DULOXETINE HYDROCHLORIDE
(du-lox'e-teen)
Cymbalta
Classifications: central nervous system agent; psychotherapeutic agent; antidepressant; serotonin norepinephrine reuptake inhibitor (snri)
Prototype: Venlafaxine
Pregnancy Category: C
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20 mg, 30 mg, 60 mg capsules
Exact mechanism of action in controlling depression or pain is unknown. As a selective serotonin and norepinephrine reuptake
inhibitor (SSNRI), duloxetine causes potentiation of serotonergic and noradrenergic activity in the CNS.
Antidepressant effect is presumed to be due to its dual inhibition of CNS presynaptic neuronal uptake of serotonin and norepinephrine,
thus increasing the serum levels of both substances.
Treatment of major depression, diabetic peripheral neuropathy.
Chronic pain syndromes.
MAOI therapy; uncontrolled narrow-angle glaucoma; abrupt discontinuation; pregnancy (category C), lactation. Safety and efficacy
in children <18 y not established.
Anorexia nervosa, history of mania, history of suicidal ideation; cardiac or hepatic disease; renal impairment or renal failure;
hypertension.
Depression
Adult: PO 40–60 mg/d in one or two divided doses
Diabetic Neuropathy or Chronic Pain
Adult: PO 60 mg/d in one or two divided doses
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Oral
- Do not initiate therapy within 14 d of the last dose of an MAOI.
- Must be swallowed whole. Do not cut, chew, or crush. Do not sprinkle on food or mix with liquids.
- Store at 15°–30° C (59°–86° F).
Body as a Whole: Fatigue, hot flashes. CNS: Dizziness, somnolence, tremor, insomnia
.
GI:
Nausea, dry mouth, constipation
, diarrhea, vomiting. Metabolic: Decreased appetite, weight loss. Skin: Increased sweating. Special Senses: Blurred vision. Urogenital: Decreased libido, abnormal orgasm, erectile dysfunction, ejaculatory dysfunction. Cholestatic jaundice and hepatitis.
Drug:
Alcohol may result in increased liver function tests; maois may result in hyperthermia, rigidity, mental status changes, myoclonus, autonomic instability, features resembling neuroleptic
malignant syndrome; cimetidine, fluoxetine, fluvoxamine, paroxetine, quinidine
,
quinolones may increase levels and half-life of duloxetine; may increase levels and toxicity of thioridazine
,
tricyclic antidepressants. Amphetamine, dextroamphetamine, buspirone, cocaine, dexfenfluramine, fenfluramine, lithium, phentermine, sibutramine, nefazodone
,
ssris, triptans, tramadol, trazodone may cause serotonin syndrome. Herbal:
St. John's Wort, tryptophan may cause serotonin syndrome.
Peak: 6 h. Metabolism: Metabolized in the liver by CYP2D6 and CYP1A2. Elimination: 70% excreted in urine, 20% excreted in feces. Half-Life: 12 h (8–17 h).
Assessment & Drug Effects
- Ensure that a complete list of all concurrent medications is obtained.
- Monitor for S&S of numerous drug-drug interactions (see Interaction section).
- Lab test: LFTs for unexplained abdominal pain or enlarged liver.
- Monitor closely for and report suicide ideation, especially when drug is initiated or dosage changed.
- Report emergence of any of the following: anxiety, agitation, panic attacks, insomnia, irritability, hostility, psychomotor
restlessness, hypomania, and mania.
- Monitor BP, especially in those being treated for hypertension.
Patient & Family Education
- The beneficial effects of this drug may not be felt for approximately 4 wk.
- Report any of the following: suicidal ideation (especially early in treatment or when dosage is changed), palpitations, anxiety,
hyperactivity, agitation, panic attacks, insomnia, irritability, hostility, restlessness.
- Do not abruptly discontinue taking this drug. Notify physician if side effects are bothersome.
- Avoid or minimize use of alcohol while taking this drug.
- Do not self-treat for coughs, colds, or allergies. Consult physician.
- Do not breast feed while taking this drug.
1%)
Canadian drug name; 
Prototype drug