Duloxetine (Cymbalta, Yentreve, Xeristar, Arclaim)
Duloxetine is a new type of antidepressant that has been on the market since 2004. It has been heavily marketed and is one of the most commercially successful medications in the world.
The Bottom Line: What You Really Need to Know
- Duloxetine (Trade Names: Cymbalta) is used to treat depression, anxiety and Diabetic Peripheral Neuropathy. It is sometimes used to treat stress incontinence or fibromyalgia.
- The usual dose is 60 mg/day.
- Duloxetine interacts with many medications. Make sure your doctor and pharmacist know about all of the medications you take, including over-the-counter medications, herbal remedies, homeopathic remedies, vitamins, supplements and medications you only take occasionally.
- It will probably be a week or two before you notice any difference in the way you feel.
- Don't stop taking duloxetine suddenly; the dose must be tapered gradually or you may experience withdrawal symptoms.
- Most people have a few mild side effects, like dry mouth, nausea or headache, when they start taking duloxetine. They usually go away with time.
- If you experience loss of interest in sex or diminished sexual ability, talk to your doctor about it.
- Have a friend or family member check in with you every day for the first few weeks you take duloxetine. Ask him or her to help monitor your condition for
- Worsening depression
- Restlessness, irritability, agitation, hostility or aggression
- Unusual thoughts or thoughts of suicide
- Report any serious or unusual side effects to your doctor.
- Women who are trying to get pregnant or are pregnant should talk to their doctors before using duloxetine. It should not be taken if you are nursing a baby.
- People with liver disease should not take duloxetine.
Duloxetine is primarily used to treat depression. The FDA has also approved it for the treatment of Generalized Anxiety Disorder (GAD) and Diabetic Peripheral Neuropathy (DPN).
In some countries duloxetine is approved for the treatment of stress incontinence. The owner, Eli Lilly, was seeking approval for treating stress incontinence, but has withdrawn the application. During the clinical trials, a small number of women had suicidal thoughts or attempted suicide.
Duloxetine is used to treat fibromyalgia. Clinical trials are being conducted to see if it helps fibromyalgia and chronic fatigue syndrome.
Dosage and instructions
The usual dose of duloxetine is 60 mg/day. When taken for depression, it is sometimes divided into two 30 mg doses; otherwise duloxetine is taken once a day in a single dose.
Sometimes duloxetine is started at a low dose and increased as tolerated. This is especially true in people with diabetic peripheral neuropathy, who may also have kidney disease.
Duloxetine comes in a capsule and it should be swallowed whole. Don't crush or chew it, and don't take the capsule apart and mix the medication with food or liquids.
How duloxetine works
Duloxetine is a new type of antidepressant called Selective Serotonin-Norepinephrine Reuptake Inhibitors (SSNRI). It prevents the reabsorption of both norepinephrine and serotonin at nerve endings. Researchers believe that the dual action on both neurotransmitters helps with both depression and the perception of pain.
Most people experience some side effects when they begin taking duloxetine. The side effects usually go away after a few weeks. If they persist, you may need a lower dose of medicine or it may need to be stopped altogether.
The most common side effects are:
- Dry mouth
- Sleep disturbances
Other side effects that can occur include:
- Dizziness or fainting when you first stand up
- Loss of appetite and weight loss
- Rapid weight gain
- Blurred vision or other visual problems, including detached retina
- Tingling, numbness, "brain zaps" and other unusual sensations
- Canker sores
- Upset stomach, abdominal cramps, diarrhea or constipation
- Sexual problems
- Hot flashes
- Bad taste
- Problems urinating
- High blood pressure
- Cold hands and feet
- Jaundice/liver problems
- Water intoxication
- Excessive bruising or evidence of bleeding
MAOI antidepressants: Duloxetine can have a very serious interaction with monamine oxidase inhibiting antidepressants that can include very high fevers, convulsions and death. You should not take duloxetine for at least two weeks after you stop taking MAOIs. At least five days should elapse after you stop taking duloxetine before you take an MAOI.
Serotonergic medications: Serotinergic medications can interact with duloxetine in a toxic way and produce serotonin syndrome. Early symptoms of serotonin syndrome may be limited to nervousness, agitation, tremor and sweating. It can progress to high fever, seizures, muscle rigidity, coma, cardiovascular collapse, multiple organ failure and death. Serotonergic medications that should be avoided while you are taking duloxetine include:
- SSRI antidepressants
- SSNRI antidepressants
- Tricyclic antidepressants
- Triptans-medications used to treat migraine headaches
- Linezolid-an antibiotic
- St. John's Wort
Other medications that interfere or interact with duloxetine are:
- Cimetadine (tagamet)
- Ciprofloxin (cipro)
- Propafenone, flecainide, quinidine-medications for irregular heart beats
- Thoridazine (Mellaril)
- Blood thinners
- NSAIDs-non-steroidal anti-inflammatory medicatons like ibuprofen and aspirin
- Tranquilizers and antianxiety medications
- Seizure medications
- Sleep medications
- Muscle relaxers
- Narcotics and pain medications
- Antipsychotic medications
The manufacturer suggests withdrawing gradually from duloxetine to avoid experiencing symptoms like dizziness, nausea or headache. There are many individual reports of severe withdrawal symptoms with duloxetine that last for weeks even when the drug is tapered. Symptoms that have been reported with duloxetine withdrawal include
- Mood swings and changes
- "Brain zaps," "electric shocks," "brain shivers" and other unusual sensations
- Excessive fatigue
- Buzzing in the ears
Be sure to discuss any symptoms you experience during withdrawal with your doctor.
Warnings, precautions and contraindications
Suicide risk: All antidepressants can increase the risk of suicide, especially when you first start taking them. People should be closely monitored during the first weeks or months of therapy with a new medication. Any unusual thoughts or behaviors or changes in mood should be reported immediately to the physician.
Other antidepressants: Duloxetine should not be taken with other antidepressants because of the potential for serious intractions.
Liver disease: Duloxetine should not be taken if you have liver problems. Your doctor may want to draw blood to check your liver function every so often. There have been reports of liver damage in people who were taking duloxetine.
Kidney disease: Duloxetine should be used with caution in people who have kidney disease.
Pregnancy and lactation: When duloxetine is taken during the 3rd trimester of pregnancy there is a six-fold increase in the chance that the baby will have problems after birth, especially Persistent Pulmonary Hypertension of the Neonate (PPHN).
Some SSRI antidepressants are thought to increase the chance of having congenital heart defects when taken during the first trimester of pregnancy. Duloxetine and other antidepressants should be used with extreme caution, if at all, during pregnancy.
You should not breast feed while taking duloxetine.blog comments powered by Disqus