Duloxetine
Antidepressant · Serotonin and noradrenaline reuptake inhibitor
Indications
Major depressive disorder, diabetic peripheral neuropathic pain.
Dosage
Adults: Major depressive disorder: Initial & maintenance dose: 60 mg once daily. Generalized anxiety disorders: 30 mg daily, increased if necessary to 60 mg once daily; max 120 mg daily. Diabetic peripheral neuropathic pain: 60 mg once daily; max 120 mg in divided doses. Children: Not recommended.
Adverse Effects
GI disorders, excessive sweating, CNS disorders e.g. dizziness, fatigue, insomnia, somnolence, blurred vision, dysuria, headache, dry mouth, somnolence, wt loss, palpitations, tremor, paraesthesia, tinnitus, yawning, rash, dysuria, pollakiuria, musculoskeletal pain, muscle spasm, anorexia, increased BP, flushing, abdominal pain, erectile dysfunction, ejaculation disorders, agitation, increased libido, anxiety, abnormal orgasm, abnormal dreams.
Risk Factor (Pregnancy/Lactation)
Pregnancy: Risk cannot be ruled out. Lactation: Contraindicated or not recommended. Contraindications: Concomitant use with MAOIs, potent CYP1A2 inhibitors. Hepatic or severe renal impairment. Uncontrolled narrow-angle glaucoma. Precautions: History of mania/hypomania, seizures, bipolar disorder. Renal impairment. Concomitant use with antidepressants. Elderly. Liver transaminase elevations. May impair ability to drive or use machines. Increased IOP or risk of narrow angle glaucoma. Hypertension, cardiac disease; monitor BP. Bleeding tendency. Risk factors for hyponatraemia. Dose increases may be detrimental in patients who develop akathisia. Elderly.
Interactions
Drugs metabolised by CYP2D6 (e.g. flecainide, vinblastine, carbamazepine, tricyclic antidepressants, propafenone, metoprolol). Potent CYP1A2 inhibitors/inducers. CNS-active drugs e.g. diazepam, imipramine, phenytoin, haloperidol, alcohol. MAOIs, SSRIs, ciprofloxacin, other antidepressants, risperidone, St John's wort, anticoagulants, drugs affecting platelet function, centrally acting agents, drugs associated with hepatic injury, SNRIs, warfarin, triptans, other serotonergic drugs.
Advice to Patient
Take with or without meals. Do not chew or crush capsules, swallow whole. Do not stop taking medication abruptly, gradually lower the dose and then stop. Contact prescriber if there is high fever, muscle rigidity, agitation, chills, confusion, increased sweating, diarrhea, poor coordination, restlessness, shaking, talking or acting with uncontrolled excitement, tremor and twitching. Limit alcohol intake during therapy. Change position slowly from sitting or lying to standing. On start of therapy or change of dosage, patient should be watched carefully for suicidal tendency by caregiver or family.
Pharmacokinetics
Absorption: Well absorbed, 2-hour delay in absorption after ingestion; food decreases extent of absorption approx. 10% (no effect on Cmax). Metabolism: Hepatic. Half-life elimination: Approx. 12 hours (range: 8 to 17 hours); approx. 4 hours longer in elderly women. Time to peak: 6 hours; 10 hours when ingested with food. Excretion: Urine ( approx. 70%; <1 % of total dose as unchanged drug): feces (approx. 20%).
Brands with this active ingredient
Compiled by Healify Pharmacy from published drug references. How we compile it →
Always consult a pharmacist or doctor.