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Duloxetine | SNRI | Anti-Depressant

IntroductionDuloxetine available under brand names of Dulan, Duron, Cymbalta is used off-label for conditions like stress incontinence and peripheral neuropathy brought on by chemotherapy. Major depressive disorder (MDD), generalised anxiety disorder (GAD), fibromyalgia, diabetic peripheral neuropathy, and chronic musculoskeletal pain are all conditions that can be treated with duloxetine.
Class of MedicineIt belongs to the group of drugs known as SNRIs, or serotonin and norepinephrine reuptake inhibitors. This activity explains the benefits of duloxetine as a treatment for a variety of illnesses, how it works, and when it should not be used.
Mode of ActionDuloxetine treats depression and anxiety by inhibiting serotonin and norepinephrine reuptake, integrating two therapeutic processes in a single drug. Additionally, dopamine levels in the prefrontal brain are raised by duloxetine. The blockage of norepinephrine transporters is the mechanism of action for the rise in dopamine levels. These transporters are able to function on both dopamine and norepinephrine because they have a strong affinity for dopamine. As a result, blocking norepinephrine transporters may result in a rise in dopamine. The prefrontal cortex, which lacks dopamine transporters and mainly relies on norepinephrine transporters for reuptake, is the location of this surge in dopamine.
Duloxetine works to treat depression and anxiety by inhibiting the reuptake of serotonin and norepinephrine. This combines two therapeutic methods into a single medication. Duloxetine raises dopamine levels in the prefrontal cortex as well. Norepinephrine transporters are inhibited as part of the mechanism of action for the rise in dopamine levels. The fact that these transporters can function on both dopamine and norepinephrine is due to their high affinity for dopamine. Inhibiting norepinephrine transporters can therefore result in a rise in dopamine. The prefrontal cortex, which has less dopamine transporters and a higher reliance on norepinephrine transporters for reuptake, is where this surge in dopamine is concentrated.
Medical UsesIbuprofen is a common pain reliever used to treat a variety of aches and pains, such as back pain, period pain, and toothache. It also helps with inflammation from strains and sprains, as well as arthritis discomfort. It comes in the form of tablets, capsules, and a syrup that you ingest.
Avaiability & UsageDue to its excellent oral absorption, duloxetine is most frequently administered in capsules, either with or without food. It is not advised to chew or crush duloxetine. Duloxetine, however, may hold its stability for up to two hours after being opened and sprinkled on apple juice or apple sauce, according to tests.

Treatment for fibromyalgia:
30 mg taken once day for a week, followed by an increase to 60 mg taken once daily. Another option is to use a titration strategy, starting with a dose of 20 mg per day and gradually increasing it by 20 mg each week, up to 60 mg, as tolerated. The daily maximum is 60 mg.
Treatment for generalised anxiety disorder (GAD): The starting dose is 60 mg, but depending on the patient’s tolerance, the dose may be reduced to 30 mg once daily for a week before being increased to 60 mg once daily. Increasing doses above 60 mg/day have been reported to offer benefits by certain experts, despite research showing no extra benefits.
Treatment for unipolar major depressive disorder (MDD): A single dose of 40 to 60 mg/day or two divided doses are both acceptable. It might be essential to start with 30 mg/day for a week before increasing the dosage to 60 mg/day. 60 milligrammes per day for maintenance.

Initially, 60 mg can be given to treat the pain brought on by diabetic peripheral neuropathy; however, depending on the patient, lower starting doses may be more suitable. The daily maximum is 60 mg.

Chronic musculoskeletal pain treatment:
Low back pain: As an adjuvant therapy, 30 mg can be used once daily for a week before being increased to 60 mg once day as tolerated. The daily maximum is 60 mg.

Knee pain:
When an additional therapy, 30 mg once day for a week can be administered, and as tolerated, up to 60 mg once daily

Side EffectsCommon adverse effects of duloxetine include:

Abdominal pain
Weight loss
Chane in libido
Decreased appetite
Erectile dysfunction

(while taking with other medicine)
Patient Pregnant
Due to the FDA pregnancy category C of duloxetine, there is a possibility of danger to foetal development. Duloxetine showed negative effects on embryo/fetal development in animal reproduction studies. As a result, the doctor should only recommend duloxetine if the advantages outweigh the possible risks to the foetus.Women Who Breastfeed
Duloxetine can have affects on breastfeeding infants because it is secreted in breast milk. The relative infant dose (RID) of duloxetine, according to certain research, is 2.3%. When compared to the mother’s dose, the RID is the dose consumed by breast milk. Breastfeeding is acceptable with a RID of less than 10%. Some sources state that if the mother is taking psychiatric medication, nursing should only be encouraged if the RID is less than 5%.

Nevertheless, it is important to keep an eye out for behavioural changes, sleep disturbances, feeding abnormalities, growth, and neurodevelopment in a baby who is nursed by a woman who uses duloxetine .[7]

Numerous instances of clinically severe hyponatremia in older persons are correlated with the use of SSRIs and SNRIs. Duloxetine should only be prescribed with caution to elderly patients. However, it is not necessary to change the dosage based on the patient’s age .[8]

Important WarningDeaths have resulted from dosages as low as 1000 mg. Serotonin syndrome, seizures, coma, somnolence, syncope, tachycardia, autonomic instability, diarrhoea, and vomiting are all indications of an overdose. Agitation, restlessness, confusion, diaphoresis, heat, tachycardia, nausea, vomiting, tremor, rigidity of the muscles, hyperreflexia, myoclonus, dilated pupils, dry mucous membranes, and increased bowel noises are all symptoms of serotonin syndrome. Serotonin syndrome is particularly prone to clonus and hyperreflexia.

An overdose of duloxetine cannot be reversed. Cyproheptadine and cooling techniques may be utilised if the patient has serotonin syndrome. Patients with aberrant vital signs require observation, and serious instances can necessitate ICU-level treatment.

Available BrandsDulan