This post is written anonymously (see Petra’s story).
I outlined how my daughter Petra came to take Cymbalta on this blog a few months ago (see Petra’s story; also see Symbolta of Sorts). This post tells of events that led to her coming off the medication.
Petra is an enthusiast for motor sport events. She has been on track days, hill climbs and driver training events. She is a member of an Italian car club. She is a safe, smooth and confident driver, who has held a driver’s license since age 17 – for over six years now. She has had no disqualifications or accidents.
Shortly after starting Cymbalta, she noticed that alcohol seemed to affect her judgment while driving. So she stopped driving if she had had any drink. This was easy because at the time she would tend to drink quite heavily or not at all.
One afternoon she had two glasses of beer (8 oz each) while listening to music at a city venue. The event ran for most of the afternoon. She felt happy to drive home. On the way home she was stopped for a random breath test and to her horror recorded a 0.05 Blood Alcohol level on the police breathalyzer. Fortunately, the police officer decided that since the reading was exactly 0.05 and probably falling, she could wait in her car for a while and then continue home.
This was very close to a disaster. In Australia a reading of 0.05 or higher means that your driver’s license may be suspended pending a court hearing, which is likely to result in a fine plus automatic license disqualification for a minimum of 3 months. The loss of independence and convenience and the loss of something that she takes pride in would have been a real blow.
I purchased an alcometer. A standard drink for Australian purposes is one that contains 10 gm (about 12.5 ml) of alcohol. One such standard drink can be expected to raise Blood Alcohol Content (BAC) by about 0.025 grams per 100ml of blood. BAC levels are commonly thought to fall at the rate of about 0.02 per hour.
We confirmed on several tests that Petra would return a reading of 0.04 per 375 ml of beer (this was 1.4 standard drinks). This was the first problem. The second was that the reading didn’t fall at the expected 0.02 per hour and her BAC would consistently show 0.08 for 2 beers and 0.12 for 3 beers consumed over 2-3 hours.
Petra’s friends, brother and myself all had much lower readings. The consistency of the tests was good. I also tested our device against a police roadside check and obtained the same result as the police device. Finding that Petra returned readings in excess of 0.2 after the consumption of several alcoholic beverages over quite long periods of time was a shock and a big concern. Clearly alcohol was going to be a serious problem for her under these circumstances.
Petra raised this with her doctor, whose response was dismissive – your device was ‘probably inaccurate’. A local pharmacist observed that some young women return much higher readings than expected and that this was probably ‘normal for them’. Our solicitor said that ‘Magistrates are not interested in young women who claim to have only had 2 drinks’.
Petra has now stopped Cymbalta. She says that alcohol does not now seem to affect her anywhere near as much.
So we ran the test again, with the same device as before. This time she returned a reading of 0.03 soon after the consumption of 2 x 375 mls beers, where the figure was 0.08 for the same drinks while taking Cymbalta. This is almost the same as her brother’s reading of 0.02 for the same consumption.
She then had one 375 ml drink with lunch and we checked how quickly her levels fell. She returned a reading of 0.00 1 hour and 35 mins after the start of lunch.
Conclusion: Cymbalta more than doubles the effect of alcohol for some people at least. This could lead to and probably has led to regrettable consequences including harm to self and others, loss of driving licenses, fines, and other losses.
Eli Lilly’s prescribing information for Cymbalta is as follows:
When Cymbalta and ethanol were administered several hours apart so that peak concentrations of each would coincide, Cymbalta did not increase the impairment of mental and motor skills caused by alcohol.
Although Cymbalta does not increase the impairment of mental and motor skills caused by alcohol, use of Cymbalta concomitantly with heavy alcohol intake may be associated with severe liver injury. For this reason, Cymbalta should not be prescribed for patients with substantial alcohol use
There is no mention of the risks Petra ran and others seem likely to be running.
It is difficult to explain this finding but if valid there is no reason to think these risks are confined to Cymbalta. The testing that drugs undergo does not test for this possibility. There are routine drug and alcohol driving simulation tests which an hour after alcohol often show better performance on the combination of drug and alcohol than on alcohol alone – but no-one tests what might be happening several hours later.
Cymbalta and many other drugs can have an effect on liver function. At present this seems the likeliest way to explain this effect.
In the meantime, anyone on any medication who thinks they might have been affected should check themselves out. Anyone who has ever had a driving conviction may have a case to have their conviction overturned on the basis of company negligence. The same may apply to anyone who has ever lost a job or had an accident at work.
Anyone paying increased premiums on their insurance as a result of a drunk driving accident or offence may have a case to reclaim their insurance payments.
There is an urgent need to establish the genetic bases behind effects like this. It is likely that not just Petra but others in her family would be similarly affected, and so it is not just the affected person who needs checking.
The implications for employers of possible accidents at work apparently linked to alcohol but not primarily caused by alcohol are immense.
The already high risks of birth defects and miscarriages in women of child-bearing years stemming from antidepressants, and possible mental handicap in their children, would be compounded in this case by additional increased risks from alcohol. A woman taking a single glass of wine, of which several a week should be harmless, might be exposing her child to riskier concentrations than she thought.
There are clearly issues here for health and other insurance companies covering occupational hazards at large corporations such as General Motors.
We are interested in every report we can get of people having problems that might be attributed to intoxication by alcohol and drugs as well as all possible reports of drug induced cravings for alcohol – See Out of my Mind: Driven to Drink. Please add your accounts to these posts to help get recognition for these issues