Is Cymbalta (Duloxetine) Safe During Pregnancy?

What does the evidence say about cymbalta during pregnancy?

1. Taking duloxetine during pregnancy is not expected to raise the chance of birth defects above the general population's baseline rate of about 3%. 1
2. A nationwide cohort study of more than 2 million pregnancies, including 1,512 exposed to duloxetine, found no increased risk of major birth defects (odds ratio 0.98) or stillbirth (relative risk 1.18) compared with unexposed pregnancies. 2
3. A large cohort study found the relative risk of heavy bleeding after birth (postpartum hemorrhage) was about 1.5 times higher in women who took duloxetine during pregnancy compared with those who didn't, a pattern also seen with other SNRI antidepressants like venlafaxine. 3
4. Babies exposed to duloxetine late in pregnancy can have temporary symptoms after birth, including breathing problems, jitteriness, changes in muscle tone, and trouble sleeping or eating, most of which resolve within weeks. 4
5. Duloxetine passes into breast milk in small amounts, and harmful effects haven't been reported in breastfed infants, though a pediatric provider should be told about the exposure so they can watch for excess sleepiness or poor weight gain. 1

Is cymbalta safe in each trimester?

• First trimester. If you're already taking duloxetine when you become pregnant, large studies haven't found a higher chance of birth defects, so many people continue their dose with their prescriber's guidance rather than stopping abruptly.
• Second trimester. Depression and anxiety symptoms can shift as pregnancy progresses, so this is a good time to check in with your prescriber about whether your current dose is still working for you.
• Third trimester. Because duloxetine has been linked to a higher chance of postpartum hemorrhage, and because newborns exposed late in pregnancy can have temporary withdrawal-like symptoms, make sure your delivery team and your baby's care team know you're taking it.