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Cymbalta (Duloxetine)
Generic Name: Duloxetine
Brand Names: Cymbalta, Yentreve
Order Duloxetine (generic Cymbalta)
| Dosage |
Quantity |
Price |
Order |
| Duloxetine 30 mg |
60 capsules |
$42 |
|
| Duloxetine 30 mg |
90 capsules |
$58 |
|
| Duloxetine 30 mg |
180 capsules |
$106 |
|
| Duloxetine 40 mg |
60 capsules |
$52 |
|
| Duloxetine 40 mg |
90 capsules |
$77 |
|
| Duloxetine 40 mg |
180 capsules |
$139 |
|
| Duloxetine 60 mg |
60 capsules |
$74 |
|
| Duloxetine 60 mg |
90 capsules |
$104 |
|
| Duloxetine 60 mg |
180 capsules |
$199 |
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- Payment methods: VISA
- Worldwide shipping: Registered Air Mail
Medical uses:
Duloxetine, a selective serotonin and noradrenaline reuptake inhibitor
(SNRI), was launched for the treatment of major depressive episodes in
January 2005, under the trade name Cymbalta. It has also been licensed
for moderate to severe stress urinary incontinence under the trade name
Yentreve (in Europe). Cymbalta is now licensed for the treatment of
diabetic peripheral neuropathic pain and generalized anxiety disorder (GAD).
Recently, duloxetine was shown to improve cognition, depression, and pain in elderly with recurrent depression.
Contraindications:
- Uncontrolled narrow-angle glaucoma
- MAOI therapy
- Hypersensitivity to duloxetine
Dosage:
ADULTS:
Diabetic peripheral neuropathic pain
60 mg once daily.
Major depressive disorder
40 mg daily (given as 20 mg twice daily) to 60 mg daily (given once daily or as 30 mg twice daily).
Anxiety
30 mg daily for 1 week then increase to 60 mg per day. Dosage increases should be made in increments of 30 mg/day.
Dosages up to 120 mg/day have been studied, however, no greater benefit over 60 mg/day was realized.
CHILDREN:
Safety and efficacy not established.
Side effects:
CNS: somnolence (21%); dizziness (17%); headache (15%); fatigue,
insomnia (13%); asthenia (8%); decreased libido (7%); tremor (5%); agitation (4%).
Gastrointestinal: nausea (38%); constipation, dry mouth (15%); decreased appetite (11%); diarrhea (8%); vomiting (5%).
Genitourinary: delayed ejaculation, erectile dysfunction, anorgasmia (5%).
Other: hyperhidrosis (8%), increased sweating (6%).
Precautions:
- Duloxetine may cause urinary hesitation.
- Renal dysfunction: Not recommended for patients with a CrCl < 30ml/min.
- Hepatotoxicity: Duloxetine should not be given to patients who drink alcohol heavily or who has chronic
liver disease. May markedly increase serum transaminase levels (> 20 times the upper limit of normal).
- Narrow-angle glaucoma: Duloxetine increases
the chances of mydriasis. It should be avoided in patients with uncontrolled narrow-angle glaucoma.
- Blood pressure: Elevations in BP may occur.
Drug interactions:
- Alcohol: avoid, alcohol may increase hepatotoxic potential of duloxetine.
- CYP1A2 inhibitors: (fluvoxamine, ketoconazole, norfloxacin,
ofloxacin, rofecoxib): may increase the levels of duloxetine.
- CYP2D6 inhibitors: (chlorpromazine, delavirdine, miconazole, pergolide, quinidine, quinine, ritonavir,
and ropinirole): may increase the levels of duloxetine.
- Desipramine: duloxetine may increase desipramine levels.
- MAO inhibitors: risk of serotonin syndrome. This combination is contraindicated. Wait 5 days after
discontinuance of duloxetine before initiating MAO inhibitor; wait at least 2 weeks between discontinuance of MAO
inhibitor and initiation of duloxetine.
- SSRIs, SNRIs, Sibutramine, Serotonin agonists (eg, triptans, lithium): risk of serotonin syndrome.
- Thioridazine: duloxetine may increase serum concentrations of thioridazine, which has been associated
with the development of malignant ventricular arrhythmias; use caution.
- Tricyclic antidepressants: serum levels may be increased by duloxetine.
Pregnancy & Lactation
Pregnancy category C
Neonates exposed to duloxetine late in the third trimester may develop complications requiring prolonged
hospitalization, respiratory support, and tube feeding.
Nursing mothers
Duloxetine enters breast milk; not recommended.
References:
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