Duloxetina (Efficacy)

Duloxetine is an antidepressant inhibitor of the reuptake of serotonin and noradrenaline (SNRI). It weakly inhibits the reuptake of dopamine without a significant affinity for histaminergic, dopaminergic, cholinergic and adrenergic receptors.

It is used mainly in the treatment of major depressive disorders (MDD), in the treatment of diabetic peripheral neuropathic pain in adults and in the treatment of generalized anxiety disorder (GAD).

CONTRAINDICATIONS

Duloxetine is contraindicated in patients with hypersensitivity to the drug, in patients with liver disease that produces liver failure, in patients with severe renal insufficiency and in those with arterial hypertension not controlled.

The prescription of duloxetine is contraindicated in combination with irreversible non-selective MAOI antidepressants and potent inhibitors of CYP1A2 such as fluvoxamine, ciprofloxacin or enoxacin.

CAUTIONS

Precautions should be taken in patients with mild or moderate renal impairment, in patients with a history of mania or diagnosed of bipolar disorder and/or with seizures. Precautions in patients with risk of narrow-angle glaucoma and in patients whose underlying pathology may be compromised by an increase in heart rate or blood pressure.

Caution should be exercised in the concomitant use of duloxetine with other antidepressants (especially selective reversible MAOIs), with substances that impair metabolism or that are associated with liver damage and with oral anticoagulants and/or drugs that affect platelet function.

Take care when prescribing duloxetine in patients with known hemorrhagic diathesis; patients with high risk of hyponatremia (elderly, cirrhosis, dehydration, diuretic treatment) and in the elderly.

There are frequent adverse reactions in combination of duloxetine with Hypericum perforatum.

A follow-up of the patient should be carried out, at the beginning of the treatment and after changing the dose, due to the existing risk of suicide. There are no safety and efficacy data in children under 18 years old for the treatment of diabetic peripheral neuropathic pain or for generalized anxiety disorder.

Do not interrupt treatment abruptly due to the risk of withdrawal symptoms. Obsessive/psychomotor restlessness may develop in the first weeks of treatment.

Duloxetine is not recommended in combination with serotonergic, tricyclic antidepressants (clomipramine or amitriptyline), venlafaxine, triptans, tramadol or tryptophan.

SIDE EFFECTS

Headache, drowsiness, dizziness, lethargy, tremors, paresthesia; decreased appetite; insomnia, agitation, decreased libido, anxiety, abnormal orgasms, abnormal dreams; blurry vision; tinnitus; increased blood pressure, flushing; nausea, dry mouth, constipation, diarrhea, abdominal pain, vomiting, increased sweating, rashes, skeletal muscle pain, muscle spasm; dysuria, erectile dysfunction, ejaculation disorder, falls, fatigue, weight loss

PHARMACOLOGIC INTERACTIONS

Caution when taking duloxetine together with drugs that act on the central nervous system (CNS): alcohol, benzodiazepines, morphinomimetics, antipsychotics, phenobarbital, sedating antihistamines). Caution in concomitance with medicinal products metabolized by CYP2D6 (risperidone, nortriptyline, amitriptyline, imipramine, flecainide, propafenone, metoprolol).

The plasma concentration of duloxetine can be increased by: CYP1A2 inhibitors such as fluvoxamine.

The plasma concentration of duloxetine can be diminished by: inducers of CYP1A2.

BRAND NAMES:

  • Xeristar ®
  • Cymbalta ®

Gene or region studied

  • HTR1A
  • COMT
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