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Metabolism and Elimination Biotransformation and disposition of CYMBALTA in humans have been determined following oral administration of 14C-labeled CYMBALTA. CYMBALTA comprises about 3% of the total radiolabeled material in the plasma, indication that it undergoes extensive metabolism to numerous metabolites. The major biotransformation pathways for CYMBALTA involve oxidation of the naphthyl ring followed by conjugation and further oxidation. Both CYP2D6 and CYP1A2 catalyze the oxidation of the naphthyl ring in vitro. Metabolites found in plasma include 4 hydroxy duloxetine glucuronide and 5-hydroxy, 6-methoxy duloxetine sulfate. Many additional metabolites have been identified in urine, some representing only minor pathways of elimination. Only trace 1% of the dose amounts of unchanged CYMBALTA are present in the urine. Most about 70% of the CYMBALTA dose appears I the urine as metabolites of CYMBALTA; about 20% is excreted in the feces. Needless to say I have been off of it for 1 1/2 weeks now and those side effects have not resolved. I am very concerned and alarmed by the constant feeling of coming out of my skin. I am so very anxious and have become irritable and snap at others. I HATE this feeling of absolute loss of control over my body. It includes nerve sensations down my arms and legs accompanied by weakness. Unfortunately, most of your comments do not offer hope that these problems will resolve quickly. I cant imagine dealing with this for a long period of time. Mine seem mild compared to some I read and I am truly sorry for those of you experiencing problems.
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