Duloxetine

Ask A Pharmacist

Self medication is not recommended. Always discuss medication changes with your physician and pharmacist.

Name: Duloxetine (dull-OX-eh-teen), Cymbalta™

Uses:

Duloxetine is officially approved in Canada for the management of nerve pain associated with diabetes, management of pain associated with fibromyalgia, management of chronic low back pain and symptom relief of depression and anxiety.

How duloxetine works:

Duloxetine works by increasing chemicals in the brain (norepinephrine and serotonin). Balancing of these chemicals in the brain helps to decrease pain perception by “dampening” or “turning down” the feelings of pain.

Precautions:

Before using duloxetine talk to your physician about other medical conditions you have including liver disease or severe kidney disease. These conditions may determine if duloxetine is the right medication for you. Talk to your physician and pharmacist about other prescribed medications, non-prescription medications including natural products you are taking to make sure there are no interactions with duloxetine. 

Duloxetine may cause dizziness or drowsiness so do not drive until you know how it affects you. Avoidance of alcohol is recommended.

Dosing:

Take duloxetine with or without food, once or twice daily as ordered.

If you forget to take a dose, take it as soon as you remember. If it is close to your next dose then skip the missed dose (do NOT take double the dose). Swallow the capsule whole, do not crush or chew it. This preserves the delayed-release formulation to prevent the drug from being released in the stomach.

Doses of duloxetine are usually started at a low dose (30mg once daily) and increased slowly to allow your body to get used to the medication. The usual daily dose is 60mg once daily. Some patients may be increased up to 60mg twice daily. A week or two is needed to begin to notice an improvement in pain, and four weeks to feel the full benefits.

If stopping duloxetine do not stop suddenly to avoid withdrawal reactions. Always discuss this with your physician.

Side Effects:

All medications that have positive effects (usefulness) also have negative effects (side effects). A balance between the two is necessary. Starting at a low dose and increasing the dose gradually decreases the chance of side effects.

Most common side effects with duloxetine are nausea, sedation, dizziness, and dry mouth. Nausea is decreased by taking with food. Dizziness is decreased if you move slowly when changing from lying down or sitting, to a standing position.

Summary:

Duloxetine works on increasing two chemicals in the brain that help reduce pain.  It helps balance brain neurotransmitters known to be important in fibromyalgia and nerve pain. It does not repair nerve damage. It may be used with other analgesics that work by a different pain relief method.

Always discuss medication with your physician and pharmacist to see if this medication is appropriate for you.

Janice Sumpton RPh, BScPhm.              February 21, 2011