Generic Name: Duloxetine Hydrochloride
Brand Names: Cymbalta, Irenka, Drizalma
Drug Class: SNRI, Anti-depressant, Anxiolytic, Neuropathic painkiller
Similar Class Drugs: Desvenlafaxine, Venlafaxine
Available Dosage forms: Delayed-release sprinkle capsule
What is Duloxetine?
Duloxetine is an anti-depressant used to treat major depression and generalized anxiety disorder (GAD) in adults.1 It has a dual affinity for both serotonin and norepinephrine transporters. The inhibitory action on norepinephrine transporters in the pre-frontal cortex allows the upregulation of dopamine in the region.1 It downregulates the activity of the serotonin transporter and delays the uptake of serotonin from synaptic clefts. Raised levels of both serotonin and norepinephrine lead to a reduction in depressive symptoms.
It also helps relieve neuropathic pain by potentiating the activity of serotonergic and noradrenergic neurons. Elevated serotonin and norepinephrine block the incoming pain impulses from the dorsal horn of the spinal cord before they reach the brain.
Duloxetine is considered a first-line drug for the treatment of generalized anxiety disorder.2 Other conditions treated by the drug include:
– Fibromyalgia
– Peripheral neuropathy in diabetics
– Peripheral neuropathy in patients undergoing chemotherapy
– Stress urinary incontinence after prostatectomy
– Chronic musculoskeletal pain
How to use Duloxetine?
The medication is available in capsules of different dosages. It is best to take medicine at the same time each day to prevent skipping doses. You can swallow the capsule with water or break it and release the contents in apple sauce or apple juice.1 The capsule is taken with or without food. Always take it with food if you suffer from stomach upset.
It takes a few weeks for the drug to reach a plasma level that is enough to cause an effect. Do not stop treatment without your doctor’s consent, as this might lead to worsening of side effects and relapse of your condition.
What are the side effects of Duloxetine?
Following are the usual side effects of Duloxetine:
– Headache
– Drowsiness
– GI effects (constipation, nausea, diarrhea, loss of appetite)
– Dry mouth
Adverse effects include:
– Serotonin syndrome
– Hepatotoxicity
– Manic episodes
– Hyponatremia
– Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
– Suicidal tendencies (especially in children and adolescents)
Who should not use Duloxetine?
It should be used with caution in:
– Pregnant and breastfeeding women
– Geriatric patients
– Children and young adults
– End-stage renal disease
References
- Dhaliwal JS, Spurling BC, Molla M. Duloxetine. [Updated 2021 Jun 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK549806/
- Carter NJ, McCormack PL. Duloxetine: a review of its use in the treatment of generalized anxiety disorder. CNS Drugs. 2009;23(6):523-41. doi: 10.2165/00023210-200923060-00006. PMID: 19480470.
