duloxetine, Cymbalta (cont.)
Omudhome Ogbru, PharmD
Omudhome Ogbru, PharmD
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.
Medical and Pharmacy Editor:
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
Last Editorial Review: 1/6/2012
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