Duloxetine

💊 What is Duloxetine used for?

• •Major depressive disorder (depression) in adults
• •Generalized anxiety disorder in adults and in children and teens 7 years of age and older
• •Diabetic peripheral neuropathic pain in adults
• •Fibromyalgia in adults and in teens 13 years of age and older
• •Chronic musculoskeletal pain in adults

How it works

The label describes duloxetine as a selective serotonin and norepinephrine reuptake inhibitor (SNRI). This means it acts on two chemical messengers, serotonin and norepinephrine. The label does not give further detail on how it works in the body.

How it is usually taken

• •The label says duloxetine is taken once daily, with or without food. Swallow the capsule whole. Do not chew or crush it, and do not open it and sprinkle the contents on food or mix them with liquids, because this may affect the special coating. Follow the instructions from your prescriber or pharmacist about your own schedule and amount.

Comes as

• •20 mg delayed-release capsules
• •30 mg delayed-release capsules
• •40 mg delayed-release capsules
• •60 mg delayed-release capsules

⚠️ Duloxetine side effects

🛑 Who should not take Duloxetine, and who should be careful

The label says not to take it if

• 🚨You take a monoamine oxidase inhibitor (MAOI). The label says not to take duloxetine with an MAOI intended to treat psychiatric disorders.
• 🚨You have stopped an MAOI within the last 14 days. The label says duloxetine should not be started in that case unless directed by your healthcare provider.
• 🚨You take an MAOI and plan to start duloxetine, or you plan to take an MAOI within 5 days of stopping duloxetine. The label says this is contraindicated unless your healthcare provider directs it.
• 🚨You are being treated with linezolid or intravenous methylene blue. The label says starting duloxetine in this situation is contraindicated.

Tell your doctor before taking it if

• •Tell your prescriber if you have heart problems or high blood pressure. The label says blood pressure should be checked before starting and during treatment.
• •Tell your prescriber if you have diabetes. The label says duloxetine can make it harder for some people with diabetes to control blood sugar.
• •Tell your prescriber if you have liver problems or kidney problems. The label says to avoid use with substantial alcohol use or chronic liver disease.
• •Tell your prescriber if you have glaucoma or a history of narrow angles in the eye.
• •Tell your prescriber if you have had seizures or convulsions.
• •Tell your prescriber if you have bipolar disorder or mania, or a family history of bipolar illness.
• •Tell your prescriber if you have low sodium levels in your blood.
• •Tell your prescriber if you have delayed stomach emptying or a history of bleeding problems.
• •Tell your prescriber if you are pregnant or planning to become pregnant.
• •The label says the medicine may cause falls, fainting, or dizziness from low blood pressure when standing up, and dose reduction or stopping may be considered if these happen.

🔀 Duloxetine with other medicines, food and alcohol

The label says to discuss these with your doctor or pharmacist

• •MAOIs (monoamine oxidase inhibitors): contraindicated, as described above. This includes linezolid and intravenous methylene blue.
• •Other medicines that affect serotonin: the label says the risk of serotonin syndrome increases when duloxetine is taken with other serotonergic agents.
• •CYP1A2 inhibitors such as fluvoxamine, cimetidine, and quinolone antibiotics like ciprofloxacin and enoxacin: the label says to avoid potent CYP1A2 inhibitors. Fluvoxamine raised duloxetine levels in the label study.
• •CYP2D6 inhibitors such as paroxetine, fluoxetine, and quinidine: these may increase duloxetine levels.
• •Thioridazine: the label says to avoid using it with duloxetine.
• •Blood thinners and bleeding-risk medicines such as NSAIDs, aspirin, antiplatelet drugs, anticoagulants, and warfarin: the label says these may increase the risk of bleeding.
• •Medicines that lower blood sodium, and other medicines that can cause low sodium, may matter because the label lists low sodium as a warning.

Alcohol and food

The label says duloxetine can be taken with or without food. The label advises avoiding use in people with substantial alcohol use or chronic liver disease.

🤰 Duloxetine in pregnancy and breastfeeding

Pregnancy

The label says duloxetine may harm an unborn baby, and pregnant patients should talk with their healthcare provider about the risks. A pregnancy registry for people exposed during pregnancy is available through the National Pregnancy Registry for Antidepressants, at 1-866-961-2388. The label says use in the month before delivery may be associated with an increased risk of postpartum hemorrhage. It also says there are risks from untreated depression and fibromyalgia during pregnancy. Tell your healthcare provider right away if you become pregnant or think you may be pregnant.

Breastfeeding

The label does not say.

🗓️ Storage, missed doses and taking too much

Storage

The label says to store at 25°C (77°F), with short excursions permitted between 15°C and 30°C (59°F to 86°F).

If a dose is missed

The label says that if a dose is missed, take it as soon as you remember. If it is almost time for the next dose, skip the missed dose and take the next one at the regular time. Do not take two doses at the same time.

If too much is taken

The label reports fatal outcomes from acute overdoses, including one involving 1000 mg of duloxetine alone. Signs of overdose may include sleepiness, coma, serotonin syndrome, seizures, fainting, fast heartbeat, low or high blood pressure, and vomiting. The label says there is no specific antidote, and treatment consists of general supportive measures. In an emergency, call 911.

🗒️ Questions to ask about Duloxetine

• Is duloxetine the right choice for my condition, and what other treatment options are there?
• How will you monitor me for changes in mood, suicidal thoughts, or behavior, especially when I start or change my dose?
• Are any of my other medicines, including over-the-counter products, an MAOI, or a serotonergic medicine?
• How will I know if I need to stop the medicine, and how should it be reduced to avoid discontinuation symptoms?
• Should I be checking my blood pressure, blood sugar, or liver function during treatment?
• What should I do if I miss a dose?
• Should I avoid alcohol while taking this medicine?

❓ Duloxetine: frequently asked questions