Duloxetine

  • Brand Name : Cymbalta
  • Drug Class : Antidepressants, SNRIs, Fibromyalgia Agents
  • Medical Author : John P. Cunha, DO, FACOEP
  • Medical Reviewer :
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What Is Duloxetine and How Does It Work?

Duloxetine is a type of antidepressant known as a serotoninnorepinephrine reuptake inhibitor used to treat depression and anxiety. In addition, duloxetine is used to help relieve nerve pain (peripheral neuropathy) in people with diabetes or ongoing pain due to medical conditions such as arthritis, chronic back pain, or fibromyalgia (a condition that causes widespread pain).

Duloxetine may improve your mood, sleep, appetite, and energy level, and decrease nervousness. It can also decrease pain due to certain medical conditions. Duloxetine is known as a serotonin-norepinephrine reuptake inhibitor (SNRI). This medication works by helping to restore the balance of certain natural substances (serotonin and norepinephrine) in the brain.

  • Duloxetine is available under the following different brand and other names: Cymbalta.

What Are Dosages of Duloxetine?

Dosages of Duloxetine

Adult and Pediatric Dosage Forms & Strengths

Capsule, delayed-release

  • 20mg
  • 30mg
  • 40mg
  • 60mg

Dosage Considerations — Should Be Given As Follows: Major Depressive Disorder

  • 40-60 mg/day taken orally initially (in single daily dose or divided once every 12 hours for 1 week if the patient needs to adjust to therapy)
  • Titrate dose in increments of 30 mg/day over 1 week as tolerated
  • Target dosage: 60 mg/day taken orally (in single daily dose or divided once every 12 hours); not to exceed 120 mg/day (safety of dosages greater than120 mg/day has not been evaluated)

Diabetic Peripheral Neuropathic Pain

  • 60 mg/day taken orally initially (in single daily dose or divided once every 12 hours); consider lowering dosage if tolerability is a concern
  • Target dosage: 60 mg/day taken orally; not to exceed 60 mg/day

Generalized Anxiety Disorder

  • 60 mg/day taken orally initially (in single daily dose or divided once every 12 hours); may be increased in increments of 30 mg/day if tolerability is a concern
  • Target dosage: 60 mg/day taken orally; not to exceed 120 mg/day

Fibromyalgia

  • 30 mg/day taken orally initially for 1 week to allow for therapy adjustment
  • Target dosage: 60 mg/day taken orally; not to exceed 60 mg/day; no additional benefit shown by doses greater than 60 mg in clinical trials

Chronic Musculoskeletal Pain

  • Treatment of chronic musculoskeletal pain, including discomfort from osteoarthritis and chronic lower back pain
  • 30 mg/day taken orally initially for 1 week to allow for therapy adjustment
  • Target dosage: 60 mg/day taken orally; not to exceed 60 mg/day

Dosing Modifications

  • Severe renal impairment (CrCl greater than 30 mL/min) or end-stage renal disease (ESRD): Use not recommended
  • Hepatic impairment: Use not recommended, because of risk of hepatic injury

Considerations

  • Dosages 60 mg/day or more have not been shown to offer additional benefits
  • Major depressive disorder and generalized anxiety disorder: Acute episodes often necessitate several months of sustained therapy
  • Diabetic peripheral neuropathic pain: Efficacy for greater than12 weeks has not been studied; if diabetes is complicated by renal disease, consider lower starting dosage with a gradual increase to effective dosage
  • Fibromyalgia: Efficacy for 12 weeks or more has not been studied; continue treatment on basis of individual patient response
  • Chronic musculoskeletal pain: Efficacy for 13 weeks or more has not been studied
  • Uncontrolled narrow-angle glaucoma: Use not recommended due to increased risk of mydriasis

Discontinuance

  • Gradually reduce dosage
  • Abrupt discontinuance may result in symptoms (e.g., dizziness, nausea, headache, paresthesia, fatigue, vomiting, irritability, insomnia, diarrhea, anxiety, hyperhidrosis)
  • Wait 14 days or more after discontinuance of monoamine oxidase inhibitor (MAOI) therapy to initiate duloxetine therapy; wait 5 days or more after discontinuance of duloxetine therapy to initiate MAOI therapy

Generalized Anxiety Disorder

  • Less than 7 years: Safety and efficacy not established
  • 7-17 years: 30 mg taken orally once daily initially; after 2 weeks, may consider increasing dose to 60 mg/day
  • Recommended dosage range: 30-60 mg/day
  • Some patients may benefit from doses greater than 60 mg/day; if increased beyond 60 mg/day, use increments of 30 mg/day
  • The maximum dose studied was 120 mg/day; safety of doses greater than 120 mg/day has not been evaluated

renal impairment

  • Avoid use in patients with severe renal impairment (GFR <30 mL/min)

Hepatic Impairment

Administration

  • Because of enteric coating, must be swallowed whole; do not chew, crush, or open capsule and sprinkle contents in food or liquid
  • Can be taken without regard to meals

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