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.
Combining duloxetine with aspirin,
nonsteroidal anti-inflammatory drugs (NSAIDs),
warfarin (Coumadin) or other drugs that are associated with bleeding may
increase the risk of bleeding, because duloxetine itself is associated with
bleeding. Duloxetine has an enteric coating that prevents dissolution until it
reaches a segment of the gastrointestinal that has a pH higher than 5.5. In
theory, drugs that raise the pH in the gastrointestinal system (for example,
omeprazole [Prilosec]) may cause duloxetine to be released early while
conditions that slow gastric emptying (for example, diabetes) may cause
premature breakdown of duloxetine. Nevertheless, administration of duloxetine
with an antacid or famotidine (Axid) did not significantly affect the absorption
of duloxetine.
Duloxetine may reduce the breakdown of desipramine (Norpramine), leading to
increased blood concentrations of desipramine and potential side effects.
PREGNANCY: In animal studies, duloxetine has been shown to have
adverse effects on fetal development. There are no adequate studies in pregnant
women. Duloxetine should be used during
pregnancy only if the potential benefit
justifies the potential risk to the fetus.
NURSING MOTHERS: Duloxetine is excreted into the milk of lactating
women. Because the safety of duloxetine in infants is not known,
nursing while
on duloxetine is not recommended.
SIDE EFFECTS: The most common side effects noted with duloxetine are
nausea, dry mouth, constipation,
diarrhea, fatigue, difficulty sleeping, and
dizziness. Increased blood pressure can occur and should be monitored.
Seizures
have been reported. Sexual dysfunction (decreased sex drive and delayed orgasm
and ejaculation) has been associated with duloxetine. Some patients may
experience withdrawal reactions upon stopping duloxetine. Symptoms of withdrawal
include anxiety, nausea, nervousness, and insomnia. The dose of duloxetine
should be gradually reduced when therapy is discontinued to prevent symptoms of
withdrawal. Antidepressants increased the risk of
suicidal thinking and behavior
(suicidality) in short-term studies in children and adolescents with depression
and other psychiatric disorders. Anyone considering the use of duloxetine or any
other antidepressant in a child or adolescent must balance this risk with the
clinical need. Patients who are started on therapy should be closely observed
for clinical worsening, suicidality, or unusual changes in behavior.
Reference: Cymbalta Prescribing Information, September 2011
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.
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