Duloxetine - Cymbalta®, Yentreve®
Drug Class – Serotonin/Norepinephrine Reuptake Inhibitor (SNRI) – similar to venlafaxine (Effexor®)
Mechanism of Action – duloxetine inhibits serotonin and norepinephrine reuptake and exerts antidepressant and pain inhibitory actions by potentiating the serotonergic and noradrenergic activity in the CNS
Dosage Forms – Oral capsule delayed release 20 mg, 30 mg, 40 mg, 60 mg
Dosing – Depression 20-30 mg po BID or 60 mg once daily (max 120 mg). Peripheral neuropathy, pain, fibromyalgia 60 mg po once daily (max 120 mg). Urinary incontinence 40 mg po BID.
Indications
1.Anxiety
2.Depression
3.Diabetic, peripheral neuropathy pain, fibromyalgia, musculoskeletal pain
4.Urinary incontinence
Duloxetine - Cymbalta®, Yentreve®
Dosage adjustment
•Avoid use in severe hepatic impairment
•Initiate at lower doses in CrCl < 30 mL/min
Contraindications
•Hypersensitivity to duloxetine
•Uncontrolled angle-closure glaucoma
•Within two weeks of MAOI
Warnings
•Suicidality
•Hyponatremia
•Not approved in kids
Pregnancy
•Not recommended in pregnancy – 3rd trimester
•Duloxetine is generally considered safe in breastfeeding
Duloxetine - Cymbalta®, Yentreve®
Drug Interactions
•Anticoagulants, antiplatelets, NSAIDs
•Triptans, SSRIs, tramadol
•Linezolid, TCAs, MAOIs
•CYP2D6 substrates, CYP1A2 and 2D6 inhibitors
Adverse Effects
•Headache, drowsiness, fatigue, nausea, hyponatremia
Monitoring Parameters
•Improvement in symptoms of anxiety, depression, pain and urinary incontinence
•Worsening of depression/suicidality
•BP, CBC, electrolytes
Therapeutic Pearls
•Useful for depressed patients that also present with pain
Duloxetine - Cymbalta®, Yentreve®
Drug Class – Serotonin/Norepinephrine Reuptake Inhibitor (SNRI) – similar to venlafaxine (Effexor®)
Mechanism of Action – duloxetine inhibits serotonin and norepinephrine reuptake and exerts antidepressant and pain inhibitory actions by potentiating the serotonergic and noradrenergic activity in the CNS
Dosage Forms – Oral capsule delayed release 20 mg, 30 mg, 40 mg, 60 mg
Dosing – Depression 20-30 mg po BID or 60 mg once daily (max 120 mg). Peripheral neuropathy, pain, fibromyalgia 60 mg po once daily (max 120 mg). Urinary incontinence 40 mg po BID.
Indications
1.Anxiety
2.Depression
3.Diabetic, peripheral neuropathy pain, fibromyalgia, musculoskeletal pain
4.Urinary incontinence
Duloxetine - Cymbalta®, Yentreve®
Dosage adjustment
•Avoid use in severe hepatic impairment
•Initiate at lower doses in CrCl < 30 mL/min
Contraindications
•Hypersensitivity to duloxetine
•Uncontrolled angle-closure glaucoma
•Within two weeks of MAOI
Warnings
•Suicidality
•Hyponatremia
•Not approved in kids
Pregnancy
•Not recommended in pregnancy – 3rd trimester
•Duloxetine is generally considered safe in breastfeeding
Duloxetine - Cymbalta®, Yentreve®
Drug Interactions
•Anticoagulants, antiplatelets, NSAIDs
•Triptans, SSRIs, tramadol
•Linezolid, TCAs, MAOIs
•CYP2D6 substrates, CYP1A2 and 2D6 inhibitors
Adverse Effects
•Headache, drowsiness, fatigue, nausea, hyponatremia
Monitoring Parameters
•Improvement in symptoms of anxiety, depression, pain and urinary incontinence
•Worsening of depression/suicidality
•BP, CBC, electrolytes
Therapeutic Pearls
•Useful for depressed patients that also present with pain
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