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Duloxetine Cymbalta for CIPN

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How effective is duloxetine Cymbalta for CIPN (chemotherapy-induced peripheral neuropathy)? The good news is that, according to the research below,  cymbalta reduced pain in CIPN more than the placebo did.

The bad news is that the risk of side effects can be problematic for the MM patient. Let me explain.

According to research, %20-40% of MM patients present with kidney involvement at diagnosis. And up to 50% of MM die from kidney failure.

So when I see an article citing kidney damage as a side effect of a pain therapy for a common side effect of MM treatment, I will blog about it.


Which FDA approved therapies for the treatment of multiple myeloma can damage kidney health?

  1. Proteasome Inhibitors
  • Bortezomib (Velcade) – Generally considered safer for kidneys compared to other treatments, but rare cases of acute kidney injury (AKI) have been reported.
  • Carfilzomib (Kyprolis) – More nephrotoxic than bortezomib; associated with an increased risk of AKI and hypertension-related kidney damage.
  • Ixazomib (Ninlaro) – Less nephrotoxic but still requires monitoring in patients with kidney impairment.

2.   Immunomodulatory Drugs (IMiDs)

  • Lenalidomide (Revlimid) – Can cause renal impairment, especially in patients with pre-existing kidney disease; dose adjustments are needed based on kidney function.
  • Pomalidomide (Pomalyst) – Less nephrotoxic than lenalidomide but still requires dose modifications in kidney-impaired patients.
  • Thalidomide (Thalomid) – Rarely causes direct nephrotoxicity but can increase the risk of thromboembolism, which may lead to renal complications.

3. Alkylating Agents

  • Melphalan (Alkeran) – Can cause renal toxicity, particularly in high-dose chemotherapy for stem cell transplants.
  • Cyclophosphamide (Cytoxan) – Associated with hemorrhagic cystitis and kidney damage at high doses.

4.      Corticosteroids (Dexamethasone, Prednisone)

    • While these drugs help control myeloma-related kidney damage by reducing inflammation, they can also cause fluid retention, hypertension, and worsening diabetes, which indirectly harm the kidneys.

5. Bisphosphonates (for bone disease in multiple myeloma)

    • Zoledronic acid (Zometa) – Can cause nephrotoxicity, especially in patients with pre-existing kidney impairment; requires careful dosing.
    • Pamidronate (Aredia) – Less nephrotoxic than zoledronic acid but still poses a risk of kidney injury with long-term use.


In my experience as a myeloma patient, oncology does a poor job of explaining possible side effects and rarely if ever offers non-conventional, non-FDA approved therapies.

Email me at David.PeopleBeatingCancer@gmail.com with your questions about your MM, side effects, etc.

Thank you,

David Emerson

  • MM Survivor
  • MM Cancer Coach
  • Director PeopleBeatingCancer

Effect of duloxetine on pain, function, and quality of life among patients with chemotherapy-induced painful peripheral neuropathy: a randomized clinical trial

Objective- The primary objective was to determine the effect of duloxetine 60 mg daily on CIPN “average” pain severity…

Intervention-The initial treatment consisted of duloxetine/placebo 30mg/one capsule daily for the first week, then 60mg/two capsules for four additional weeks…

Results- Individuals receiving duloxetine as initial treatment (weeks 1–5) reported a larger mean decrease in average pain (1.06; 95% CI: 0.72, 1.40) compared to placebo-treated patients (0.34; 95% CI: 0.01, 0.66) (p = 0.003) (effect size = 0.513). The observed mean difference in the average pain score between the duloxetine and placebo groups was 0.73 (95% CI: 0.26, 1.20). 59% of duloxetine-treated patients compared to 38% of placebo-treated patients reported decreased pain of any amount.

Conclusions-Among patients with painful CIPN, the use of duloxetine compared with placebo for 5 weeks resulted in a greater reduction in pain…

Approximately 20–40% of patients with cancer who receive neurotoxic chemotherapy (e.g., taxanes, platinums, vinca alkaloids, bortezomib) will develop painful chemotherapy-induced peripheral neuropathy (CIPN). Painful CIPN can persist from months to years beyond chemotherapy completion, causing significant challenges for cancer survivors due to negative influence on function and quality of life (QOL).

Duloxetine (Cymbalta, Drizalma Sprinkle) – Uses, Side Effects, and More

How does duloxetine work (mechanism of action)?

Duloxetine belongs to a group of medicines called serotonin-norepinephrine reuptake inhibitors (SNRIs). It works by increasing the amount of natural chemicals or neurotransmitters called serotonin and norepinephrine in the brain…

Side Effects

What are the most common side effects of duloxetine?

The most common side effects of duloxetine are listed below. Tell your healthcare provider if you have any of these side effects that bother you…

What are the serious side effects of duloxetine?

While less common, the most serious side effects of duloxetine are described below, along with what to do if they happen…

Liver Damage. Liver damage, also called hepatotoxicity, can happen when taking duloxetine. Stop taking duloxetine and call your healthcare provider right away if you have any of the following symptoms of liver damage…

Kidney Problems. Duloxetine should not be used if your kidneys are not working as well as they should be. If there is a concern about the health of your kidneys, your healthcare provider may do tests to determine if they are working well enough to take this medicine.

Liver Problems. Duloxetine should not be used if your liver is not working as well as it should be. If there is a concern about the health of your liver, your healthcare provider may do tests to determine if it is working well enough to take this medicine.

duloxetine Cymbalta for CIPN duloxetine Cymbalta for CIPN

 

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