- 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.
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).
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The most common side effects of Cymbalta are:
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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, shingles, vitamin or nutritional deficiencies, and illnesses like diabetes, syphilis, AIDS, and kidney failure. Peripheral neuropathy is diagnosed with exams and tests. Treatment for the condition depends on the cause. Usually, the prognosis for peripheral neuropathy is good if the cause can be successfully treated or prevented.
Depression in teenagers may be caused by many factors. Symptoms of teen depression include apathy, irresponsible behavior, sadness, sudden drop in grades, withdrawal from friends, and alcohol and drug use. Treatment of depression in adolescents may involve psychotherapy and medications.
Fibromyalgia 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.
Anxiety 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.
Postherpetic neuralgia (PHN) is a painful complication of shingles. Symptoms include severe pain, itchy skin, and possible weakness or paralysis of the area. There is no treatment for postherapetic neuralgia that is effective for all patients.
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 include: 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.
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Treatment & Diagnosis
- Tingling in Hands and Feet
- Mood Swings
- Poor Hygiene
- Loss of Temperature Sensation
- Unusual Behavior
- Inability to Regulate Emotions
- Peripheral Neuropathy
- Bipolar Disorder
- Obsessive-Compulsive Disorder (OCD)
- Panic Attack
- Generalized Anxiety Disorder
- Antisocial Personality Disorder
- Complex Regional Pain Syndrome (CRPS)
- Bulimia Nervosa
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- Lyrica (pregabalin) vs. Cymbalta (duloxetine)
- gabapentin (Gralise) vs. duloxetine (Cymbalta)
- milnacipran, Savella
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