Dulin

Indications

Duloxetine is a capsule used for:

• Depression (major depressive disorder)
• Generalised anxiety disorder (long-lasting, hard-to-control worry)
• Nerve pain caused by diabetes (diabetic peripheral neuropathic pain)
• Fibromyalgia and some types of long-term muscle and joint pain, such as low back pain or knee osteoarthritis

How It Works

Duloxetine raises the levels of two natural brain chemicals, serotonin and noradrenaline, by stopping nerve cells from taking them back up too quickly. This helps lift mood, ease anxiety and reduce how strongly pain signals are felt. It usually takes 2 to 4 weeks to notice the full benefit.

Dosage and Administration

• Depression: usually 60 mg once a day. Some people start with 30 mg once a day for a week to reduce nausea.
• Anxiety: usually 30 to 60 mg once a day; the doctor may increase it if needed.
• Diabetic nerve pain: usually 60 mg once a day.
• Fibromyalgia and long-term muscle pain: usually 30 mg once a day for a week, then 60 mg once a day.

Swallow the capsule whole with water, with or without food; do not crush, chew or open it. Do not stop taking it suddenly; the doctor will lower the dose slowly over at least 2 weeks. It is not usually used in children unless a specialist prescribes it.

Interactions

• Do not take with MAO inhibitor antidepressants (such as Selegiline or Moclobemide), Linezolid or Methylene Blue. At least 14 days must pass after stopping an MAO inhibitor before starting Duloxetine, and 5 days after stopping Duloxetine before starting one.
• Fluvoxamine, Ciprofloxacin and Enoxacin can greatly raise Duloxetine levels and should not be taken with it.
• Other medicines that raise serotonin (other antidepressants, Tramadol, Triptans for migraine, St John's wort) increase the risk of serotonin syndrome.
• Aspirin, NSAID painkillers (such as Ibuprofen) and blood thinners (such as Warfarin) increase the risk of bleeding.
• Alcohol increases the risk of liver damage and drowsiness.

Contraindications

• Allergy to Duloxetine
• Taking or recently taking an MAO inhibitor
• Taking Fluvoxamine, Ciprofloxacin or Enoxacin
• Liver disease
• Severe kidney disease
• Uncontrolled narrow-angle glaucoma
• Uncontrolled high blood pressure

Side Effects

Common side effects include nausea, dry mouth, headache, sleepiness or trouble sleeping, dizziness, constipation, loss of appetite, sweating, tiredness and sexual problems. Nausea often eases after the first 1 to 2 weeks.

Get urgent medical help if there is:

• Thoughts of harming yourself, or sudden worsening of mood, agitation or restlessness, especially in the first weeks or after a dose change and in people under 25
• Confusion, fever, sweating, shaking, muscle twitching and a fast heartbeat (possible serotonin syndrome)
• Yellow skin or eyes, dark urine or pain in the upper right belly
• Severe skin rash, blisters, or swelling of the face or throat
• Black stools, vomiting blood or unusual bleeding
• Eye pain with blurred vision, fainting or fits

Pregnancy and Lactation

Discuss with the doctor before or as soon as pregnancy is planned or found. Taking it late in pregnancy can cause withdrawal-like symptoms in the newborn and may raise the risk of heavy bleeding after delivery. Small amounts pass into breast milk; the doctor will weigh up whether to continue. Do not stop suddenly without advice.

Precautions and Warnings

• Blood pressure should be checked, especially at the start.
• Use with care in people with epilepsy, bipolar disorder, glaucoma, bleeding problems or heart disease.
• Older people may develop low blood sodium, causing confusion, weakness or falls.
• It can cause dizziness or sleepiness; do not drive or use machines until you know how it affects you.
• Limit alcohol.
• Stopping suddenly can cause dizziness, "electric shock" feelings, anxiety, nausea and sleep problems.

Overdose

Overdose can cause severe drowsiness, vomiting, fits, a very fast heartbeat, serotonin syndrome and coma, and can be dangerous especially when mixed with other medicines or alcohol. Go to an emergency department straight away and take the pack with you.

Therapeutic Class

Antidepressant, serotonin and noradrenaline reuptake inhibitor (SNRI).

Storage

Store below 30°C in a dry place, away from light, and out of the reach of children.