Drug Action
Inhibits the re-uptake of serotonin and noradrenaline.
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Drug reference
Inhibits the re-uptake of serotonin and noradrenaline.
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Major depressive disorder ▶BY MOUTH ▶Adult: 60 mg once daily Generalised anxiety disorder ▶BY MOUTH ▶Adult: Initially 30 mg once daily, increased if necessary to 60 mg once daily; maximum 120 mg per day Diabetic neuropathy ▶BY MOUTH ▶Adult: 60 mg once daily, discontinue if inadequate response after 2 months; review treatment at least every 3 months, maximum dose to be given in divided doses; maximum 120 mg per day Moderate to severe stress urinary incontinence ▶BY MOUTH ▶Adult (female): 40 mg twice daily, patient should be assessed for benefit and tolerability after 2–4 weeks, alternatively initially 20 mg twice daily for 2 weeks, this can minimise side effects, then increased to 40 mg twice daily, the patient should be assessed for benefit and tolerability after 2–4 weeks.
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Bleeding disorders. cardiac disease. elderly. history of mania. history of seizures. hypertension (avoid if uncontrolled). raised intra-ocular pressure. susceptibility to angle-closure glaucoma
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CYMBALTA ® Scottish Medicines Consortium (SMC) decisions ▶With oral use for Diabetic neuropathy The Scottish Medicines Consortium has advised (September 2006) that duloxetine (Cymbalta ®) should be restricted for use by specialists when other treatments for diabetic peripheral neuropathic pain are unsuitable or inadequate.
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→Appendix 1: duloxetine
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▶Common or very common Anxiety. appetite decreased. constipation. diarrhoea. dizziness. drowsiness. dry mouth. fall. fatigue. flushing. gastrointestinal discomfort . gastrointestinal disorders. headache. muscle complaints . nausea. pain. palpitations. paraesthesia. sexual dysfunction. skin reactions. sleep disorders. sweat Nervous system changes. tinnitus. tremor. urinary disorders. vision disorders. vomiting. weight changes. yawning ▶Uncommon Apathy. arrhythmias. behaviour abnormal. burping. chills. concentration impaired. disorientation. dysphagia. ear pain. feeling abnormal. gait abnormal. haemorrhage. hepatic disorders. hyperglycaemia. increased risk of infection. malaise. menstrual disorder. movement disorders. mydriasis. peripheral coldness. photosensitivity reaction. postural hypotension. suicidal tendencies. syncope. taste altered. temperature sensation altered. testicular pain. thirst. throat tightness. vertigo ▶Rare or very rare Angioedema. cutaneous vasculitis. dehydration. galactorrhoea. glaucoma. hallucination. hyperprolactinaemia. hypertensive crisis. hyponatraemia . hypothyroidism. mania. menopausal symptoms. oral disorders. seizure. serotonin syndrome. SIADH. Stevens- Johnson syndrome. urine odour abnormal SIDE-EFFECTS, FURTHER INFORMATION Symptoms of sexual dysfunction may persist after treatment has stopped.
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Toxicity in animal studies—avoid in patients with stress urinary incontinence; in other conditions use only if potential benefit outweighs risk. Risk of neonatal withdrawal symptoms if used near term.
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Present in milk—manufacturer advises avoid.
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Manufacturer advises avoid.
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Avoid if eGFR less than 30 mL/minute/1.73 m2.
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There can be variation in the licensing of different medicines containing the same drug. Gastro-resistant capsule CAUTIONARY AND ADVISORY LABELS 2 ▶Duloxetine (Non-proprietary) Duloxetine (as Duloxetine hydrochloride) 20 mg Duloxetine 20mg gastro-resistant capsules | 28 capsule P £18.48 DT = £2.56 Duloxetine (as Duloxetine hydrochloride) 30 mg Duloxetine 30mg gastro-resistant capsules | 28 capsule P £22.40 DT = £1.63 Duloxetine (as Duloxetine hydrochloride) 40 mg Duloxetine 40mg gastro-resistant capsules | 56 capsule P £36.96 DT = £4.57 Duloxetine (as Duloxetine hydrochloride) 60 mg Duloxetine 60mg gastro-resistant capsules | 28 capsule P £27.72 DT = £2.33 ▶Cymbalta (Eli Lilly and Company Ltd) Duloxetine (as Duloxetine hydrochloride) 30 mg Cymbalta 30mg gastro-resistant capsules | 28 capsule P £22.40 DT = £1.63 Duloxetine (as Duloxetine hydrochloride) 60 mg Cymbalta 60mg gastro-resistant capsules | 28 capsule P £27.72 DT = £2.33 ▶Depalta (Disposable Medical Equipment Ltd) Duloxetine (as Duloxetine hydrochloride) 30 mg Depalta 30mg gastro-resistant capsules | 28 capsule P £2.95 DT = £1.63 Duloxetine (as Duloxetine hydrochloride) 60 mg Depalta 60mg gastro-resistant capsules | 28 capsule P £4.25 DT = £2.33 ▶Duciltia (Aristo Pharma Ltd) Duloxetine (as Duloxetine hydrochloride) 30 mg Duciltia 30mg gastro-resistant capsules | 28 capsule P £22.40 DT = £1.63 Duloxetine (as Duloxetine hydrochloride) 60 mg Duciltia 60mg gastro-resistant capsules | 28 capsule P £27.72 DT = £2.33 ▶Dutor (Torrent Pharma (UK) Ltd) Duloxetine (as Duloxetine hydrochloride) 20 mg Dutor 20mg gastro-resistant capsules | 28 capsule P £18.48 DT = £2.56 Duloxetine (as Duloxetine hydrochloride) 30 mg Dutor 30mg gastro-resistant capsules | 28 capsule P £22.40 DT = £1.63 Duloxetine (as Duloxetine hydrochloride) 40 mg Dutor 40mg gastro-resistant capsules | 56 capsule P £36.96 DT = £4.57 Duloxetine (as Duloxetine hydrochloride) 60 mg Dutor 60mg gastro-resistant capsules | 28 capsule P £27.72 DT = £2.33 ▶Yentreve (Eli Lilly and Company Ltd) Duloxetine (as Duloxetine hydrochloride) 20 mg Yentreve 20mg gastro-resistant capsules | 28 capsule P £18.48 DT = £2.56 Duloxetine (as Duloxetine hydrochloride) 40 mg Yentreve 40mg gastro-resistant capsules | 56 capsule P £36.96 DT = £4.57
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Nausea, vomiting, headache, anxiety, dizziness, paraesthesia, sleep disturbances, and tremor are the most common features of abrupt withdrawal or marked reduction of the dose; dose should be reduced over at least 1–2 weeks.
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60 mg once daily
First-line fragment. Read the complete Indications and Dose section above.
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Initially 30 mg once daily, increased if necessary
First-line fragment. Read the complete Indications and Dose section above.
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60 mg once daily, discontinue if inadequate
First-line fragment. Read the complete Indications and Dose section above.
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40 mg twice daily, patient should be
First-line fragment. Read the complete Indications and Dose section above.
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