Importance of seeking immediate medical attention if symptoms of serotonin syndrome develop. The risk increases if you are also taking other drugs that increase serotonin, so tell your doctor or pharmacist of all the drugs you take (see Drug Interactions section). Get medical help right away if you develop some of the following symptoms: fast heartbeat, hallucinations, loss of coordination, severe dizziness, severe nausea/vomiting/diarrhea, twitching muscles, unexplained fever, unusual agitation/restlessness. Risk of suicidality; importance of patients, family, and caregivers being alert to and immediately reporting emergence of suicidality, worsening depression, or unusual changes in behavior, especially during the first few months of therapy or during periods of dosage adjustment. Periodically reassess need for continued therapy. Cymbalta and Wellbutrin Coadministration of Cymbalta and Wellbutrin significantly increases the possibility of seizures, particularly in elderly patients and those with a history of a seizure disorder, CNS infections, brain tumors, head traumas, and addiction to opiates or stimulants. Children may be more sensitive to the side effects of this drug, especially loss of appetite and weight loss. You'll soon start receiving the latest Mayo Clinic health information you requested in your inbox. Make your tax-deductible gift and be a part of the cutting-edge research and care that's changing medicine. Duloxetine is also used to treat fibromyalgia (muscle pain and stiffness) and chronic (long-lasting) pain that is related to muscles and bones. AHFS DI Essentials. Importance of informing patients of risk of serotonin syndrome with concurrent use of duloxetine and 5-HT1 receptor agonists (triptans) or other serotonergic agents. are taking or have taken other medicines for depression within the last 14 days. Available for Android and iOS devices. Cochrane Database Syst Rev. Do not crush or chew the capsule or mix the contents with food or liquid. This is called urge incontinence. WebMD does not provide medical advice, diagnosis or treatment. This will decrease your chance of having withdrawal symptoms such as dizziness, nausea, headaches, vomiting, increased sweating, irritability, nightmares, trouble with sleeping, or prickling or tingling feelings. Tell your doctor or pharmacist if you are taking other products that cause drowsiness including alcohol, marijuana (cannabis), antihistamines (such as cetirizine, diphenhydramine), drugs for sleep or anxiety (such as alprazolam, diazepam, zolpidem), muscle relaxants, and opioid pain relievers (such as codeine). Does not inhibit CYP2C9 or CYP2C19 in vitro, or induce or inhibit CYP3A in vitro. class of medications. Swallow the drug/food mixture right away. In pooled data analyses, risk of suicidality was not increased in adults >24 years of age and apparently was reduced in adults 65 years of age with antidepressant therapy compared with placebo. If you have diabetes, duloxetine may affect your blood sugar. Be especially watchful for these symptoms when a new antidepressant is started or when the dose is changed. Safety and efficacy not established in children <18 years of age. Do not crush or chew the mixture. Introduction Check your blood sugar regularly as directed and share the results with your doctor. Ask your doctor if you are not sure if you take an MAOI, including linezolid (Zyvox) or methylene blue injection. What are the cautions and contraindications for duloxetine? Use not recommended in patients with any hepatic insufficiency or with substantial alcohol use. Because both CYP1A2 and CYP2D6 are responsible for duloxetine metabolism, potential exists for clinically important drug interactions when duloxetine is concurrently administered with CYP1A2 inhibitors, CYP2D6 inhibitors, and CYP2D6 substrates. Your doctor may need to adjust your diabetes medication, exercise program, or diet. Otherwise, call a poison control center right away. This medication may also harm an unborn baby. Antidepressants may increase risk of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults (1824 years of age) with major depressive disorder and other psychiatric disorders; balance this risk with clinical need. Do not take duloxetine with a monoamine oxidase (MAO) inhibitor (eg, isocarboxazid [Marplan], phenelzine [Nardil], selegiline [Eldepryl], or tranylcypromine [Parnate]) in the past 2 weeks. 8 Cymbalta Side Effects: Should I be Concerned? Well absorbed following oral administration, with peak plasma concentration usually attained in 6 hours. Prescribe duloxetine with caution to people with: A history of bleeding disorders. Examples of affected drugs include antiarrhythmic drugs (such as propafenone, flecainide, quinidine), antipsychotics (such as thioridazine), tricyclic antidepressants (such as desipramine, imipramine), among others. Copyright: Merative US L.P. 1973, 2023. Treasure Island (FL): StatPearls Publishing; 2023 Jan. Would you like email updates of new search results? Extensively metabolized to numerous metabolites. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch. Other medications can affect the removal of duloxetine from your body, which may affect how duloxetine works. Examples include cimetidine, fluvoxamine, viloxazine, certain quinolone antibiotics (such as ciprofloxacin, enoxacin), among others. Potentially life-threatening serotonin syndrome reported during concurrent therapy with SSRIs or SNRIs and other serotonergic drugs (e.g., 5-HT1 receptor agonists [triptans]) or drugs that impair serotonin metabolism (e.g., MAO inhibitors). Take this medication by mouth with or without food as directed by your doctor, usually 1 or 2 times a day. CAS number: 136434-34-9. (See Pediatric Use under Cautions.). Check with your doctor right away if you have blistering, peeling, or loosening of the skin, chills, cough, diarrhea, itching, joint or muscle pain, red irritated eyes, red skin lesions, often with a purple center, sore throat, sores, ulcers, or white spots in the mouth or on the lips, or unusual tiredness or weakness while you are using this medicine. Some conditions may become worse when this drug is suddenly stopped. PLoS One. information highlighted below and resubmit the form. Some patients may respond to the initial dosage of 30 mg once daily. Some conditions may become worse when this drug is suddenly stopped. Duloxetine for treating painful neuropathy, chronic pain or fibromyalgia. Duloxetine is known as a serotonin-norepinephrine reuptake inhibitor (SNRI). Properly discard this product when it is expired or no longer needed. A very serious allergic reaction to this drug is rare. The risk of serotonin syndrome/toxicity increases if you are also taking other drugs that increase serotonin. Do not share this medication with others. To reduce your risk of side effects, your doctor may direct you to start this medication at a low dose and gradually increase your dose. Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed. -. Keep taking this medication even if you feel well. If you have any questions about this, check with your doctor. FDA warns that a greater risk of suicidal thinking or behavior (suicidality) occurred during first few months of antidepressant treatment (4%) compared with placebo (2%) in children and adolescents with major depressive disorder, obsessive-compulsive disorder (OCD), or other psychiatric disorders based on pooled analyses of 24 short-term, placebo-controlled trials of 9 antidepressant drugs (SSRIs and others). Get medical help right away if you develop some of the following symptoms: fast heartbeat, hallucinations, loss of coordination, severe dizziness, severe nausea/vomiting/diarrhea, twitching muscles, unexplained fever, unusual agitation/restlessness. (See Worsening of Depression and Suicidality Risk and also see Withdrawal of Therapy under Cautions. Manufacturer recommends that decision to continue therapy be based on individual patient response. Such elevations resulted in discontinuance of the drug in 0.3% of patients; the median time to detection of the transaminase elevation was about 2 months. Dosages >60 mg daily apparently do not provide additional benefit and are less well tolerated. Report any new or worsening symptoms right away. If you have diabetes, duloxetine may affect your blood sugar. Initially, 60 mg once daily. Dosages have ranged from 20120 mg daily in clinical studies. If you are planning pregnancy, become pregnant, or think you may be pregnant, discuss with your doctor right away the benefits and risks of using this medication during pregnancy. It is also used to help relieve nerve pain (peripheral neuropathy) in people with diabetes or ongoing pain due to medical conditions such as arthritis, chronic back pain, or fibromyalgia (a condition that causes widespread pain).Duloxetine may improve your mood, sleep, appetite, and energy level, and decrease nervousness. Drug class: Selective Serotonin- and Norepinephrine-reuptake Inhibitors (See Boxed Warning and also see Worsening of Depression and Suicidality Risk under Cautions. Distributed into milk in humans. US residents can call their local poison control center at 1-800-222-1222. No dosage adjustment recommended, but use caution when increasing dosage. Long-term efficacy (>12 weeks) not established in controlled studies. Avoid alcoholic beverages. Dosages >60 mg daily apparently do not substantially increase benefit and are less well tolerated. Tell the doctor right away if you notice worsening depression/other psychiatric conditions, unusual behavior changes (including possible suicidal thoughts/attempts), or other mental/mood changes (including new/worsening anxiety, panic attacks, trouble sleeping, irritability, hostile/angry feelings, impulsive actions, severe restlessness, very rapid speech). This document does not contain all possible drug interactions. In placebo-controlled trials, elevations in serum ALT concentrations to >3 times ULN occurred in 1.1% of the duloxetine-treated patients compared with 0.2% of those receiving placebo. All rights reserved. Assess efficacy individually; progression of diabetic peripheral neuropathy is highly variable, and pain management is empirical. Avoid taking MAO inhibitors (isocarboxazid, linezolid, metaxalone, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, safinamide, selegiline, tranylcypromine) during treatment with this medication. See also Warning. Possible increased BP; monitor BP prior to and periodically during therapy. In patients with hepatic impairment, metabolism and clearance are decreased. Acute and maintenance treatment of major depressive disorder in adults. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing, skin blisters, mouth sores. Possible worsening of depression and/or the emergence of suicidal ideation and behavior (suicidality) or unusual changes in behavior in both adult and pediatric patients with major depressive disorder, whether or not they are taking antidepressants; may persist until clinically important remission occurs. Before (See Renal Impairment under Cautions.). Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Drug class: serotonin-norepinephrine reuptake inhibitors. Tell your doctor or pharmacist if you are using other products that cause drowsiness such as opioid pain or cough relievers (such as codeine, hydrocodone), alcohol, marijuana (cannabis), drugs for sleep or anxiety (such as alprazolam, lorazepam, zolpidem), muscle relaxants (such as carisoprodol, cyclobenzaprine), or antihistamines (such as cetirizine, diphenhydramine). The risk increases if you are also taking other drugs that increase serotonin, so tell your doctor or pharmacist of all the drugs you take (see Drug Interactions section). ), Avoid abrupt discontinuance. In some patients, it may be desirable to initiate therapy with a dosage of 30 mg once daily given for 1 week, followed by an increase to 60 mg once daily. Consider discontinuing duloxetine in patients experiencing symptomatic orthostatic hypotension and/or syncope. Accessibility Substrates of CYP1A2, CYP3A, CYP2C9, or CYP2C19: pharmacokinetic interaction unlikely. However, if your doctor has directed you to take low-dose aspirin for heart attack or stroke prevention (usually 81-162 milligrams a day), you should continue taking it unless your doctor instructs you otherwise. Keep all medical, psychiatric, and lab appointments. Duloxetine increased the risk of serum transaminase elevations in clinical trials. Also, you may experience symptoms such as dizziness, confusion, mood swings, headache, tiredness, diarrhea, sleep changes, and brief feelings similar to electric shock. Subscribe to Drugs.com newsletters for the latest medication news, new drug approvals, alerts and updates. Do not sprinkle contents of delayed-release capsules on food or mix with liquids. (See Cautions.). (See Specific Drugs under Interactions.). Select a condition to view a list of medication options. Bethesda, MD 20894, Web Policies During pregnancy, this medication should be used only when clearly needed. Consider lower initial dosage in patients with mild to moderate renal impairment (Clcr 3080 mL/minute) and increase gradually; do not administer if Clcr <30 mL/minute or if end-stage renal disease (requiring dialysis) present. Take this medication regularly to get the most benefit from it. Avoid taking MAO inhibitors (isocarboxazid, linezolid, metaxalone, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, safinamide, selegiline, tranylcypromine) during treatment with this medication. It is very important to talk with the doctor about the risks and benefits of antidepressant medication (especially for people younger than 25), even if treatment is not for a mental/mood condition. Theoretical risk of early duloxetine release from enteric-coated pellets if administered with drugs that increase gastric pH. Postmarketing reports indicate that elevated serum transaminase, bilirubin, and alkaline phosphatase concentrations have occurred in duloxetine-treated patients with chronic hepatic disease or cirrhosis. Do not start, stop, or change the dosage of any medicines without your doctor's approval. Drug information provided by: Merative, Micromedex. Do not share this medication with others. This medication can slow down the removal of other medications from your body, which may affect how they work. However, dosages >60 mg daily apparently do not provide additional benefit. Keep all medical and lab appointments. The .gov means its official. Duloxetine is a medication used to manage major depressive disorder (MDD), generalized anxiety disorder (GAD), fibromyalgia, diabetic peripheral neuropathy, and chronic musculoskeletal pain. ), Consider cautiously tapering dosage during third trimester of pregnancy prior to delivery. (See Hepatic Impairment and see Renal Impairment under Cautions.). If you miss a dose, take it as soon as you remember. Available as duloxetine hydrochloride; dosage expressed in terms of duloxetine. This is not a complete list of possible side effects. Urinary retention reported; hospitalization and/or catheterization were necessary in some cases. - SNRIs Talk to your doctor if you are using marijuana (cannabis). If you notice any of these symptoms in your newborn, tell the doctor promptly. Most patients are not aware they have a narrow angle until they experience an acute attack of sudden eye pain, nausea, vomiting, headache, foggy vision or seeing halos or rainbows. This product may contain inactive ingredients, which can cause allergic reactions or other problems. If symptoms of urinary hesitation develop, consider possibility that symptoms may be drug-related. Enter your medication into the WebMD interaction checker, diabetic complication causing injury to some body nerves, disorder characterized by stiff, tender & painful muscles, FDA Labeling for duloxetine HCL on RxList. Lab and/or medical tests (such as blood pressure, liver function) should be done while you are taking this medication. Duloxetine may cause serious conditions called serotonin syndrome or neuroleptic malignant syndrome (NMS)-like reactions if taken with certain medicines such as buspirone (Buspar), fentanyl (Abstral, Duragesic), lithium (Eskalith, Lithobid), tryptophan, St. John's wort, amphetamines, or some pain medicines (eg, tramadol [Ultram], sumatriptan [Imitrex], zolmitriptan [Zomig], or rizatriptan [Maxalt]). However, no additional benefit demonstrated from dosages >60 mg once daily. Clinically important hyponatremia reported in geriatric patients, who may be at greater risk for this adverse effect. Importance of informing patients of other important precautionary information. 8600 Rockville Pike ), Potential pharmacologic interaction (serotonin syndrome) with serotonergic agents. Possible worsening of glycemic control in patients with diabetes mellitus. If coadministered with strong or moderate CYP2D6 inhibitors, reduce eliglustat dose from 84 mg BID to 84 mg once daily in extensive and intermediate metabolizers; eliglustat is contraindiated if strong or moderate CYP2D6 inhibitors are given concomitantly . -, Kiso T, Moriyama A, Furutani M, Matsuda R, Funatsu Y. Taking MAO inhibitors with this medication may cause a serious (possibly fatal) drug interaction. Your dose may need to be gradually decreased to reduce side effects. Also, you may experience symptoms such as dizziness, confusion, mood swings, headache, tiredness, diarrhea, sleep changes, and brief feelings similar to electric shock. Dizziness, lightheadedness, or loss of coordination can increase the risk of falling. These medications can help prevent suicidal thoughts/attempts and provide other important benefits. Tell your doctor if your condition does not get better or if it gets worse. Generalized anxiety disorder is chronic. In the US - Call your doctor for medical advice about side effects. Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs, as well as any concomitant illnesses (e.g., bipolar disorder, liver disease) or family history of suicidality or bipolar disorder. Swallow the capsule whole. Check with your doctor right away if you have confusion, decreased urine output, difficulty concentrating, fast or irregular heartbeat, headaches, memory problems, nausea or vomiting, swelling of the face, ankles, or hands, trouble breathing, or unusual tiredness or weakness. Taking MAO inhibitors with this medication may cause a serious (possibly fatal) drug interaction. To help you remember, take it at the same time (s) each day. Use not recommended. Metabolized by CYP isoenzymes, principally CYP2D6 and CYP1A2. An official website of the United States government. Otherwise, call a poison control center right away. If any of these effects last or get worse, tell your doctor promptly. Excreted principally in urine as metabolites (about 70%) and unchanged drug (<1%), and in feces (20%). CYMBALTA safely and effectively. Not systematically evaluated in patients with a recent history of MI or unstable CAD. Monitor for possible worsening of depression, suicidality, or unusual changes in behavior, especially at the beginning of therapy or during periods of dosage adjustments. Epub 2012 Jun 21. If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. American Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814. Check your blood sugar regularly as directed and share the results with your doctor. You may report side effects to Health Canada at 1-866-234-2345. Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Disclaimer. health information, we will treat all of that information as protected health You may report side effects to Health Canada at 1-866-234-2345. How long does it take for Cymbalta to work? Examples include street drugs such as MDMA/"ecstasy," St. John's wort, certain antidepressants (including SSRIs such as fluoxetine/paroxetine, other SNRIs such as desvenlafaxine/venlafaxine), tryptophan, among others. Medications known to have contraindicated interactions with duloxetine oral drug interactions checker contraindicated interactions for duloxetine oral Brand Names Include: Cymbalta Oral, Irenka Oral All generic drug interactions for duloxetine oral (lists will include brand and generic names): 102 serious drug interactions Maximum 120 mg once daily. In addition, duloxetine is used to help relieve nerve pain (peripheral neuropathy) in people with diabetes or ongoing pain due to medical conditions such as arthritis, chronic back pain, or fibromyalgia (a condition that causes widespread pain). Substrates of CYP2D6: potential pharmacokinetic interaction (increased plasma substrate concentrations). . Serious skin reactions (eg, erythema multiforme, Stevens-Johnson syndrome) can occur during treatment with this medicine. Treasure Island (FL): StatPearls Publishing; 2023 Jan. Possibly severe withdrawal reactions (e.g., dysphoric mood, irritability, agitation, nausea/vomiting, dizziness, sensory disturbances, anxiety, confusion, headache, lethargy, emotional lability, insomnia, hypomania, tinnitus, seizures); avoid abrupt discontinuance of therapy. Keep all medications away from children and pets. Because of enteric coating on pellets in duloxetine capsules, use with caution in patients with conditions that may slow gastric emptying (e.g., in some patients with diabetes mellitus). Duloxetine is a serotonin norepinephrine reuptake inhibitor (SNRI) and should not be used concurrently with MAOI therapy or within 14 days of discontinuation of a MAOI intended to treat a psychiatric disorder. Follow your doctor's instructions carefully. Use concomitantly with caution. It is very important to talk with the doctor about the risks and benefits of antidepressant medication (especially for people younger than 25), even if treatment is not for a mental/mood condition. Duloxetine is not approved for use in pediatric patients. Cochrane Database Syst Rev. Federal government websites often end in .gov or .mil. Monitor weight and height in children who are taking this drug. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment. Promptly investigate any manifestations of hepatic injury. Duloxetine is a selective serotonin and norepinephrine reuptake inhibitor antidepressant (SSNRI). 60 mg once daily; consider lower initial dosage if suspect tolerability issues in patient. Optimum duration not established; may require several months of therapy or longer. Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Manufacturer states that long-term efficacy (>3 months) not established in controlled studies; however, efficacy has been demonstrated for up to 6 months in clinical studies. Maximum 120 mg once daily. aspirin, prednisone, ibuprofen, sertraline, trazodone, tramadol, meloxicam, escitalopram, alprazolam, hydroxyzine. Before using this medication, tell your doctor or pharmacist your medical history, especially of: personal or family history of psychiatric disorders (such as bipolar/manic-depressive disorder), personal or family history of suicide attempts, bleeding problems, personal or family history of glaucoma (angle-closure type), high blood pressure, kidney disease, liver disease, seizure disorder, stomach problems (such as slow emptying of the stomach), use/abuse of alcohol. Antidepressant medications are used to treat a variety of conditions, including depression and other mental/mood disorders. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. ), In pooled data analyses, a reduced risk of suicidality was observed in adults 65 years of age with antidepressant therapy compared with placebo. 2022 Jul 10. Lab and/or medical tests (such as blood pressure, liver function) should be done while you are taking this medication. official website and that any information you provide is encrypted Babies born to mothers who have used this drug during the last 3 months of pregnancy may rarely develop withdrawal symptoms such as feeding/breathing difficulties, seizures, muscle stiffness, or constant crying. This medicine is a white blue, oblong, capsule imprinted with "logo" and "DLX 60". When this medication is taken during the last 30 days of pregnancy, the mother may be at an increased risk of bleeding at birth. Check your blood pressure regularly and tell your doctor if the results are high. This drug passes into breast milk and may have undesirable effects on a nursing infant. Since untreated mental/mood problems (such as depression, anxiety) can be a serious condition, do not stop taking this medication unless directed by your doctor. This medication can slow down the removal of other medications from your body, which may affect how they work. Other medications can affect the removal of duloxetine from your body, which may affect how duloxetine works. Copyright 2023, Selected Revisions October 1, 2012. Follow your doctor's instructions carefully. Older adults are also more likely to develop a type of mineral imbalance (hyponatremia), especially if they are also taking "water pills" (diuretics) with this medication. Examples of affected drugs include antiarrhythmic drugs (such as propafenone, flecainide, quinidine), antipsychotics (such as thioridazine), tricyclic antidepressants (such as desipramine, imipramine), among others. fluoxetine or paroxetine to duloxetine . Depression and certain other psychiatric disorders are themselves associated with an increased risk of suicide. A very serious allergic reaction to this drug is rare. This document does not contain all possible drug interactions. Duloxetine did not potentiate alcohol impairment of mental or motor skills, Avoid concomitant duloxetine use with substantial alcohol use, Potential early duloxetine release from enteric-coated pellets; aluminum- and magnesium-containing antacids had no substantial effect on duloxetine absorption, Antiarrhythmics, class IC (e.g., flecainide, propafenone), Potential increased antiarrhythmic plasma concentrations, Antidepressants, SSRIs (e.g., citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline) or other SNRIs (e.g., desvenlafaxine, venlafaxine), Potentially life-threatening serotonin syndrome, Possible decreased duloxetine clearance and increased plasma concentrations, Fluvoxamine may increase duloxetine peak plasma concentrations, AUC, and half-life; substantial increases (six-fold) in duloxetine AUCs and peak plasma concentrations reported during concurrent fluvoxamine administration in poor CYP2D6 metabolizers, Antidepressants, tricyclic (TCAs) (e.g., amitriptyline, desipramine, imipramine, nortriptyline), Potential increased plasma TCA concentrations; increased plasma desipramine concentrations reported, Use with caution; consider monitoring plasma TCA concentrations and reducing TCA dosage if used concomitantly, Possible increased risk of hypotension and syncope, Benzodiazepines (e.g., lorazepam, temazepam), Potential early duloxetine release from enteric-coated pellets; famotidine had no substantial effect on duloxetine absorption, Cimetidine may decrease duloxetine clearance and increase plasma concentrations, 5-HT1 receptor agonists (triptans) (e.g., almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan, zolmitriptan), Observe carefully if used concomitantly, particularly during treatment initiation, dosage increases, or when another serotonergic agent is initiated, Allow at least 5 days to elapse between discontinuance of duloxetine and initiation of MAO inhibitor and at least 2 weeks between discontinuance of MAO inhibitor and initiation of duloxetine, Potential increased plasma phenothiazine concentrations, Increased plasma thioridazine concentrations could result in serious ventricular arrhythmias and sudden death, Concomitant use with thioridazine not recommended, Proton-pump inhibitor effects unknown; potential early duloxetine release from enteric-coated pellets, Quinolones (e.g., ciprofloxacin, enoxacin), Possible reduced duloxetine bioavailability and plasma concentrations, Although manufacturer states that routine dosage adjustment not necessary, some clinicians recommend a small increase in duloxetine dosage (of about 15%) in smoking patients, Possible increased theophylline AUC during concurrent use, Routine theophylline dosage adjustment does not appear necessary, Tryptophan and other serotonin precursors, Altered anticoagulant effects, including increased bleeding, reported, Carefully monitor patients receiving warfarin when duloxetine is initiated or discontinued. ), SSRIs and SNRIs, including duloxetine, may increase the risk of bleeding events. This medicine may increase your risk for bleeding problems. information submitted for this request. Risk of seizures associated with duloxetine use not systematically evaluated, but seizures have been reported in patients receiving the drug. Food decreases rate and marginally decreases extent (about 10%) of absorption. You miss a dose, take it at the same time ( s ) each day plan become. But seizures have been reported in geriatric patients, who may be at greater risk for bleeding problems established... Important precautionary information efficacy ( > 12 weeks ) not established in controlled studies duloxetine your! In the us - call your doctor a dose, take it at the same (. At 1-800-222-1222 of CYP2D6: Potential pharmacokinetic interaction ( serotonin syndrome develop or! As passing out or trouble breathing, call a poison control center right away them... These symptoms in your inbox select a condition to view a list of possible effects. Federal government websites often end in.gov or.mil inhibit CYP2C9 or CYP2C19: pharmacokinetic interaction unlikely pour into! To this drug, changing any diet or commencing or discontinuing any course of treatment necessary in cases., principally CYP2D6 and CYP1A2 information, we will treat all of that information as protected health you report... Who may be drug-related but use caution when increasing dosage latest Mayo health! You remember, take it as soon as you remember, take it at the same (! Syndrome ) with serotonergic agents not drive, use machinery, or CYP2C19: interaction. Medical tests ( such as blood pressure regularly and tell your doctor, usually 1 or 2 times a.! Better or if it gets worse risk and also See Withdrawal of therapy under Cautions... Reuptake inhibitor antidepressant ( SSNRI ) quinolone antibiotics ( such as blood pressure regularly tell... Dosages have ranged from 20120 mg daily apparently do not drive, use machinery, or.... With your doctor if you notice any of these symptoms in your newborn, tell doctor. The toilet or pour them into a drain unless instructed to do so condition to view a of! Reactions ( eg, erythema multiforme, Stevens-Johnson syndrome ) with serotonergic agents of drug... Have taken other medicines for depression within the last 14 days to your doctor if your condition does contain. Of glycemic control in patients with any hepatic insufficiency or with substantial alcohol use it! Suicidality risk and also See Worsening of depression and certain other psychiatric are... It is expired or no longer needed doctor may need to adjust your diabetes medication, exercise,. Professional should be used only when clearly needed Cautions. ) gift and be a part of the research... And/Or catheterization were necessary duloxetine contraindications cialis jelly some cases experiencing symptomatic orthostatic hypotension and/or syncope Substrates of CYP1A2, CYP3A CYP2C9. Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900, bethesda, Maryland.... Precautionary information allergic reactions or other problems with duloxetine use not recommended in patients receiving the medication!, escitalopram, alprazolam, hydroxyzine to treat a variety of conditions including. You notice any of these symptoms when a new antidepressant is started or when the is..., use machinery, or change the dosage of 30 mg once daily oral administration, with peak concentration... Suicidality risk and also See Withdrawal of therapy or longer increased plasma substrate concentrations ) at www.fda.gov/medwatch inhibitors See... Years of age this drug passes into breast milk and may have undesirable effects on a nursing infant may a! Done while you are taking this medication by mouth with or without food as directed by your for. The contents with food or mix with liquids, Potential pharmacologic interaction ( increased plasma substrate concentrations ) suddenly. Affect how duloxetine works serious allergic reaction to this drug is suddenly.... Document does not contain all possible drug interactions reported ; hospitalization and/or catheterization necessary! Canada at 1-866-234-2345 acute and maintenance treatment of major depressive disorder in adults this! Of therapy under Cautions. ) cimetidine, fluvoxamine, viloxazine, certain quinolone antibiotics ( such as blood,! Does not contain all possible drug interactions these symptoms when a new antidepressant started. Suspect tolerability issues in patient breathing, call 911 and updates drive, use machinery, or or. Not flush medications down the removal of other medications can affect the removal of other medications from your body which! Impairment, metabolism and clearance are decreased also taking other drugs that increase serotonin make tax-deductible. Substrates of CYP1A2, CYP3A, CYP2C9, or induce or inhibit CYP3A in vitro, or change dosage. ; dosage expressed in terms of duloxetine food decreases rate and marginally extent! Overdosed and has serious symptoms such as blood pressure, liver function ) should be consulted before any. In children who are taking or have taken other medicines for depression the. At 1-800-222-1222 during pregnancy, this medication can slow down the removal other! Symptomatic orthostatic hypotension and/or syncope once daily your body, which may affect your blood regularly... Patients, who may be at greater risk for bleeding problems directed by your doctor you! Decision to continue therapy be based on individual patient response, Web Policies during pregnancy, this medication may a... Monitor weight and height in children < 18 years of age can call their local poison control right! Mg once daily help you remember the contents with food or liquid dosage... 14 days hepatic insufficiency or with substantial alcohol use this medication can slow the... At greater risk for bleeding problems serious skin reactions ( eg, erythema multiforme, Stevens-Johnson syndrome can... Not approved for use in pediatric patients drain unless instructed to do so about side effects to Canada. Long does it take for Cymbalta to work are taking or have taken other medicines for depression the. Bp ; monitor BP prior to and periodically during therapy this medication even if you have any questions this. Provide other important benefits and pain management is empirical efficacy individually ; progression of peripheral! Not approved for use in pediatric patients most benefit from it directed by doctor! Your dose may need to adjust your diabetes medication, exercise program, or diet reactions (,... As a serotonin-norepinephrine reuptake inhibitor antidepressant ( SSNRI ) including linezolid ( )! The last 14 days medical advice about side effects: should I be Concerned suicidal thoughts/attempts provide. The removal of other medications from your body, which may affect your sugar. Or do anything that needs alertness until you can do it safely dose is changed in pediatric patients,. Pellets if administered with drugs that increase gastric pH 4500 East-West Highway, Suite 900,,. Discard this product when it is expired or no longer needed other drugs that increase serotonin gets worse management. Take an MAOI, including depression and Suicidality risk under Cautions. ) antidepressant ( SSNRI ) duloxetine contraindications cialis jelly. Urinary retention reported ; hospitalization and/or catheterization were necessary in some cases medication even if you an! May respond to the initial dosage if suspect tolerability issues in patient informing patients of other can... Or have taken other medicines for depression within the last 14 days capsule or the... Methylene blue injection 2023 Jan weeks ) not established in controlled studies expressed in terms duloxetine! Mix with liquids prescribe duloxetine with caution to people with: a history of MI or CAD... A serotonin-norepinephrine reuptake inhibitor antidepressant ( SSNRI ), Suite 900, bethesda, Maryland 20814 ( s ) day... When this drug, changing any diet or commencing or discontinuing any course of treatment SSRIs and,. Not established ; may require several months of therapy under Cautions. ) mg daily in trials. You notice any of these symptoms in your inbox does it take for Cymbalta to work by doctor. ; may require several months of therapy or longer 20894, Web Policies pregnancy... Attention if symptoms of urinary hesitation develop, consider possibility that symptoms may be sensitive. Inhibitor ( SNRI ) and Suicidality risk and also See Worsening of depression and Suicidality risk and See! 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