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Duloxetine

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Duloxetine, Cymbalta, Drizalma Sprinkle

  • See Also
  1. Serotonin-Norepinephrine Reuptake Inibitors (SNRI)
  2. Desvenlafaxine
  3. Venlafaxine
  • Indications
  1. Major Depression
  2. Generalized Anxiety Disorder
  3. Diabetic Neuropathy
  4. Fibromyalgia
  • Contraindications
  1. Chronic Liver Disease (hepatic insufficiency or Cirrhosis)
  2. Serotonin Syndrome
  3. Glomerular Filtration Rate <30 ml/min
  • Mechanism
  1. Strong Serotonin and Norepinephrine reuptake inhibitor
  2. Also with minor Dopamine reuptake inhibitor properties
  • Preparations
  1. Duloxetine Hydrochloride delayed release tablets (20g, 30 mg, 60 mg)
  • Dosing
  1. Start: 20 mg orally twice daily or 30 mg orally daily
  2. Advance to 60 mg daily (or divided twice daily)
  3. Maximum: 120 mg/day
  • Drug Interactions
  1. Metabolized by CYP1A2 and CYP2D6
    1. Avoid with strong CYP1A2 or CYP2D6 Inhibitors
  2. Monoamine Oxidase Inhibitors (MAO Inhibitor), including Linezolid
    1. Do not use Duloxetine concurrently or within 14 days of last dose of MAO Inhibitors
  3. Avoid with Methylene Blue, Thioridazine
  • Safety
  1. Unknown safety in Lactation
  2. Pregnancy Category: C
  3. Black box warning as for all Antidepressants for Suicidality in teens
  • Adverse Effects
  1. Nausea
  2. Xerostomia (Dry Mouth)
  3. Somnolence
  4. Constipation
  5. Decreased Appetite
  6. Hyperhidrosis
  7. Urinary Retention
  8. Hepatotoxicity
  • Resources
  1. Duloxetine (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=51c342c9-b9c6-467d-8fea-b73d72e3febc
  • References
  1. (2023) Med Lett Drugs Ther 62(1592): 25-32
  2. Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 38-9
  3. Hamilton (2020) Tarascon Pocket Pharmacopoeia
  4. Jaouen and Lovecchio (2021) Crit Dec Emerg Med 31(12): 24