Cymbalta
Active ingredient – Duloxetine
Pharmacologic Category – SNRI; Serotonin/Norepinephrine Reuptake Inhibitor;
Antidepressant
Uses – Treatment of Major Depressive Disorder; Management of Pain Associated w/
Diabetic Neuropathy
Mechanism of Action – Duloxetine is a potent inhibitor of neuronal serotonin and
Norepinephrine reuptake and a weak inhibitor of dopamine reuptake. Duloxetine does
not possess MAO-inhibitory activity.
Unlabeled/Investigational Uses – Stress Incontinence; Management of Chronic Pain
Syndromes; Fibromyalgia Management
Pregnancy Risk Factor – C
Lactation – Excretion in breast milk is unknown at this time; unknown/not
recommended
Contraindications – Concomitant use or within 2 weeks of MAO inhibitors, uncontrolled
narrow angle glaucoma
Warnings/Precautions – Antidepressants may increase the risk of suicidal thoughts and
behavior in children & adolescents with major depressive disorder & other depressive
disorders need to consider risk prior to prescribing. Closely monitor for clinical
worsening, suicidal, or unusual changes in behavior; the child's family or caregiver
should be instructed to closely observe the patient and communicate condition with
healthcare provider. Duloxetine is not FDA approved for use in children. Adults
treated with antidepressants should be observed similarly for clinical worsening and
suicidal, especially during the initial few months of a course of drug therapy, or at
times of dose changes, either increases or decreases. A medication guide should be
dispensed with each prescription. The possibility of a suicide attempt is inherent in
major depression and may persist until remission occurs. Worsening depression and
severe abrupt suicidal that are not part of the presenting symptoms may require
discontinuation or modification of drug therapy. Use caution in high-risk patients
during initiation of therapy. Prescriptions should be written for the smallest quantity
consistent with good patient care. The patient's family or caregiver should be alerted
to monitor patients for the emergence of suicidal and associated behaviors such as
anxiety, agitation, panic attacks, insomnia, irritability, hostility, impulsivity,
akathisia, hypomania, and mania; patients should be instructed to notify their
healthcare provider if any of these symptoms or worsening depression or psychosis
occur.
Key adverse effects – CNS depression: Has a low potential to impair cognitive or
motor performance; caution operating hazardous machinery or driving. SIADH and
hyponatremia: Has been associated with the development of SIADH; hyponatremia has
been reported rarely, predominately in the elderly. Urinary hesitancy: May cause
increased urinary resistance; advise patient to report symptoms of urinary
hesitation/difficulty.
Concurrent drug therapy – Agents that lower seizure threshold: Concurrent therapy
with other drugs which lower the seizure threshold. CNS depressants: Use caution
with concomitant therapy. MAO inhibitors: Potential for severe reaction when used
with MAO inhibitors; autonomic instability, coma, death, delirium, diaphoresis,
hyperthermia, mental status changes/agitation, muscular rigidity, myoclonus,
neuroleptic malignant syndrome features, and seizures may occur.
Withdrawal syndrome – May cause dysphoric mood, irritability, agitation, dizziness,
sensory disturbances, anxiety, confusion, headache, lethargy, emotional labiality,
insomnia, hypomania, tinnitus, and seizures. Upon discontinuation of Duloxetine
therapy, gradually taper dose. If intolerable symptoms occur following a decrease in
dosage or upon discontinuation of therapy, then resuming the previous dose with a
more gradual taper should be considered
Monitoring Parameters – Blood pressure should be regularly monitored, especially in
patients with a high blood pressure; mental status for depression, suicidal ideation
(especially at the beginning of therapy or when doses are increased or decreased),
anxiety, social functioning, mania & panic attacks
Patient Education – Take exactly as directed. Swallow capsule whole; do not open or
crush. It may take 2-3 weeks to achieve desired results. Inform health care provider of
all prescription medications, OTC medications, or herbal products you are taking.
Assess other medications patient may be taking for effectiveness and potential
interactions. May cause increase in blood pressure & need to Monitor blood pressure at
the beginning of treatment and periodically throughout treatment. There is a need for
monitoring for worsening of depression and suicide ideation. Taper dosage slowly when
discontinuing; Don’t discontinue abruptly.
Available forms @ Delmarva Pharmacy
Cymbalta
20 mg (30)
30 mg (30)
60 mg (30