Therapeutic Class |
Antidepressant, Serotonin / Norepinephrine Reuptake Inhibitor |
Indications |
Acute and maintenance treatment of major depressive disorder (MDD). |
Adult Doses |
Oral: Maximum dose: 120 mg/day. Major depressive disorder: |
Doses in Renal impairment |
Not recommended for use in Clcr <30 mL/minute or ESRD (contraindicated in Canadian labeling). |
Doses in Hepatic impairment |
Not recommended for use in hepatic impairment. |
Contraindications |
Uncontrolled narrow-angle glaucoma. Concomitant use or within 2 week of MAOIs. Renal and hepatic impairment. MAO inhibitor therapy must be stopped for 14 days before duloxetine is initiated.Treatment with MAO inhibitors should not be initiated until 5 days after the discontinuation of duloxetine. |
Boxed Warning |
Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults (18-24 years of age) with major depressive disorder (MDD) and other psychiatric disorders. Duloxetine is not FDA approved for use in children. |
Warnings / Precautions |
Avoid alcohol and abrupt cessation. May impair ability to drive or engage in task requiring alertness. Increased risk of suicidal thinking and behaviour when used in children and adolescents. Pregnancy, lactation. |
Adverse Reactions |
Central nervous system: Headache, somnolence , fatigue , dizziness, insomnia, agitation, anxiety, dreams abnormal, yawning, hypoesthesia, lethargy, vertigo, chills, sleep disorder Dermatologic: Hyperhydrosis Endocrine & metabolic: Libido decreased, hot flushes, orgasm abnormality Gastrointestinal: Nausea, xerostomia, constipation, diarrhea, appetite decreased, abdominal pain, vomiting, dyspepsia, weight loss, flatulence, taste abnormal, weight gain Genitourinary: Erectile dysfunction, ejaculation delayed, ejaculatory dysfunction Hepatic: ALT >3x ULN Neuromuscular & skeletal: Muscle spasms, tremor, musculoskeletal pain, paresthesia, rigors Ocular: Blurred vision Respiratory: Nasopharyngitis, cough Miscellaneous: Influenza |
Overdose Reactions |
Signs and symptoms include serotonin syndrome, somnolence, vomiting and seizures. Treatment consists of general measures such as maintaining an adequate airway, oxygenation and ventilation. Monitor cardiac rhythm and vital signs. Induction of emesis is not recommended. Gastric lavage with appropriate airway protection, if needed, may be used if performed soon after ingestion or in symptomatic patients. |
Drug Interactions |
Increased risk of hepatic toxicity in patients with substantial alcohol use. Increased risk of serotonin syndrome when used with 5HT1 receptor agonists, MAOIs, lithium, tramadol or St John's wort. Avoid concurrent use with drugs that inhibit hepatic enzymes CYP1A2 and CYP2D6. |
Food Interactions |
Ethanol: Ethanol may increase hepatotoxic potential of duloxetine. Ethanol may also increase CNS depression; monitor for increased effects with coadministration. Caution patients about effects. Herb/Nutraceutical: Avoid valerian, St John's wort, SAMe, kava kava, and gotu kola (may increase CNS depression). |
Mechanism of Actions |
It is a potent inhibitor of neuronal uptake of serotonin and norepinephrine and also a weak inhibitor of dopamine reuptake. |
Metabolism |
Substrate (major) of CYP1A2, 2D6; inhibits CYP2D6 (moderate) |
Pharmacodynamics |
Absorption: Well absorbed from the GI tract after oral admin. |
Patient Counselling |
If you think there was an overdose, call your local poison control center or ER right away. |
Administration |
May be taken with or without food. |
Pregnancy Category |
C: Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks. |
Lactation |
Enters breast milk/not recommended |
ATC Classification |
N06AX21 |
GenericPedia Classification |
|
Available As |
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Duloxetine
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Duloxetine Containing Brands
Duloxetine is used in following diseases
Drug - Drug Interactions of Duloxetine
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