Adult Dosing
Major depressive disorder (MDD)
- 40-60 mg/day PO divided Daily-bid; may start 30 mg PO qd x 1 wk in some patients
- Increase dose in 30 mg increments
- Max: 120 mg/day
- Note: Doses > 60 mg/day rarely more effective, may increase adverse event risk
Generalized anxiety disorder
- 60 mg PO Daily; may start 30 mg PO qd x 1 wk in some patients if tolerability concern
- Increase dose in 30 mg increments
- Max: 120 mg/day
- Note: Doses > 60 mg/day rarely more effective, may increase adverse event risk
Diabetic neuropathy
- 60 mg PO Daily; may start 30 mg PO Daily x 1 wk in some patients if tolerability concern
- Increase dose in 30 mg increments
- Max: 120 mg/day
- Note: Doses > 60 mg/day rarely more effective, may increase adverse event risk
Fibromyalgia, Chronic musculoskeletal pain
- Start 30 mg PO Daily x 1wk; increase to 60 mg PO Daily
- Max: 120 mg/day
- Note: Doses > 60 mg/day rarely more effective, may increase adverse event risk
Obsessive-compulsive disorder [Non-FDA Approved]
Pediatric Dosing
- Safety and effectiveness in peditric population has not been established
[Outline]
Renal Dose Adjustment (Basded on CrCl)
- 30-80 mL/min: Use lower starting dose and gradual titration in diabetics
- < 30 mL/min: Avoid use
Hepatic Dose Adjustment
- Hepatic impairment: Contraindicated
- Advise family members for need for close supervision. Monitor for clinical worsening, suicidality, and unusual changes in behavior, especially during the initial few months of a course of drug therapy, or at times of dose changes
- Hepatic failure, sometimes fatal, presenting as hepatitis with abdominal pain, hepatomegaly, and elevated transaminases levels have been reported. Discontinue duloxetine in patients who develop jaundice, or other evidence of clinically significant liver dysfunction
- Orthostatic hypotension and syncope have been reported with therapeutic doses
- Serotonin syndrome or neuroleptic malignant syndrome, which includes hyperthermia, muscle rigidity, autonomic instability and mental status changes, has been reported with SNRI and SSRIs
- Concomitant use of duloxetine with MAOIs intended to treat depression is contraindicated
- Duloxetine may increase risk of bleeding events. Bleeding events, ranging from ecchymosis, hematoma, epistaxis, petechiae, and life-threatening hemorrhage, may occur. Concomitant use of aspirin, NSAIDs, and warfarin increases the risk
- Neonates exposed to duloxetine late in the third trimester may develop complications requiring prolonged hospitalization, respiratory support, and tube feeding
- Hyponatremia and SIADH have been reported and appear to be reversible when duloxetine is discontinued
- Activation of mania-hypomania may occur
- Taper gradually to discontinue
- Duloxetine may cause urinary retention. Rare instances of hospitalization and/or catheterization due to urinary retention have occured
Cautions: Use cautiously in
- Renal impairment (CrCl < 30 mL/min)
- Hepatic impairment
- Diabetes mellitus
- Hypertension
- Hyponatremia
- Volume depletion
- Dehydration
- Concomitant administration of diuretics
- History of seizure disorder
- History of mania/hypomania
- Co administration of NSAID's (may increase risk of bleeding)
- Bleeding risk
- GI motility disorder
- Glaucoma, controlled angle-closure
- Obstructive uropathy
- Smoking habit changes
- Pts <25 yo
- Elderly pts
- Pregnancy (3rd trimester)
- Lactation
Pregnancy Category:C. Avoid exposure in third trimester.
Breastfeeding: Breastfeeding while on Cymbalta is not recommended.
Pricing data from www.DrugStore.com in U.S.A.
- Cymbalta 60 MG CPEP [Bottle] (LILLY)
30 mg = $181.98
90 mg = $509.96 - Cymbalta 30 MG CPEP [Bottle] (LILLY)
30 mg = $181.98
90 mg = $516
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
