Duloxetine

Therapeutic Class
Antidepressant, Serotonin / Norepinephrine Reuptake Inhibitor
Indications

Acute and maintenance treatment of major depressive disorder (MDD).
Treatment of generalized anxiety disorder (GAD).
Management of diabetic peripheral neuropathic pain (DPNP), fibromyalgia (FM), chronic musculoskeletal pain (eg, chronic low back pain, osteoarthritis).
Treatment of stress incontinence - unlabeled.

Adult Doses

Oral:

Maximum dose: 120 mg/day.

Major depressive disorder:
Initial: 40-60 mg/day; dose may be divided (ie, 20 or 30 mg twice daily) or given as a single daily dose.
Maintenance: 60 mg once daily; for doses >60 mg/day, titrate dose in increments of 30 mg/day over 1 week.
Diabetic neuropathy: 
60 mg once daily.
Fibromyalgia:
30 mg once daily for 1 week, then increase to 60 mg once daily as tolerated. 
Generalized anxiety disorder: 
Initial: 30-60 mg/day as a single daily dose; patients initiated at 30 mg/day should be titrated to 60 mg/day after 1 week.
Chronic musculoskeletal pain: 
30 mg once daily for 1 week, then increase to 60 mg once daily as tolerated.
Stress incontinence (unlabeled use):
40 mg twice daily.

Doses in Renal impairment

Not recommended for use in Clcr <30 mL/minute or ESRD (contraindicated in Canadian labeling).
In mild-moderate impairment, lower initial doses may be considered with titration guided by response and tolerability.

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.
Potentially Fatal: Avoid use with antiarrhythmics (amiodarone, quinidine), antipsychotics (chlorpromazine), TCAs (fluoxetine, fluvoxamine), azole antifungals, quinolones (ciprofloxacin), ciclosporin.
See Below for More duloxetine Drug Interactions

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.
Distribution: About 96% bound to plasma proteins, mainly albumin and α1-acid glycoprotein.
Metabolism: Extensively metabolised by CYP1A2 and CYP2D6.
Excretion: Mainly excreted in the urine; about 20% is excreted in the faeces. Elimination half-life: 8-17 hr.

Patient Counselling

If you think there was an overdose, call your local poison control center or ER right away.
Signs of a very bad reaction to the drug. These include wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat.
If you are planning to harm yourself or the want to harm yourself gets worse, call  ER right away.

Administration

May be taken with or without food.
Swallow whole, do not chew/crush.

Pregnancy Category

C: Drug Pregnancy Category 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
  • Duloxetine 20 mg
  • Duloxetine 30 mg
  • Duloxetine 40 mg
  • Duloxetine 60 mg
  • Subscribe for latest updates

    Subscribe to our e-mail newsletter to receive updates.

    No comments yet.

    Post Review about Duloxetine


    Duloxetine Containing Brands

    We are Developing Our database, More results coming soon.

    Duloxetine is used in following diseases

    We are Developing Our database, More results coming soon.

    Drug - Drug Interactions of Duloxetine

    We are Developing Our database, More results coming soon.