section name header

Pronunciation

do-LOX-e-teen

Classifications

Therapeutic Classification: antidepressants

Pharmacologic Classification: selective serotonin and norepinephrine reuptake inhibitors-SSNRIs

Indications

BEERS REMS


Action

  • Inhibits serotonin and norepinephrine reuptake in the CNS. Both antidepressant and pain inhibition are centrally mediated.
Therapeutic effects:
  • Decreased depressive symptomatology.
  • Decreased neuropathic pain.
  • Decreased symptoms of anxiety.
  • Decreased pain.

Pharmacokinetics

Absorption: Well absorbed following oral administration.

Distribution: Unknown.

Protein Binding: >90%.

Metabolism/Excretion: Primarily metabolized in the liver via the CYP2D6 and CYP1A2 isoenzymes; the CYP2D6 isoenzyme exhibits genetic polymorphism; 7% of population may be poor metabolizers and may have significantly duloxetine concentrations and an risk of adverse effects.

Half-Life: 12 hr.

Time/Action Profile

(plasma concentrations)

ROUTEONSETPEAKDURATION
POunknown6 hr12 hr





Contraind./Precautions

Contraindicated in:

Use Cautiously in:

Adv. Reactions/Side Effects

CV: hypertension, orthostatic hypotension

Derm: sweating, ERYTHEMA MULTIFORME, pruritus, rash, STEVENS-JOHNSON SYNDROME (SJS)

EENT: intraocular pressure, blurred vision

Endo: SIADH

F and E: hyponatremia

GI: appetite, constipation, dry mouth, nausea, liver enzymes, diarrhea, gastritis, HEPATOTOXICITY, PANCREATITIS, vomiting

GU: dysuria, libido, delayed/absent orgasm, ejaculatory delay/failure, erectile dysfunction, urinary retention

Hemat: BLEEDING

Neuro: drowsiness, fatigue, insomnia, activation of mania, dizziness, fainting, falls, NEUROLEPTIC MALIGNANT SYNDROME, nightmares, SEIZURES, SUICIDAL THOUGHTS, tremor

Misc: SEROTONIN SYNDROME

Interactions

Drug-drug:

Drug-Natural Products:

Route/Dosage

Major Depressive Disorder

Generalized Anxiety Disorder

Diabetic Peripheral Neuropathic Pain

Fibromyalgia

Chronic Musculoskeletal Pain

Availability

(Generic available)

Assessment

Lab Test Considerations:

Implementation

Patient/Family Teaching

Evaluation/Desired Outcomes

US Brand Names

Cymbalta

Pill Image

duloxetine_195-8569.jpg