- Fibromyalgia Overview Slideshow
- Take the Fibromyalgia Quiz
- Fibromyalgia: 12 Tips for Coping Slideshow
- What is duloxetine, and how does it work (mechanism of action)?
- What are the uses for duloxetine?
- What are the side effects of duloxetine?
- What is the dosage for duloxetine?
- What drugs interact with duloxetine?
- Is duloxetine safe to take if I'm pregnant or breastfeeding?
- What else should I know about duloxetine?
What is duloxetine, and how does it work (mechanism of action)?
Duloxetine is a selective serotonin and norepinephrine reuptake inhibitor (SNRI) antidepressants used for treating depression, anxiety disorder, and pain. 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.
Duloxetine is approved for treating the following conditions:
What are the uses for duloxetine?
What are the side effects of duloxetine?
The most common side effects of 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:
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.
Quick GuideFibromyalgia Symptoms, Diagnosis & Treatment
What is the dosage for duloxetine?
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. However, the maximum dose for depression or anxiety disorder is 120 mg/day.
What drugs interact with duloxetine?
- 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.
- Combining duloxetine with aspirin, nonsteroidal antiinflammatory 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, Prilosec) may cause duloxetine to be released early while conditions that slow gastric empyting (for example, diabetes) may cause premature breakdown of duloxetine. Nevertheless, aAdministration 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.
Is duloxetine safe to take if I'm pregnant or breastfeeding?
Duloxetine is excreted into the milk of lactating women. Because the safety of duloxetine in infants is not known, breastfeeding while on duloxetine is not recommended.
What else should I know about duloxetine?
Do I need a prescirption for duloxetine?
Yes, a presciption is needed.
What brand names are available for duloxetine?
What preparations of duloxetine are available?
Delayed-release capsules: 20, 30 and 60 mg
How should I keep duloxetine stored?
Capsules should be stored at room temperature, between 15 C to 30 C (59 F to 86 F).
Reference: FDA Prescribing Information.
- generalized anxiety disorder,
- and neuropathic pain associated with diabetic peripheral neuropathy.
The most common side effects of Cymbalta are:
Multimedia: Slideshows, Images & Quizzes
Bipolar Disorder (Mania) Quiz: Test Your Emotional Wellness IQ
Who is at risk for developing bipolar disorder? Are you? Take this Bipolar Disorder Quiz to learn more about bipolar disorder, if...
Depression Quiz: Signs & Symptoms
Many people do not recognize the symptoms and warning signs of depression and depressive disorders in children and adults. With...
Pain Quiz: Test Your IQ of Pain
Is pain all in the brain? Take the Pain Quiz to learn everything you've ever wanted to know about the unpleasant sensation we...
Picture of Fibromyalgia
A syndrome characterized by chronic pain, stiffness, and tenderness of muscles, tendons, and joints without detectable...
Nerve Pain: Symptoms, Causes, and Treatment Options
Learn about nerve pain symptoms, causes, and treatment options. Discover medications, treatments, and natural remedies that can...
Schizophrenia: Symptoms, Types, Causes, Treatment
What is schizophrenia? Learn about schizophrenia symptoms, signs, and treatment. Read about schizophrenia types such as paranoid...
Learn to Spot Depression: Symptoms, Warning Signs, Medication
What is depression? Get information on symptoms, signs, tests, and treatments for many types of depression including major...
Diabetic Peripheral Neuropathy: Improve Diabetes Nerve Pain
Read about diabetic peripheral neuropathy and exercises to manage nerve pain. Learn how to cope with the symptoms of diabetic...
Chronic Pain Syndrome: Treatment and Management for CPS
What is chronic pain syndrome (CPS)? See causes, symptoms and treatment options including medications. Learn about pain...
Depression Tips: Exercise, Diet, Stress Reduction, and More in Pictures
The right exercise, diet, and activities -- even playing with a pet --can help you recover from depression. Learn simple...
How Does Acupuncture Work? Benefits, Needles, Definition
What is acupuncture? How does acupuncture work? Does acupuncture hurt? Learn various acupuncture points, the definition of...
Anxiety Disorder Pictures: Symptoms, Panic Attacks, and More with Pictures
Learn about generalized anxiety disorder (GAD). See if your worries are normal or something more by learning about symptoms,...
Physical Symptoms of Depression in Pictures
Depression can cause physical problems such as insomnia, chest pain, fatigue, headaches, and more. Learn the signs of depression...
Depression Myths: Overwork, Recklessness and More in Pictures
Explore the myths and facts about depression. See how folk remedies and half-truths still prevent many from getting treatment for...
Healthy Aging: Sneaky Depression Triggers in Pictures
There are many causes and triggers of depression. From too little vitamin B12 to too much time alone, look at these surprising...
Depression Therapy: Myths, Facts, and More in Pictures
False ideas scare many depression suffers away from therapy and the quick relief and help these pros can provide. Let our experts...
Postpartum Depression: Symptoms, Diagnosis and Treatment
Postpartum depression is a treatable medical illness which affects women after giving birth. Learn about the symptoms, diagnosis...
Related Disease Conditions
Peripheral neuropathy is a problem with the functioning of the nerves outside of the spinal cord. Symptoms may include numbness,...
Fibromyalgia is a chronic pain condition characterized by symptoms such as fatigue, sleep disturbances, and tender points. Stress...
Anxiety is a feeling of apprehension and fear characterized by symptoms such as trouble concentrating, headaches, sleep problems,...
Depression is an illness that involves the body, mood, and thoughts and affects the way a person eats and sleeps, the way one...
Postherpetic neuralgia (PHN) is a painful complication of shingles. Symptoms include: severe pain, itchy skin, and...
Diabetic Neuropathy (Symptoms, Causes, Diagnosis, Treatment)
Diabetic neuropathy a condition in which nerve damage has occurred as a complication of diabetes. The pain from the nerve...
Head and Neck Cancer
Head and neck cancer is cancer of the oral cavity, salivary glands, paranasal sinuses and nasal cavity, pharynx, larynx, or lymph...
Pain management and treatment can be simple or complex, according to its cause. There are two basic types of pain, nociceptive...
Bipolar disorder (or manic depression) is a mental illness characterized by depression, mania, and severe mood swings. Treatment...
Posttraumatic Stress Disorder
Post-traumatic stress disorder (PTSD), a psychiatric condition, can develop after any catastrophic life event. Symptoms include...
Depression in Children
Childhood depression can interfere with social activities, interests, schoolwork and family life. Symptoms and signs include...
Schizotypal Personality Disorder
Schizotypal personality disorder is characterized by odd behaviors, feelings, perceptions, and ways of relating to others that...
Chronic pain is pain (an unpleasant sense of discomfort) that persists or progresses over a long period of time. In contrast to...
Depression in teenagers may be caused by many factors. Symptoms of teen depression include apathy, irresponsible behavior,...
Obsessive Compulsive Disorder (OCD)
Obsessive compulsive disorder (OCD) is an anxiety disorder that causes a person to suffer repeated obsessions and compulsions....
Dysthymia is a less severe form of chronic depression. Symptoms and signs include insomnia, suicidal thoughts, guilt, empty...
Bipolar Disorder vs. Schizophrenia
Bipolar disorder and schizophrenia are mental illnesses that share some risk factors and treatments. Symptoms of bipolar disorder...
Postpartum depression is a form of depression that occurs within a year after delivery. It is thought that rapid hormone changes...
Mental health is an optimal way of thinking, relating to others, and feeling. All of the diagnosable mental disorders fall under...
People with bulimia nervosa, an eating disorder that involves episodes of bingeing and purging, experience symptoms and signs...
Duck syndrome is a situation initially coined at Stanford University whereby a college student may seem to be calm on the surface...
Depression in the Elderly
Depression in the elderly is very common. That doesn't mean, though, it's normal. Treatment may involve antidepressants,...
Pain Management: Neuropathic Pain
Neuropathic pain is chronic pain resulting from injury to the nervous system. The injury can be to the central nervous system...
Treatment & Diagnosis
Medications & Supplements
- Antidepressants (Depression Medications)
- venlafaxine, Effexor XR (Effexor has been discontinued in the US)
- Anxiolytics (for Anxiety) Drug Class Side Effects
- desvenlafaxine (Pristiq, Khedezla)
- Celexa vs. Cymbalta (Comparison of Differences and Similarities)
- Cymbalta vs. Wellbutrin Comparison
- milnacipran, Savella
Prevention & Wellness
- What Drugs Work Best for Diabetic Nerve Pain?
- Try Drug-Free Options First for Low Back Pain, New Guidelines Say
- 1 in 6 U.S. Adults Takes a Psychiatric Drug: Study
- Study Questions Use of Antidepressants for Children, Teens
- Did Studies Lack Key Data on Link Between Antidepressants, Youth Suicides?
- Weight Gain From Antidepressants Is Minimal, Study Suggests
- Generic Cymbalta Approved
- Antidepressant Lessens Chemo-Related Pain
- Antidepressant Cymbalta Might Ease Chemo-Linked Pain
- Newer Antidepressants Work Equally Well, Study Finds
- Depression Rising, but Psychotherapy Declines
Daily Health News
Subscribe to MedicineNet's General Health Newsletter
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.
Top duloxetine Related ArticlesComplete List
AnxietyAnxiety is a feeling of apprehension and fear characterized by symptoms such as trouble concentrating, headaches, sleep problems, and irritability. Anxiety disorders are serious medical illnesses that affect approximately 19 million American adults. Treatment for anxiety may incorporate medications and psychotherapy.
Bipolar DisorderBipolar 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.
Bipolar Disorder QuizWho is at risk for developing bipolar disorder? Are you? Take this Bipolar Disorder Quiz to learn more about bipolar disorder, if you're at risk, and what you can do about it.
DepressionDepression 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).
Depression SlideshowWhat is depression? Get information on symptoms, signs, tests, and treatments for many types of depression including major depression, chronic depression, teen depression, and postpartum depression.
Depression QuizMany people do not recognize the symptoms and warning signs of depression and depressive disorders in children and adults. With proper diagnosis, treatments and medications are available. Take this quiz to learn more about recovery from depression.
Diabetic neuropathy a condition in which nerve damage has occurred as a complication of diabetes. The pain from the nerve damage can be severe with tingling or numbness in the part of the body affected. Diabetic neuropathy can occur anywhere in the body. Diabetic neuropathy can cause symptoms like intense pain, numbness, burning, or tingling in the part of the body affected by the condition.
There are four types of neuropathy include peripheral, autonomic, proximal and focal. Natural therapies and medications may help relieve the pain and other symptoms of diabetic neuropathy.
Exercises for DPNRead about diabetic peripheral neuropathy and exercises to manage nerve pain. Learn how to cope with the symptoms of diabetic peripheral neuropathy through pain management exercises.
Fibromyalgia FactsFibromyalgia is a chronic pain condition characterized by symptoms such as fatigue, sleep disturbances, and tender points. Stress reduction, exercise, and medication are the standard treatments for fibromyalgia.
Fibromyalgia PictureA syndrome characterized by chronic pain, stiffness, and tenderness of muscles, tendons, and joints without detectable inflammation. See a picture of Fibromyalgia and learn more about the health topic.
Head and Neck CancerHead and neck cancer is cancer of the oral cavity, salivary glands, paranasal sinuses and nasal cavity, pharynx, larynx, or lymph nodes in the upper part of the neck. These cancers account for 3% to 5% of cancers in the U.S. Tobacco and alcohol use are important risk factors. Treatment may involve surgery, radiation therapy, and/or chemotherapy.
Nerve Pain SlideshowLearn about nerve pain symptoms, causes, and treatment options. Discover medications, treatments, and natural remedies that can offer relief for dealing with the symptoms caused by nerve pain.
Pain ManagementPain 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 include:
- complex regional pain syndrome,
- interstitial cystitis,
- and irritable bowel syndrome.
Take the Pain QuizIs pain all in the brain? Take the Pain Quiz to learn everything you've ever wanted to know about the unpleasant sensation we call pain.
Peripheral NeuropathyPeripheral 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.
Postherpetic NeuralgiaPostherpetic neuralgia (PHN) is a painful complication of shingles. Symptoms include:
- severe pain,
- itchy skin,
- and possible weakness or paralysis of the area.
Posttraumatic Stress DisorderPost-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.
Schizophrenia SlideshowWhat is schizophrenia? Learn about schizophrenia symptoms, signs, and treatment. Read about schizophrenia types such as paranoid schizophrenia, catatonic schizophrenia, and disorganized schizophrenia.