Medications and Drugs
Pharmacy Author: Omudhome Ogbru, PharmD
Medical and Pharmacy Editor: Jay W. Marks, MD
GENERIC NAME: duloxetine
BRAND NAME: Cymbalta
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: No
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, and pain associated with diabetic peripheral
neuropathy or fibromyalgia.
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 or fibromyalgia is 60
mg daily. 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 (for example,
tryptophan, and sumatriptan
(Imitrex).
Fluoxetine (Prozac, Serafem), paroxetine
(Paxil, Paxil CR, Pexeva), fluvoxamine
(Luvox), and quinidine
(Quinidine Gluconate, Quinidine Sulfate) increase blood levels of
duloxetine by reducing its metabolism in the liver. Such combinations may
increase adverse effects of duloxetine.
Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.
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