Top 300 Pharmacy Drug Cards

DULOXETINE: Cymbalta

Class: Serotonin/Norepinephrine Reuptake Inhibitor

Dosage Forms. Capsule, Delayed Release: 20 mg, 30 mg, 60 mg

Common FDA Label Indication, Dosing, and Titration.

1. Anxiety: 60 mg po daily, may titrate to 120 mg po daily

2. Depression: 20-30 mg po bid, may titrate to 120 mg po daily

3. Diabetic peripheral neuropathy pain, fibromyalgia, musculoskeletal pain: 60 mg po daily, may titrate to 120 mg po daily

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Off-Label Uses.

1. Urinary incontinence: 40 mg po bid

MOA. Duloxetine is a selective serotonin and norepinephrine reuptake inhibitor that exerts its antidepressant and pain inhibitory actions by potentiating the serotonergic and noradrenergic activity in the CNS. It has no significant affinity for adrenergic, dopaminergic, cholinergic, opioid, glutamate, or histaminergic receptors in vitro and does not inhibit monoamine oxidase.

Drug Characteristics: Duloxetine

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Medication Safety Issues: Duloxetine

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Drug Interactions: Duloxetine

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Adverse Reactions: Duloxetine

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Efficacy Monitoring Parameters. Improvement in symptoms of depression, pain, or anxiety.

Toxicity Monitoring Parameters. Worsening of depression, suicidality, or unusual changes in behavior; monitor BP, CBC, electrolytes, and LFTs at baseline and periodically during therapy; ocular pressure and mydriasis.

Key Patient Counseling Points. Report withdrawal symptoms (eg, dysphoric mood, irritability, agitation, sensory disturbances), especially during abrupt discontinuation of therapy. Drug may cause hepatotoxicity and increased risk of bleeding (gastrointestinal, ecchymoses, epistaxis, petechiae). May require 1-4 wk for improvement. Report worsening depression, suicidal ideation, or unusual changes in behavior, especially at initiation of therapy or with dose changes. Children at higher risk for these effects during the first few months of therapy. Patient should watch for signs/symptoms of bleeding events and hepatotoxicity. Avoid alcohol. Monitor carefully if on concurrent meds that alter coagulation.

Clinical Pearls. Duloxetine not approved for use in children.