Esophageal spasms/achalasia related to Duloxetine?

I am a 50 year old female with a 20 year history of major depression which has been extremely resistant to treatment. About 6 weeks ago I started taking the drug Duloxetine(Cymbalta). I took it for about 3 weeks at 30 mg once a day, then my doctor increased it to 60 mg. My depression is much better and I do not want to stop taking the drug. I have taken many medications for many health problems over the years and I have been very fortunate in that I have never been bothered by significant side effects. Unfortunately it appears that I am developing swallowing problems which may be related to this drug.

Starting about 4 days after the increase in dose, I began having problems swallowing. As I eat I begin to feel pain in my chest, approximately at the level of the gastroesophageal junction. The pain is quite severe and increases in intensity if I continue to eat. It feels as though a lump of food is "stuck" in the lower esophagus and cannot pass into the stomach. Although it is worst when I eat dry solid foods such as bread, it also occurs with soft foods and fluids. It feels like a severe spasm in my esophagus. The only way to stop the pain is to force myself to vomit. At first this happened only about once or twice a week, but now it occurs at nearly every meal. I also belch frequently (something I never did before). I rarely experience heartburn, so I don't think it is GERD. Dysphagia, eructation and esophageal stenosis are listed as infrequent side effects of Doloxetine in the prescribing information.

I have several other medical problems which predate this problem, including breast cancer (two years ago, treated successfully), which can cause "pseudoachalasia", according to the literature.

Have you had any experience with esophageal problems related to this drug? If so, does the problem continue to get worse, or does it subside over time?

[Kevin Pho, MD]

Spasms and dysphagia are rare side effects of this medication - I have the frequency as less than 1% according to the PDR.  

You may want to consider an upper endoscopy or barium swallow to ensure there isn't anything else that can be leading to your symptoms.

If the symptoms are caused by the Cymbalta, stopping to medication to see if this has an effect on the symptoms can be considered.  

These options can be discussed with your personal physician.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
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