Duloxen 20 mg

Description

Indications

Duloxen is a serotonin-norepinephrine reuptake inhibitor (SNRI) prescribed for the treatment of the following conditions:

• Major Depressive Disorder (MDD)
• Generalized Anxiety Disorder (GAD)
• Diabetic Peripheral Neuropathic Pain (DPNP)
• Fibromyalgia
• Chronic Musculoskeletal Pain

Take the medication according to the advice of a registered physician.

Pharmacology

Duloxetine Hydrochloride is an SNRI intended for oral administration. It primarily works by inhibiting the reuptake of serotonin and norepinephrine, with a weaker effect on dopamine reuptake. Duloxetine does not significantly interact with dopaminergic, adrenergic, cholinergic, histaminergic, opioid, glutamate, or GABA receptors in vitro. It does not inhibit monoamine oxidase (MAO). When taken orally, Duloxetine is well absorbed and metabolized primarily by the liver.

Dosage & Administration

• Major Depressive Disorder (MDD):
  Starting Dose: 40 mg/day to 60 mg/day
  Target Dose: Acute: 40 mg/day (20 mg twice daily) to 60 mg/day (once daily or 30 mg twice daily); Maintenance: 60 mg/day
  Maximum Dose: 120 mg/day

• Generalized Anxiety Disorder (GAD):
  Starting Dose: 60 mg/day
  Target Dose: 60 mg/day (once daily)
  Maximum Dose: 120 mg/day

• Diabetic Peripheral Neuropathic Pain (DPNP):
  Starting Dose: 60 mg/day
  Target Dose: 60 mg/day (once daily)
  Maximum Dose: 60 mg/day

• Fibromyalgia:
  Starting Dose: 30 mg/day
  Target Dose: 60 mg/day (once daily)
  Maximum Dose: 60 mg/day

• Chronic Musculoskeletal Pain:
  Starting Dose: 30 mg/day
  Target Dose: 60 mg/day (once daily)
  Maximum Dose: 60 mg/day

For some patients, starting at 30 mg once daily may be beneficial. There is no evidence that doses higher than 60 mg/day offer additional benefits, and some side effects are dose-dependent. A gradual reduction in dosage is recommended to prevent discontinuation symptoms.

Take the medication according to the advice of a registered physician.

Interactions

Duloxen is metabolized by the CYP1A2 and CYP2D6 isozymes. When used with fluvoxamine, a potent CYP1A2 inhibitor, Duloxen’s absorption and concentration (AUC, Cmax, and t) can be increased. Other drugs, such as cimetidine and certain quinolone antibiotics (e.g., ciprofloxacin and enoxacin), may have similar effects, so co-administration should be avoided. Inhibition of CYP2D6 may lead to increased Duloxen concentrations when used together with potent CYP2D6 inhibitors.

Contraindications

Duloxen should not be used in patients with a known hypersensitivity to this drug or its ingredients. It is not approved for the treatment of bipolar depression. Patients with significant alcohol consumption or chronic liver disease should not use Duloxen. There is an increased risk of mydriasis (pupil dilation) in clinical trials, so it should be used cautiously in patients with narrow-angle glaucoma.

Side Effects

The most common side effects of Duloxen include nausea, dizziness, dry mouth, constipation, reduced appetite, fatigue, drowsiness, excessive sweating, hyperhidrosis, and weakness. It may cause a slight increase in blood pressure. No significant differences in QT, PR, and QRS intervals were observed between Duloxen-treated and placebo-treated patients.

Pregnancy & Lactation

• Pregnancy: Category C. No well-controlled studies exist for pregnant women, so Duloxen should only be used if the potential benefit justifies the possible risk to the fetus.
• Labor and Delivery: The effects of Duloxen on labor and delivery are unknown. It should only be used during labor if the potential benefits outweigh the risks.
• Lactation: It is unknown whether Duloxen and its metabolites pass into human breast milk. Therefore, nursing while taking Duloxen is not recommended.

Precautions & Warnings

Patients using antidepressants for any condition should be closely monitored for worsening symptoms, suicidality, or unusual behavioral changes, especially during the initial months of treatment or after dose adjustments. Blood pressure should be checked before starting treatment and regularly monitored throughout. Be cautious when using Duloxen with NSAIDs, aspirin, or other blood-thinning medications. It should be used cautiously in patients with a history of mania or seizure disorders.

Use in Special Populations

• Pediatric Use: Safety and effectiveness have not been established in children.
• Overdose: There is limited clinical experience with Duloxen overdose. In case of overdose, general supportive measures, such as maintaining airway, oxygenation, and vital signs monitoring, should be employed. Activated charcoal may help limit Duloxen absorption if administered soon after ingestion.

Therapeutic Class

Serotonin-norepinephrine reuptake inhibitor (SNRI)

Storage Conditions

Store below 30°C, away from light, and out of reach of children.