Generic Name: Duloxetine Brand Name(s): Generics only. No brands available.

Uses

What is duloxetine used for?

Duloxetine is 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.

How should I take duloxetine?

Take this medication by mouth as directed by your doctor, usually 1 or 2 times a day with or without food. If you have nausea, it may help to take this drug with food. Swallow the capsule whole. Do not crush or chew the capsule or mix the contents with food or liquid. Doing so can release all of the drug at once, increasing the risk of side effects.

The dosage is based on your age, medical condition and response to treatment. To reduce your risk of side effects, your doctor may direct you to start this medication at a low dose and gradually increase your dose. Follow your doctor’s instructions carefully. Take this medication regularly to get the most benefit from it. To help you remember, take it at the same time(s) each day.

It is important to continue taking this medication as prescribed even if you feel well. Do not stop taking this medication without consulting your doctor. Some conditions may become worse when this drug is suddenly stopped. Also, you may experience symptoms such as dizziness, confusion, mood swings, headache, tiredness, diarrhea, sleep changes, and brief feelings similar to electric shock. Your dose may need to be gradually decreased to reduce side effects. Report any new or worsening symptoms immediately.

Tell your doctor if your condition persists or worsens.

How do I store duloxetine?

Duloxetine is best stored at room temperature away from direct light and moisture. To prevent drug damage, you should not store duloxetine in the bathroom or the freezer. There may be different brands of duloxetine that may have different storage needs. It is important to always check the product package for instructions on storage, or ask your pharmacist. For safety, you should keep all medicines away from children and pets.

You should not flush duloxetine down the toilet or pour them into a drain unless instructed to do so. It is important to properly discard this product when it is expired or no longer needed. Consult your pharmacist for more details about how to safely discard your product.

Precautions & warnings

What should I know before using duloxetine?

Before using this drug, tell your doctor if:

  • You are pregnant or breastfeeding. This is because, while you are expecting or feeding a baby, you should only take medicines on the recommendation of a doctor.
  • You are taking any other medicines. This includes any medicines you are taking which are available to buy without a prescription, such as herbal and complementary medicines.
  • You have allergy with any of active or inactive ingredients of duloxetine or other medications.
  • You have any other illnesses, disorders, or medical conditions.

You should know that duloxetine may make you drowsy, dizzy, or may affect your judgment, thinking or coordination. Do not drive a car or operate machinery until you know how this medication affects you.

Ask your doctor about the safe use of alcoholic beverages while you are taking duloxetine. Alcohol can increase the risk of serious side effects from duloxetine.

You should know that duloxetine may cause dizziness, lightheadedness, and fainting when you get up too quickly from a lying position. This is more common when you first start taking duloxetine or with an increase in dose. To avoid this problem, get out of bed slowly, resting your feet on the floor for a few minutes before standing up.

You should know that duloxetine may cause high blood pressure. You should have your blood pressure checked before starting treatment and regularly while you are taking this medication.

You should know that duloxetine may cause angle-closure glaucoma (a condition where the fluid is suddenly blocked and unable to flow out of the eye causing a quick, severe increase in eye pressure which may lead to a loss of vision). Talk to your doctor about having an eye examination before you start taking this medication. If you have nausea, eye pain, changes in vision, such as seeing colored rings around lights, and swelling or redness in or around the eye, call your doctor or get emergency medical treatment right away.

Is it safe during pregnancy or breastfeeding?

There are no adequate studies in women for determining risk when using duloxetine during pregnancy or while breastfeeding. Please always consult with your doctor to weigh the potential benefits and risks before taking duloxetine. Duloxetine is pregnancy risk category C, according to the US Food and Drug Administration (FDA).

FDA pregnancy risk category reference below:

  • A=No risk
  • B=No risk in some studies
  • C=There may be some risk
  • D=Positive evidence of risk
  • X=Contraindicated
  • N=Unknown

Side effects

What side effects can occur from duloxetine?

Get emergency medical help if you have any of these signs of an allergic reaction: skin rash or hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

Call your doctor at once if you have:

  • Nausea, upper stomach pain, itching, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes)
  • Feeling like you might pass out
  • Agitation, hallucinations, fever, fast heart rate, overactive reflexes, vomiting, diarrhea, loss of coordination
  • Very stiff (rigid) muscles, high fever, sweating, confusion, tremors
  • Easy bruising, unusual bleeding
  • Painful or difficult urination
  • Headache, trouble concentrating, memory problems, weakness, feeling unsteady, seizure, shallow breathing or breathing that stops
  • Severe skin reaction — fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain, followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling

Other common side effects may include:

  • Dry mouth
  • Drowsiness
  • Tired feeling
  • Mild nausea or loss of appetite
  • Constipation

Not everyone experiences these side effects. There may be some side effects not listed above. If you have any concerns about a side-effect, please consult your doctor or pharmacist.

Interactions

What drugs may interact with duloxetine?

Duloxetine may interact with other drugs that you are currently taking, which can change how your drug works or increase your risk for serious side effects. To avoid any potential drug interactions, you should keep a list of all the drugs you are using (including prescription drugs, nonprescription drugs, and herbal products) and share it with your doctor and pharmacist. For your safety, do not start, stop, or change the dosage of any drugs without your doctor’s approval.

Products that may interact with this drug are:

  • 5-HT1 receptor agonists (e.g., sumatriptan), buspirone, fentanyl, linezolid, lithium, lorcaserin, MAOIs (e.g., phenelzine, rasagiline), quinidine, SNRIs (e.g., venlafaxine), SSRIs (e.g., fluoxetine, fluvoxamine), St. John’s wort, tramadol, tricyclic antidepressants (e.g., amitriptyline), or tryptophan because severe side effects, such as a reaction that may include fever, rigid muscles, blood pressure changes, mental changes, confusion, irritability, agitation, delirium, or coma, may occur.
  • Anticoagulants (e.g., warfarin), aspirin, or nonsteroidal anti-inflammatory drugs (NSAIDs) (e.g., ibuprofen) because the risk of bleeding, including stomach bleeding, may be increased.
  • Diuretics (e.g., furosemide, hydrochlorothiazide) because the risk of low blood sodium levels may be increased.
  • Cimetidine, medicines for high blood pressure, or quinolone antibiotics (e.g., ciprofloxacin) because they may increase the risk of duloxetine delayed-release capsules’s side effects.
  • Certain antiarrhythmics (e.g., flecainide, propafenone), desipramine, phenothiazines (e.g., chlorpromazine, thioridazine), or theophylline because the risk of their side effects may be increased by duloxetine delayed-release capsules.
  • Tamoxifen because its effectiveness may be decreased by duloxetine delayed-release capsules.

Does food or alcohol interact with duloxetine?

Duloxetine may interact with food or alcohol by altering the way the drug works or increase the risk for serious side effects. Please discuss with your doctor or pharmacist any potential food or alcohol interactions before using this drug.

What health conditions may interact with duloxetine?

Duloxetine may interact with your health condition. This interaction may worsen your health condition or alter the way the drug works. It is important to always let your doctor and pharmacist know all the health conditions you currently have.

Health conditions that may interact with this drug are:

  • Alcohol abuse
  • Kidney disease,
  • Liver disease (including cirrhosis)
  • Bipolar disorder (mood disorder with mania and depression)
  • Bleeding problems
  • Diabetes
  • Digestion problems
  • Glaucoma (angle-closure type)
  • Heart disease
  • Hypertension (high blood pressure)
  • Hyponatremia (low sodium in the blood)
  • Mania
  • Seizures
  • Urinating problems (e.g., urinary retention or trouble urinating)
  • Kidney disease

Dosage

The information provided is not a substitute for any medical advice. You should ALWAYS consult with your doctor or pharmacist before using duloxetine.

What is the dose of duloxetine for an adult?

Usual Adult Dose for Depression

Initial dose: 20 mg orally twice a day.

Maintenance dose: 60 mg per day, given either once a day or as 30 mg orally twice a day.

Maximum dose: 120 mg orally per day.

Duration: Acute episodes generally require several months or more of sustained pharmacological therapy; a periodic review of the need for ongoing maintenance treatment and appropriate dosing is recommended.

Usual Adult Dose for Fibromyalgia

Initial dose: 30 mg orally once a day for 1 week.

Maintenance dose: 30 to 60 mg orally once a day.

Duration: Efficacy has been demonstrated for up to 3 months in placebo-controlled studies; effectiveness beyond this has not been demonstrated in longer studies; therefore, continued treatment should be based on individual patient response.

Usual Adult Dose for Generalized Anxiety Disorder

Initial dose: 60 mg orally once a day, increased in increments of 30 mg once a day if clinically appropriate.

Maintenance dose: 60 to 120 mg orally once a day.

Maximum dose: 120 mg orally once a day.

Duration: Episodes generally require several months or more of sustained pharmacological therapy; a periodic review of the need for ongoing maintenance treatment and appropriate dosing is recommended.

Usual Adult Dose for Pain

Initial dose: 30 to 60 mg orally once a day.

Maintenance dose: 60 mg orally once a day.

Duration:

  • Diabetic peripheral neuropathy pain: Efficacy beyond 12 weeks has not been established; effectiveness should be based on individual patient response.
  • Chronic musculoskeletal pain: Efficacy beyond 13 weeks has not been established.

What is the dose of duloxetine for a child?

Initiate duloxetine at a dose of 30 mg once daily for 2 weeks before considering an increase to 60 mg.

The recommended dose range is 30 to 60 mg once daily. Some patients may benefit from doses above 60 mg once daily.

If a decision is made to increase the dose beyond 60 mg once daily, increase dose in increments of 30 mg once daily.

The maximum dose studied was 120 mg per day. The safety of doses above 120 mg once daily has not been evaluate.

How is duloxetine available?

Duloxetine is available in the following dosage forms and strengths:

  • Capsule Delay Release Particles, Oral: Cymbalta: 20 mg, 30 mg, 60 mg

What should I do in case of an emergency or overdose?

In case of an emergency or an overdose, call your local emergency services or go to your nearest emergency room.

What should I do if I miss a dose?

If you miss a dose of duloxetine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and take your regular dose as scheduled. Do not take a double dose.

Hello Health Group does not provide medical advice, diagnosis or treatment.

Review Date: July 25, 2017 | Last Modified: July 25, 2017

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