The nurse is taking a history from a client in an outpatient clinic. The client has been taking duloxetine (Cymbalta) for fibromyalgia. Which of the following over-the-counter medications would cause the nurse some concern if the client says she is taking it?

  • aspirin
  • garlic supplements
  • vitamin B6
  • cough medicine with dextromethorphan
Number 4 is correct.
Cymbalta increases the body’s serotonin level. A rare but life-threatening condition called serotonin syndrome may occur when someone takes two or more medications that increase the body’s serotonin levels. Cough medicines that contain dextromethorphan may interact with Cymbalta and cause serotonin syndrome. The other over-the-counter medications have no known interaction with Cymbalta.