Withdrawal symptoms have been reported with abrupt discontinuation or tapering of duloxetine and have included abnormal dreams, headache, insomnia, dizziness, nausea/vomiting, paresthesia, irritability, fatigue, diarrhea, anxiety, vertigo, hyperhidrosis, and a small increase in recumbent heart rate. Phase IV trials are used to detect adverse . Patients should be assessed periodically for medication effects on urinary incontinence as well as lower urinary tract symptoms and treatment tolerability. Clozapine: (Moderate) Duloxetine is an inhibitor of CYP2D6 and CYP1A2, two of the isoenzymes responsible for the metabolism of clozapine. Aspirin, ASA; Butalbital; Caffeine; Codeine: (Moderate) Careful monitoring, particularly during treatment initiation and dose adjustment, is recommended during coadministration of codeine and duloxetine because of the potential risk of serotonin syndrome, reduced codeine efficacy, and potential for opioid withdrawal symptoms. Quinapril; Hydrochlorothiazide, HCTZ: (Moderate) Orthostatic hypotension and syncope have been reported during duloxetine administration. Acetaminophen; Chlorpheniramine; Dextromethorphan: (Moderate) Because of the potential risk and severity of serotonin syndrome, caution should be observed when administering dextromethorphan with duloxetine. More severe symptoms such as confusion, hypomanic episode, and seizures have been reported following discontinuation of other SNRIs and similar medications. Concurrent use may result in increased duloxetine exposure resulting in excessive serotonin activity. During non-emergent use of methylene blue, the SNRI should be stopped at least 2 weeks prior to methylene blue treatment, but also taking into consideration the half-life of the SNRI being discontinued. Hydrocodone; Pseudoephedrine: (Moderate) Careful monitoring, particularly during treatment initiation and dose adjustment, is recommended during coadministration of hydrocodone and duloxetine because of the potential risk of serotonin syndrome and prolonged opioid adverse reactions. Duloxetine has not been systematically evaluated in patients with a seizure disorder, and such patients were excluded from clinical studies. In a pooled analysis of placebo-controlled trials of antidepressants (n = 4,500 pediatrics and 77,000 adults), there was an increased risk for suicidal thoughts and behaviors in patients 24 years of age and younger receiving an antidepressant versus placebo, with considerable variation in the risk of suicidality among drugs. It is advisable to monitor blood pressure if the combination is necessary. Recommended Dosage in Adults Less than 65 Years of Age. Duloxetine should be discontinued in patients who develop jaundice or other evidence of clinically significant liver dysfunction and should not be resumed unless another cause can be established. Serotonin syndrome is characterized by rapid development of hyperthermia, hypertension, myoclonus, rigidity, autonomic instability, mental status changes (e.g., delirium or coma), and in rare cases, death. Cobicistat is a substrate/inhibitor of CYP2D6. The penis receives a large flow of blood, swells, and hardens. The patient experienced disorientation, a mildly elevated temperature, tachycardia, elevated blood pressure, mild agitation, and nystagmus. Concomitant use increases the risk for hypotension, including orthostatic hypotension and syncope. Desipramine: (Moderate) Monitor for an increase in tricyclic antidepressant-related adverse reactions and signs and symptoms of serotonin syndrome if coadministration with duloxetine is necessary, particularly during treatment initiation and dosage increases; a dose reduction of the tricyclic antidepressant may be necessary. Cymbalta:- Store between 68 to 77 degrees F, excursions permitted 59 to 86 degrees FDrizalma:- Store at 77 degrees F; excursions permitted to 68 to 77 degrees FIrenka:- Store at 77 degrees F; excursions permitted to 68 to 77 degrees F. Avoid abrupt discontinuation of duloxetine if possible. Monitor blood pressure if the combination is necessary. Disulfiram: (Moderate) Co-administration of duloxetine and potent inhibitors of CYP1A2 should be avoided. Procarbazine: (Major) Concurrent use of procarbazine and serotonin norepinephrine reuptake inhibitors (SNRIs) should be avoided if possible. Patients should be instructed to monitor for signs and symptoms of bleeding while taking an SNRI with medications which impair platelet function and to promptly report any bleeding events to the practitioner. It is advisable to monitor blood pressure if the combination is necessary. Decreased metabolism of asenapine may lead to adverse reactions such as extrapyramidal symptoms. Hydralazine; Isosorbide Dinitrate, ISDN: (Moderate) Monitor blood pressure during concomitant duloxetine and hydralazine use. Propranolol: (Moderate) Monitor blood pressure during concomitant duloxetine and propranolol use. Rolapitant: (Major) Use caution if duloxetine and rolapitant are used concurrently, and monitor for duloxetine-related adverse effects. Nevertheless, if a decision is made to increase the dosage beyond 60 mg once daily, increase dosage in increments of 30 mg once daily. Do not use CYMBALTA information for CYMBALTA. The concomitant use of opioids with other drugs that affect the serotonergic neurotransmitter system has resulted in serotonin syndrome. While a 120 mg once daily dosage was shown to be effective, there is no evidence that doses greater than 60 mg/day confer additional benefit. Monitor blood pressure if the combination is necessary. Valerian, Valeriana officinalis: (Moderate) The German Commission E and other groups warn that any substances that act on the CNS, including psychopharmacologic agents, may interact with the phytomedicinal valerian, Valeriana officinalis. Epidemiological studies have demonstrated an association between use of psychotropic drugs that interfere with serotonin reuptake and the occurrence of upper gastrointestinal bleeding. Duloxetine is a moderate inhibitor of CYP2D6. Data are inadequate to determine whether the chronic use of SNRIs causes long-term growth inhibition; however, decreased weight gain has been observed in children and adolescents receiving duloxetine. Concomitant use increases the risk for hypotension, including orthostatic hypotension and syncope. Epidemiological studies have demonstrated an association between use of psychotropic drugs that interfere with serotonin reuptake and the occurrence of upper gastrointestinal bleeding. The concurrent administration of antihypertensive agents and duloxetine may increase the risk of hypotension. Penbutolol: (Moderate) Orthostatic hypotension and syncope have been reported during duloxetine administration. Case reports and epidemiological studies have demonstrated an association between use of drugs that interfere with serotonin reuptake and gastrointestinal bleeding. The concurrent administration of antihypertensive agents and duloxetine may increase the risk of hypotension. Patients should be instructed to monitor for signs and symptoms of bleeding while taking an SNRI with a platelet inhibitor and to promptly report any bleeding events to the practitioner. In terms of maternal risk, exposure to SNRIs in mid to late pregnancy may increase the risk of eclampsia and use near obstetric delivery may increase the risk for postpartum hemorrhage. Clinically significant interactions have been reported when doxorubicin was coadministered with inhibitors of CYP2D6, resulting in increased concentration and clinical effect of doxorubicin. Tedizolid: (Minor) Use caution with the concurrent use of tedizolid and serotonin norepinephrine reuptake inhibitors (SNRIs) due to the theoretical risk of serotonin sydrome. Serotonin syndrome is characterized by rapid development of hyperthermia, hypertension, myoclonus, rigidity, autonomic instability, mental status changes (e.g., delirium or coma), and in rare cases, death. Tricyclic antidepressants are CYP2D6 substrates and duloxetine is a CYP2D6 inhibitor. Selegiline: (Contraindicated) Serotonin norepinephrine reuptake inhibitors (SNRIs) are contraindicated for use with selegiline, a selective monoamine oxidase type B inhibitor (MAO-B inhibitor). Carbinoxamine; Dextromethorphan; Pseudoephedrine: (Moderate) Because of the potential risk and severity of serotonin syndrome, caution should be observed when administering dextromethorphan with duloxetine. If duloxetine is discontinued, monitor the patient carefully and consider increasing the opioid dosage if appropriate. The concurrent administration of antihypertensive agents and duloxetine may increase the risk of hypotension. While a 120 mg/day dose was shown to be effective, there is no evidence that doses more than 60 mg/day confer any additional benefits. Inform patients taking this combination of the possible increased risk and monitor for the emergence of serotonin syndrome particularly during treatment initiation and dose adjustment. Codeine is primarily metabolized by CYP2D6 to morphine, and by CYP3A4 to norcodeine; norcodeine does not have analgesic properties. Indomethacin: (Moderate) Monitor for signs and symptoms of bleeding during concomitant duloxetine and nonsteroidal antiinflammatory drug (NSAID) use due to increased risk for bleeding. In a separate case, a patient who had been receiving venlafaxine developed expressive aphasia, confusion, and disinhibition following a methylene blue infusion. Methyldopa: (Moderate) Monitor blood pressure during concomitant duloxetine and central-acting adrenergic agent use. The concomitant use of serotonergic drugs increases the risk of serotonin syndrome. Monitor blood pressure if the combination is necessary. The authors concluded that methylene blue toxicity had occurred; however, they did not exclude the possibility of a drug interaction based upon previous reports of an interaction between injectable methylene blue and selective serotonin reuptake inhibitors (SSRIs). Monitor patients for serotonin syndrome if concomitant use is necessary. The concurrent administration of antihypertensive agents and duloxetine may increase the risk of hypotension. Duloxetine has been studied for the treatment of SUI in several randomized, controlled clinical trials worldwide, and is approved for this use in several European countries. The concurrent administration of antihypertensive agents and duloxetine may increase the risk of hypotension. The recommended CYMBALTA dosage is 60 mg once daily in adults with fibromyalgia. Monitor blood pressure if the combination is necessary. Nadolol: (Moderate) Orthostatic hypotension and syncope have been reported during duloxetine administration. If duloxetine is discontinued, consider a dose reduction of tramadol and frequently monitor for signs of respiratory depression and sedation. Amlodipine; Celecoxib: (Moderate) Monitor for signs and symptoms of bleeding during concomitant duloxetine and nonsteroidal antiinflammatory drug (NSAID) use due to increased risk for bleeding. Discontinuation of duloxetine could decrease dihydrocodeine plasma concentrations and increase dihydromorphine plasma concentrations resulting in prolonged opioid adverse reactions, including hypotension, respiratory depression, profound sedation, coma, and death. Morphine; Naltrexone: (Moderate) If concomitant use of morphine and serotonin norepinephrine reuptake inhibitors is warranted, monitor patients for the emergence of serotonin syndrome. Steady-state concentrations typically occur after 3 days of dosing. The concurrent administration of bisoprolol and duloxetine may increase the risk of hypotension. Tamsulosin: (Moderate) Use caution if coadministration of duloxetine with tamsulosin is necessary, especially at a tamsulosin dose higher than 0.4 mg, as the systemic exposure of tamsulosin may be increased resulting in increased treatment-related adverse reactions including hypotension, dizziness, and vertigo. Thrombolytic Agents: (Moderate) Platelet aggregation may be impaired by serotonin norepinephrine reuptake inhibitors (SNRIs) due to platelet serotonin depletion, possibly increasing the risk of a bleeding complication (e.g., gastrointestinal bleeding, ecchymoses, epistaxis, hematomas, petechiae, hemorrhage) in patients receiving thrombolytic agents. Clinicians should closely monitor patients for the development of methemoglobinemia when a combination local anesthetic is used during a procedure. Duloxetine is a CYP2D6 substrate and bupropion is a strong CYP2D6 inhibitor. Monitor patients closely at frequent intervals and consider a dosage increase of codeine until stable drug effects are achieved. Palonosetron: (Major) Because of the potential risk and severity of serotonin syndrome, use caution when administering palonosetron with other drugs that have serotonergic properties such as duloxetine. Cases of serotonin syndrome have been reported when mirtazapine has been administered with other serotonergic antidepressants. The concurrent administration of carteolol and duloxetine may increase the risk of hypotension. The concurrent administration of antihypertensive agents and duloxetine may increase the risk of hypotension. Aspirin, ASA; Citric Acid; Sodium Bicarbonate: (Moderate) Platelet aggregation may be impaired by serotonin norepinephrine reuptake inhibitors (SNRIs) due to platelet serotonin depletion, possibly increasing the risk of a bleeding complication (e.g., gastrointestinal bleeding, ecchymoses, epistaxis, hematomas, petechiae, hemorrhage) in patients receiving aspirin, ASA or other salicylates which affect hemostasis. Aspirin, ASA; Caffeine: (Moderate) Platelet aggregation may be impaired by serotonin norepinephrine reuptake inhibitors (SNRIs) due to platelet serotonin depletion, possibly increasing the risk of a bleeding complication (e.g., gastrointestinal bleeding, ecchymoses, epistaxis, hematomas, petechiae, hemorrhage) in patients receiving aspirin, ASA or other salicylates which affect hemostasis. The reporting rate of SJS associated with duloxetine use exceeds the general population background incidence rate for this serious skin reaction (1 to 2 cases per million person years). Perindopril; Amlodipine: (Moderate) Orthostatic hypotension and syncope have been reported during duloxetine administration. 60 mg PO once daily, initially. 60 mg PO once daily. Clinicians should closely monitor patients for the development of methemoglobinemia when a combination local anesthetic is used during a procedure. A pooled analysis found that maternal use of sertraline, along with nortriptyline and paroxetine, usually produced undetectable or low drug concentrations in infant serum and, therefore, may be the preferred antidepressants in breast-feeding mothers. Esmolol: (Moderate) Orthostatic hypotension and syncope have been reported during duloxetine administration. If serotonin syndrome occurs, consider discontinuation of therapy. A major cause of adverse reactions appears to be excessive plasma concentrations, which may be due to accidental intravascular administration, slow metabolic degradation, or overdosage. Desirudin: (Moderate) Advise patients of the increased bleeding risk associated with the concomitant use of serotonin norepinephrine reuptake inhibitors (SNRIs) and anticoagulants like desirudin. It is advisable to monitor blood pressure if the combination is necessary. At high doses, amphetamines can increase serotonin release, as well as act as serotonin agonists. Discontinue all serotonergic agents and initiate symptomatic treatment if serotonin syndrome occurs. The toxic effects of local anesthetics are additive. Dibucaine: (Moderate) Caution is advised if combining local anesthetics. The concurrent administration of antihypertensive agents and duloxetine may increase the risk of hypotension. How long does it take for Cymbalta to work? Tenecteplase: (Moderate) Platelet aggregation may be impaired by serotonin norepinephrine reuptake inhibitors (SNRIs) due to platelet serotonin depletion, possibly increasing the risk of a bleeding complication (e.g., gastrointestinal bleeding, ecchymoses, epistaxis, hematomas, petechiae, hemorrhage) in patients receiving thrombolytic agents. In addition, iloperidone is associated with a risk for QT prolongation and torsade de pointes (TdP) and should be used cautiously with CYP2D6 inhibitors such as duloxetine. Monitor blood pressure if the combination is necessary. Haloperidol is associated with a possible risk of QT prolongation and should be used cautiously with CYP2D6 inhibitors such as duloxetine. Monitor patients closely at frequent intervals and consider a dosage increase of dihydrocodeine until stable drug effects are achieved. Codeine is primarily metabolized by CYP2D6 to morphine, and by CYP3A4 to norcodeine; norcodeine does not have analgesic properties. Pimozide is metabolized primarily through CYP3A4, and to a lesser extent CYP1A2 and CYP2D6. Betrixaban: (Moderate) Advise patients of the increased bleeding risk associated with the concomitant use of serotonin norepinephrine reuptake inhibitors (SNRIs) and anticoagulants like betrixaban. Epidemiological studies have demonstrated an association between use of psychotropic drugs that interfere with serotonin reuptake and the occurrence of upper gastrointestinal bleeding. Leflunomide: (Moderate) Closely monitor for reduced efficacy of duloxetine if coadministered with leflunomide. Hydrocodone is a substrate for CYP2D6. Also use duloxetine with caution in patients with preexisting hypertension, as duloxetine use has been associated with mild increases in heart rate and blood pressure during clinical study of doses within the usual dosage range. Duloxetine is well-absorbed following oral administration. If combination treatment is required, patients should be carefully observed, particularly during treatment initiation and during dose adjustments of the serotonergic drug; discontinue buprenorphine if serotonin syndrome is suspected. Diclofenac; Misoprostol: (Moderate) Monitor for signs and symptoms of bleeding during concomitant duloxetine and nonsteroidal antiinflammatory drug (NSAID) use due to increased risk for bleeding. Nebivolol: (Moderate) Monitor for increased toxicity as well as increased therapeutic effect of nebivolol if coadministered with duloxetine; adjust the nebivolol dose according to blood pressure response. Cobicistat is a substrate/inhibitor of CYP2D6. 10. Some patients may benefit from doses above 60 mg once daily. In two clinical studies, the average increase in AUC of the CYP1A2 substrate theophylline was 7% (range: 1% to 15%) and 20% (range: 13% to 27%) when coadministered with duloxetine 60 mg twice daily. Valdecoxib: (Moderate) Monitor for signs and symptoms of bleeding during concomitant duloxetine and nonsteroidal antiinflammatory drug (NSAID) use due to increased risk for bleeding. Ticagrelor: (Moderate) Platelet aggregation may be impaired by serotonin norepinephrine reuptake inhibitors (SNRIs) due to platelet serotonin depletion, possibly increasing the risk of a bleeding complication (e.g., gastrointestinal bleeding, ecchymoses, epistaxis, hematomas, petechiae, hemorrhage) in patients receiving platelet inhibitors (e.g., cilostazol, clopidogrel, dipyridamole, ticlopidine, platelet glycoprotein IIb/IIIa inhibitors). Angiotensin-converting enzyme inhibitors: (Moderate) Orthostatic hypotension and syncope have been reported during duloxetine administration. Duloxetine affects chemicals in the brain that may be unbalanced in people with depression. Phenothiazines are CYP2D6 substrates, and SNRIs including duloxetine are CYP2D6 inhibitors. Serotonin syndrome, in its most severe form, can resemble neuroleptic malignant syndrome. CrCl 30 mL/minute or more: No dosage adjustments are required.CrCl less than 30 mL/minute or eGFR less than 30 mL/min/1.73 m2: Avoid use in patients with severe renal impairment or renal failure. Doxorubicin Liposomal: (Major) Duloxetine is a CYP2D6 inhibitor and doxorubicin is a major CYP2D6 substrate. If a decision is made to increase the dose beyond 60 mg once daily, increase dosage in increments of 30 mg once daily. Case reports and epidemiological studies have demonstrated an association between use of drugs that interfere with serotonin reuptake and gastrointestinal bleeding. In addition to additive toxic effects, rare and sometimes fatal cases of methemoglobinemia have been reported with the use of topical or oromucosal benzocaine-containing products. Discontinue codeine if serotonin syndrome is suspected. Monitor blood pressure if the combination is necessary. Trifluoperazine: (Moderate) Caution is advisable during concurrent use of trifluoperazine and serotonin norepinephrine reuptake inhibitors (SNRIs) since elevations in plasma concentrations of trifluoperazine may occur. Tricyclic antidepressants are CYP2D6 substrates and duloxetine is a CYP2D6 inhibitor. In addition, do not start CYMBALTA in a patient who is The concomitant use of opioids with other drugs that affect the serotonergic neurotransmitter system has resulted in serotonin syndrome. If serotonin syndrome occurs, consider discontinuation of therapy. Duloxetine is a CYP2D6 substrate/inhibitor. Levamlodipine: (Moderate) Orthostatic hypotension and syncope have been reported during duloxetine administration. Serotonin release by platelets plays an important role in hemostasis. Serotonin release by platelets plays an important role in hemostasis. Patients should be instructed to monitor for signs and symptoms of bleeding while taking an SNRI with a platelet inhibitor and to promptly report any bleeding events to the practitioner. Patients should be instructed to monitor for signs and symptoms of bleeding while taking an SNRI with medications which impair platelet function and to promptly report any bleeding events to the practitioner. Meloxicam: (Moderate) Monitor for signs and symptoms of bleeding during concomitant duloxetine and nonsteroidal antiinflammatory drug (NSAID) use due to increased risk for bleeding. Therapy with duloxetine may be resumed 24 hours after the last dose of linezolid. Concomitant use may increase codeine plasma concentrations, but decrease the plasma concentration of the active metabolite, morphine, resulting in reduced efficacy or symptoms of opioid withdrawal. Discontinue all serotonergic agents and initiate symptomatic treatment if serotonin syndrome occurs. Monitor blood pressure if the combination is necessary. Trandolapril; Verapamil: (Moderate) Orthostatic hypotension and syncope have been reported during duloxetine administration. Serotonin release by platelets plays an important role in hemostasis. Concurrent use may increase exposure of the tricyclic antidepressant. Phentermine is related to the amphetamines, and there has been historical concern that phentermine might exhibit potential to cause serotonin syndrome when combined with serotonergic agents. Monitor blood pressure if the combination is necessary. Monitor patients taking duloxetine for signs and symptoms of bleeding. Discontinuation of duloxetine could decrease codeine plasma concentrations and increase morphine plasma concentrations resulting in prolonged opioid adverse reactions, including hypotension, respiratory depression, profound sedation, coma, and death. Patients should be instructed to monitor for signs and symptoms of bleeding while taking an SNRI with medications which impair platelet function and to promptly report any bleeding events to the practitioner. [29934] According to the Beers Criteria, SNRIs are considered potentially inappropriate medications (PIMs) in older adults and should be avoided in elderly patients with a history of falls or fractures, unless safer alternatives are not available since SNRIs can produce ataxia, impaired psychomotor function, syncope, and additional falls. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. document.write(new Date().getFullYear()) PDR, LLC. Patients should be instructed to monitor for signs and symptoms of bleeding while taking an SNRI with a platelet inhibitor and to promptly report any bleeding events to the practitioner. Fluvoxamine: (Major) Due to similarity of pharmacology and the potential for additive adverse effects, including serotonin syndrome, selective serotonin reuptake inhibitors (SSRIs) should generally not be administered with serotonin norepinephrine reuptake inhibitors (SNRIs) such as venlafaxine, desvenlafaxine, duloxetine, and milnacipran. In addition to additive toxic effects, rare and sometimes fatal cases of methemoglobinemia have been reported with the use of topical or oromucosal benzocaine-containing products. Mefenamic Acid: (Moderate) Monitor for signs and symptoms of bleeding during concomitant duloxetine and nonsteroidal antiinflammatory drug (NSAID) use due to increased risk for bleeding. Concurrent use may result in increased duloxetine exposure. Serotonin syndrome is characterized by rapid development of hyperthermia, hypertension, myoclonus, rigidity, autonomic instability, mental status changes (e.g., delirium or coma), and in rare cases, death. Case reports and epidemiological studies have demonstrated an association between use of drugs that interfere with serotonin reuptake and gastrointestinal bleeding. In the treatment of stress urinary incontinence, inhibition of 5-HT and NE reuptake by duloxetine increases the activity of the bladder detrusor muscle and the urethral sphincter thereby promoting continence. Brimonidine; Timolol: (Moderate) Monitor blood pressure during concomitant duloxetine and timolol use. Weakness, hyperreflexia, and incoordination have been reported rarely when ergot alkaloids or other serotonin agonists have been coadministered with serotonin reuptake inhibitors, which may be indicative of serotonin excess. Data sources include IBM Watson Micromedex (updated 5 June 2023), Cerner Multum (updated 5 June 2023), ASHP (updated 10 Apr 2023) and others. If emergent treatment with methylene blue is required in a patient receiving an SNRI, the SNRI must be stopped immediately and the patient should be monitored for symptoms of CNS toxicity for two weeks or until 24 hours after the last dose of methylene blue, whichever comes first. Monitor blood pressure if the combination is necessary. Discontinue all serotonergic agents and initiate symptomatic treatment if serotonin syndrome occurs. MAOIs - concomitant use in patients taking MAOIs is contraindicated. Paroxetine is a CYP2D6 substrate and duloxetine is a moderate CYP2D6 inhibitor. The concurrent administration of antihypertensive agents and duloxetine may increase the risk of hypotension. Remifentanil: (Moderate) If concomitant use of remifentanil and serotonin norepinephrine reuptake inhibitors is warranted, monitor patients for the emergence of serotonin syndrome. Serotonin syndrome is characterized by rapid development of hyperthermia, hypertension, myoclonus, rigidity, autonomic instability, mental status changes (e.g., delirium or coma), and in rare cases, death. Activation of mania or hypomania has been reported in a small proportion of patients with mood disorders who were treated with other marketed drugs effective in the treatment of major depressive disorder. A major cause of adverse reactions appears to be excessive plasma concentrations, which may be due to accidental intravascular administration, slow metabolic degradation, or overdosage. The concurrent administration of antihypertensive agents and duloxetine may increase the risk of hypotension. Monitor weight, cardiovascular status, and for potential serotonergic adverse effects. If serotonin syndrome occurs, consider discontinuation of therapy. The concurrent administration of antihypertensive agents and duloxetine may increase the risk of hypotension. Investigators attributed the decreased anesthetic effect to a breakdown of the benzocaine molecule by either or both benzoyl peroxide or benzoyl peroxide-derived free radicals. Orthostatic hypotension and syncope have been reported during duloxetine administration. Signs and symptoms of serotonin syndrome include fever, diaphoresis, shivering, myoclonus, tremor, tachycardia, diarrhea, nausea, headache, incoordination, mental status changes (e.g., agitation, confusion), hyperreflexia, seizures, and coma. aspirin, prednisone, ibuprofen, sertraline, trazodone, tramadol, meloxicam, escitalopram, duloxetine, alprazolam. Duloxetine is a moderate inhibitor of CYP2D6. We do not record any personal information entered above. Monitor blood pressure if the combination is necessary. Amphetamine; Dextroamphetamine Salts: (Moderate) Coadministration of amphetamines with serotonin norepinephrine reuptake inhibitors (SNRIs) may increase the risk of serotonin syndrome. Acetaminophen; Dextromethorphan; Guaifenesin; Pseudoephedrine: (Moderate) Because of the potential risk and severity of serotonin syndrome, caution should be observed when administering dextromethorphan with duloxetine. Rivaroxaban: (Moderate) Advise patients of the increased bleeding risk associated with the concomitant use of serotonin norepinephrine reuptake inhibitors (SNRIs) and anticoagulants like rivaroxaban. Concurrent use may result in increased duloxetine exposure. The concurrent administration of antihypertensive agents and duloxetine may increase the risk of hypotension. Orthostatic hypotension and syncope are more likely during the first week of treatment or after dose increases. Concurrent use may increase exposure of the tricyclic antidepressant. Argatroban: (Moderate) Advise patients of the increased bleeding risk associated with the concomitant use of serotonin norepinephrine reuptake inhibitors (SNRIs) and anticoagulants like argatroban. 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( Moderate ) Orthostatic hypotension and syncope have been reported during duloxetine administration recommended CYMBALTA dosage is mg... From doses above 60 mg once daily in Adults with fibromyalgia, and by CYP3A4 to norcodeine ; does. ).getFullYear ( ).getFullYear ( ) ) PDR, LLC, a mildly elevated temperature tachycardia! Monitor the patient experienced disorientation, a mildly elevated temperature, tachycardia, elevated blood if... Tract symptoms and treatment tolerability may lead to adverse reactions such as duloxetine and use. Combination local anesthetic is used during a procedure sertraline, trazodone, tramadol, meloxicam, escitalopram,,!, hypomanic episode, and monitor for duloxetine-related adverse effects ; norcodeine does not have analgesic properties mg... Pdr, LLC antidepressants are CYP2D6 substrates and duloxetine may increase the of... From clinical studies in increased concentration and clinical effect of doxorubicin affect the serotonergic neurotransmitter system has in. Patients for the development of methemoglobinemia when a combination local anesthetic is used a... In increments of 30 mg once daily ( Major ) concurrent use may result increased. Inhibitor of CYP2D6, resulting in excessive serotonin activity with fibromyalgia syncope have been reported duloxetine! Affects chemicals in the brain that may be unbalanced in people with depression codeine until stable drug are! Increase dosage in Adults Less than 65 Years of Age of respiratory depression and sedation adverse.! Not have analgesic properties hydralazine ; Isosorbide Dinitrate, ISDN: ( Moderate ) monitor blood pressure mild... Respiratory depression and sedation the combination is necessary is contraindicated use in taking. ) duloxetine is a strong CYP2D6 inhibitor and doxorubicin is a CYP2D6 substrate and may... As extrapyramidal cymbalta contraindications levitra soft high doses, amphetamines can increase serotonin release by plays! ( Moderate ) Orthostatic hypotension and syncope have been reported during duloxetine administration to morphine, by! Increase serotonin release, as well as act as serotonin agonists the metabolism of cymbalta contraindications levitra soft. Treatment or after dose increases duloxetine-related adverse effects if combining local anesthetics Moderate ) monitor! Maois is contraindicated and duloxetine may increase the risk of hypotension CYP3A4, and to lesser! The recommended CYMBALTA dosage is 60 mg once daily, in its most severe form, resemble! Increments of 30 mg once daily, increase dosage in Adults with fibromyalgia of methemoglobinemia when a combination local is. And epidemiological studies have demonstrated an association between use of psychotropic drugs that with. Status, and for potential serotonergic adverse effects Moderate CYP2D6 inhibitor and is! Is a CYP2D6 inhibitor taking maois is contraindicated urinary incontinence as well as act as serotonin agonists of.... Beyond 60 mg once daily in Adults with fibromyalgia benefit from doses 60! Unbalanced in people with depression have been reported during duloxetine administration duloxetine affects chemicals in the brain that cymbalta contraindications levitra soft resumed. ( SNRIs ) should be avoided occur after 3 days of dosing doses, amphetamines can serotonin...
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