Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
DRUG CLASS AND MECHANISM: Duloxetine is a selective serotonin and
norepinephrine reuptake inhibitor (SNRI) used for treating depression,
anxiety
disorder, and pain associated with
diabetic peripheral neuropathy, or
fibromyalgia. Other drugs in this class include milnacipran (Savella),
venlafaxine (Effexor), and desvenlafaxine (Pristiq). Duloxetine affects
neurotransmitters, the chemicals that nerves within the brain make and release
in order to communicate with one another. Neurotransmitters either travel across
the space between nerves and attach to receptors on the surface of nearby nerves
or they attach to receptors on the surface of the nerves that produced them, to
be taken up by the nerve and released again (a process referred to as
re-uptake).
Many experts believe that an imbalance among neurotransmitters is
the cause of depression as well as other psychiatric disorders. Serotonin and norepinephrine are two neurotransmitters released by nerves in the brain.
Duloxetine works by preventing the reuptake of serotonin and epinephrine by
nerves after they have been released. Since uptake is an important mechanism for
removing released neurotransmitters and terminating their actions on adjacent
nerves, the reduced uptake caused by duloxetine increases the effect of
serotonin and norepinephrine in the brain. The mechanism responsible for its
effectiveness treating pain is not known but also is thought to involve its
effects on serotonin and norepinephrine in the brain. Duloxetine was approved by
the FDA in August 2004.
PRESCRIPTION: Yes
GENERIC: Yes
PREPARATIONS: Delayed-release capsules: 20, 30 and 60 mg
STORAGE: Capsules should be stored at room temperature, between 15 to
30 C (59 to 86 F).
PRESCRIBED FOR: Duloxetine is used for the treatment of depression,
generalized anxiety disorder, pain associated with diabetic peripheral
neuropathy, fibromyalgia, and chronic musculoskeletal pain.
DOSING: The recommended dose for treating depression is 20 or 30 mg
twice daily or 60 mg once daily. Patients may be started with 30 mg once daily
for one week before the dose is advanced to 60 mg daily. The recommended dose
for anxiety disorder, pain associated with diabetic neuropathy, fibromyalgia, or
chronic musculoskeletal pain is 60 mg daily. Starting at 30 mg daily for one
week before increasing to 60 mg daily may help patients adjust to the drug.
There is no evidence that doses greater than 60 mg/day provide additional
benefits.
DRUG INTERACTIONS: Duloxetine should not be used in combination with a
monoamine oxidase inhibitor (MAOI) such as phenelzine (Nardil), tranylcypromine
(Parnate), isocarboxazid (Marplan), and selegiline (Eldepryl), or within 14 days
of discontinuing the MAOI. At least 5 days should be allowed after stopping
duloxetine before starting an MAOI. Combinations of SNRIs and MAOIs may lead to
serious, sometimes fatal, reactions including very high body temperature, muscle
rigidity, rapid fluctuations of heart rate and blood pressure, extreme agitation
progressing to delirium, and coma. Similar reactions may occur if duloxetine is
combined with antipsychotics,
tricyclic antidepressants or other drugs that
affect serotonin in the brain. Examples include tryptophan, sumatriptan (Imitrex),
lithium, linezolid (Zyvox), tramadol (Ultram), and St. John's Wort.Fluoxetine
(Prozac, Serafem), paroxetine (Paxil, Paxil CR, Pexeva), fluvoxamine (Luvox),
and quinidine increase blood levels of duloxetine by reducing its metabolism in
the liver. Such combinations may increase adverse effects of duloxetine.
Anxiety is a feeling of apprehension and fear characterized by physical symptoms. Anxiety disorders are serious medical illnesses that affect approximately 19 million American adults.
Fibromyalgia, formerly
known as fibrositis, causes chronic pain, stiffness, and
tenderness of muscles, tendons, and joints without detectable inflammation. Fibromyalgia patients have an unusually low pain threshold. Symptoms of fibromyalgia include fatigue, abnormal sleep, mental/emotional disturbances, abdominal pain, migraine and tension headaches, and irritable bladder. Treatment of fibromyalgia involves patient education, medication, exercise, and stress reduction.
Depression is an illness that involves the body, mood, and thoughts and affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. The principal types of depression are major depression, dysthymia, and bipolar disease (also called manic-depressive disease).
Post-traumatic stress disorder (PTSD), a psychiatric condition, can develop after any catastrophic life event. Symptoms include nightmares, flashbacks, sweating, rapid heart rate, detachment, amnesia, sleep problems, irritability, and exaggerated startle response. Treatment may involve psychotherapy, group support, and medication.
Bipolar disorder (or manic depression) is a mental illness characterized by depression, mania, and severe mood swings. Treatment may incorporate mood stabilizer medications, antidepressants, and psychotherapy.
Peripheral neuropathy is a problem with the functioning of the nerves outside of the spinal cord. Symptoms may include numbness, weakness, burning pain (especially at night), and loss of reflexes. Possible causes may include carpel tunnel syndrome, meralgia paresthetica, vitamin or nutritional deficiencies, and illnesses like diabetes, syphilis, AIDS, and kidney failure. Most causes of peripheral neuropathy can be successfully treated or prevented.
Diabetic Neuropathy is a complication of diabetes that causes damage to the nerves; this is related to the blood glucose of the body being too high for a long period of time. The four types of neuropathy include peripheral, autonomic, proximal and focal.
Pain management and treatment can be simple or complex, according to its cause. There are two basic types of pain, nociceptive pain and neuropathic pain. Some causes of neuropathic pain includes: complex regional pain syndrome, interstitial cystitis, and irritable bowel syndrome. There are a variety of methods to treat chronic pain, which are dependant on the type of pain experienced.
Chronic pain is pain (an unpleasant sense of discomfort) that persists or progresses over a long period of time. In contrast to acute pain that arises suddenly in response to a specific injury and is usually treatable, chronic pain persists over time and is often resistant to medical treatments.
Childhood depression can interfere with social activities, interests, schoolwork and family life. Symptoms and signs include anger, social withdrawal, vocal outbursts, fatigue, physical complaints, and thoughts of suicide. Treatment may involve psychotherapy and medication.
Dysthymia is a less severe form of chronic depression. Symptoms and signs include insomnia, suicidal thoughts, guilt, empty feeling, loss of energy, helplessness, sluggishness, and persistent aches and pains. Treatment may involve psychotherapy, electroconvulsive therapy, and antidepressants.
Postpartum depression is a form of depression that occurs within a year after delivery. It is thought that rapid hormone changes after childbirth may lead to depression. Symptoms of postpartum depression include crying a lot, headaches, chest pains, eating too little or too much, sleeping too little or too much, withdrawal from friends and family, and feeling irritable, sad, hopeless, worthless, guilty, and overwhelmed. Treatment typically involves talk therapy and medication.
Depression in the elderly is very common. That doesn't mean, though, it's normal. Treatment may involve antidepressants, psychotherapy, or electroconvulsive therapy.
Peripheral neuropathy is disorder of nerve(s) apart from the brain and spinal cord. Patients with peripheral neuropathy may have tingling, numbness, unusual sensations,
weakness, or burning pain.
What causes a peripheral neuropathy?
There are many possible causes of peripheral neuropathy,
including:
Diabetes Mellitus
Shingles (post herpetic neuralgia)
Vitamin deficiency, particularly B12 and folate
Alcohol
Autoimmune diseases, including lupus, rheumatoid arthritis or Guillain-Barre syndrome
AIDS, whether from the disease or its treatment,
syphilis, and kidney failure
Inherited disorders, such as amyloid polyneuropathy or
Charcot-Marie-Tooth disease
Depression RSS
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