, the risks of problems substantially increase.
However, prescription drug addiction doesn’t need to go untreated, and help is available to show people like you how to overcome drug abuse and achieve a better, healthier future free from the risks of potentially serious or even life-threatening drug interactions. In California, Resurgence Behavioral Health’s team of experts knows what it takes to address the physical and mental components of prescription drug addiction and break the shackles of addiction once and for all. Learn more about how we can help by calling us at 855-458-0050 today.
External Sources
- GoodRx – 6 Metaxalone Side Effects and How to Manage Them
- Healthline – Cymbalta Interactions: Alcohol, Medications, and Others
- WebMD – Metaxalone – Uses, Side Effects, and More
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Frequently Asked Questions
Can I take metaxalone with DULoxetine?
Taking Cymbalta (duloxetine) and metaxalone (Skelaxin) together is possible but should be done only under physician supervision due to the moderate drug interaction between them. Metaxalone has some serotonergic activity, and combining it with Cymbalta's potent serotonin reuptake inhibition can elevate serotonin levels. Most physicians who prescribe this combination do so for specific complex pain conditions and monitor the patient for interaction symptoms. Never adjust this combination without guidance from your prescriber.
Can I take a muscle relaxer with Cymbalta?
Yes, muscle relaxers can be taken with Cymbalta in some clinical contexts, but the combination requires caution. Metaxalone specifically has a moderate interaction due to serotonergic effects. Cyclobenzaprine has significant serotonergic properties and carries a more serious interaction risk with Cymbalta. Baclofen and tizanidine have different interaction profiles. Any combination of Cymbalta with a muscle relaxer should be evaluated by a prescribing physician who is aware of all medications being taken.
What drugs should not be taken with metaxalone?
Metaxalone should not be combined with MAOIs, which can cause dangerous autonomic and CNS interactions. Combining it with CNS depressants including opioids, benzodiazepines, alcohol, and sedating antihistamines significantly amplifies sedation and respiratory depression. Serotonergic drugs including SNRIs like Cymbalta (duloxetine) carry a moderate interaction risk with metaxalone because of its mild serotonergic activity, which can increase the risk of serotonin syndrome symptoms. Always disclose every medication, supplement, and substance you use to the prescribing physician before starting metaxalone.
What drugs interact badly with Cymbalta?
Cymbalta has several important drug interactions. MAOIs cause potentially fatal serotonin syndrome and are absolutely contraindicated. Tramadol, triptans, and other serotonergic drugs increase serotonin syndrome risk. Anticoagulants like warfarin may have increased bleeding risk when combined with Cymbalta. NSAIDs increase bleeding risk. CYP1A2 inhibitors like fluvoxamine increase duloxetine blood levels significantly. Alcohol worsens CNS depression and liver stress. Always disclose all medications and supplements to your prescriber.
Can Cymbalta help relax muscles?
Cymbalta has FDA approval for musculoskeletal pain including fibromyalgia and chronic low back pain, and it does have some indirect muscle-relaxing effects through reducing pain sensitization at the spinal cord level. However, it is not a direct muscle relaxant in the pharmacological sense. It does not block the neuromuscular junction or reduce spinal reflexes as traditional muscle relaxants do. Its analgesic effects are through norepinephrine and serotonin modulation in the pain processing pathway.
Is it safe to take muscle relaxers with antidepressants?
Combining Cymbalta (duloxetine) and metaxalone creates a risk of serotonin syndrome because both drugs affect serotonin pathways. Symptoms of serotonin syndrome include rapid heart rate, high blood pressure, agitation, muscle twitching, and in severe cases, seizures or loss of consciousness. This combination should only be used under close medical supervision.
What pain reliever is safe with Cymbalta?
Over-the-counter pain relievers safest to use alongside Cymbalta include acetaminophen at standard doses, which does not interact significantly with duloxetine's serotonin mechanism. NSAIDs like ibuprofen and naproxen are not absolutely contraindicated but carry an increased risk of bleeding when combined with duloxetine because both can affect platelet function. Aspirin combined with Cymbalta similarly increases bleeding risk. Tramadol should be avoided with duloxetine due to elevated serotonin syndrome risk. Any pain management while on Cymbalta should be discussed with your prescriber, particularly if you require regular or higher-dose analgesics.
Why don't doctors like to prescribe muscle relaxers?
Some physicians are cautious about prescribing muscle relaxers because many (especially cyclobenzaprine, carisoprodol, and methocarbamol) are sedating and carry abuse or dependence potential, particularly carisoprodol which is a Schedule IV substance. The evidence base for long-term muscle relaxant use is also limited; they are generally intended for short-term acute musculoskeletal conditions. For patients with substance use histories, the sedating and potentially habit-forming properties of some relaxers make prescribers particularly cautious.
Can duloxetine cause muscle spasms?
Duloxetine (Cymbalta) is not a primary cause of muscle spasms at standard therapeutic doses. However, serotonin syndrome, a rare but serious adverse effect from serotonergic drugs including duloxetine, does include muscle rigidity, myoclonus, and twitching as characteristic findings. These are neurological effects driven by excess serotonin activity rather than a direct muscular mechanism. Some people also experience restlessness and agitation on duloxetine that can feel like muscle tension or fasciculation. If you experience unexpected muscle-related symptoms while taking duloxetine, particularly alongside other serotonergic medications like metaxalone, contact your prescribing physician promptly.
Which muscle relaxer is best for anxiety?
For anxiety, the most relevant muscle relaxers are those with GABAergic or sedating properties, like baclofen or tizanidine, which reduce nervous system excitability. However, these are not prescribed specifically for anxiety. Benzodiazepines serve a similar role and produce more potent anxiolysis but carry addiction risk. For people in recovery, hydroxyzine or low-dose gabapentin may be considered for anxiety with muscle tension, though both require caution. Any decision about medication for anxiety in someone with a substance use history requires careful evaluation by a prescriber experienced in addiction medicine.
