Duloxetine - Revision history

MDElliottMD: Em-dash sweep: replace em-dash with comma per project rule; PendellsCorner verbatim quotes preserved.

2026-05-19T03:16:07Z

Em-dash sweep: replace em-dash with comma per project rule; PendellsCorner verbatim quotes preserved.

MDElliottMD: Sweep: "indications" -> "problems" sitewide terminology update (preserves MedTemplate param name)

2026-05-19T01:37:42Z

Sweep: "indications" -> "problems" sitewide terminology update (preserves MedTemplate param name)

← Older revision		Revision as of 01:37, 19 May 2026
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	\| pregnancy = Category C		\| pregnancy = Category C
	\| legal = Rx-only		\| legal = Rx-only
	\| intro = '''Duloxetine''' is a serotonin–norepinephrine reuptake inhibitor (SNRI) with a relatively balanced affinity for the serotonin (SERT) and norepinephrine (NET) transporters, distinguishing it from venlafaxine, which is primarily serotonergic at low doses. Beyond its psychiatric ~~indications~~, duloxetine is one of the most commonly prescribed agents for chronic pain syndromes — particularly diabetic peripheral neuropathy and fibromyalgia — where its norepinephrine activity in descending inhibitory pain pathways is thought to underlie analgesic efficacy.		\| intro = '''Duloxetine''' is a serotonin–norepinephrine reuptake inhibitor (SNRI) with a relatively balanced affinity for the serotonin (SERT) and norepinephrine (NET) transporters, distinguishing it from venlafaxine, which is primarily serotonergic at low doses. Beyond its psychiatric problems, duloxetine is one of the most commonly prescribed agents for chronic pain syndromes — particularly diabetic peripheral neuropathy and fibromyalgia — where its norepinephrine activity in descending inhibitory pain pathways is thought to underlie analgesic efficacy.
	\| pharmacokinetics = Well-absorbed orally with ~50% bioavailability, though substantial interindividual variability. Extensive first-pass metabolism, primarily via '''CYP1A2''' (major) and CYP2D6 (minor). Highly protein-bound (>90%). Half-life ~12 hours; steady state in ~3 days. No active metabolites of clinical significance. Capsules are enteric-coated — should not be crushed or chewed.		\| pharmacokinetics = Well-absorbed orally with ~50% bioavailability, though substantial interindividual variability. Extensive first-pass metabolism, primarily via '''CYP1A2''' (major) and CYP2D6 (minor). Highly protein-bound (>90%). Half-life ~12 hours; steady state in ~3 days. No active metabolites of clinical significance. Capsules are enteric-coated — should not be crushed or chewed.
	\| pharmacodynamics = Inhibits reuptake of both serotonin and norepinephrine at the synaptic cleft via SERT and NET. The serotonergic and noradrenergic effects are relatively balanced across the clinical dose range (60–120 mg/day), unlike venlafaxine. Modest indirect dopaminergic activity in the prefrontal cortex (via NET inhibition, since DA reuptake in PFC depends partly on NET). Minimal affinity for muscarinic, histaminic, or alpha-adrenergic receptors.		\| pharmacodynamics = Inhibits reuptake of both serotonin and norepinephrine at the synaptic cleft via SERT and NET. The serotonergic and noradrenergic effects are relatively balanced across the clinical dose range (60–120 mg/day), unlike venlafaxine. Modest indirect dopaminergic activity in the prefrontal cortex (via NET inhibition, since DA reuptake in PFC depends partly on NET). Minimal affinity for muscarinic, histaminic, or alpha-adrenergic receptors.
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	* Chronic musculoskeletal pain (osteoarthritis, chronic low back pain)		* Chronic musculoskeletal pain (osteoarthritis, chronic low back pain)
	* Stress urinary incontinence (approved in Europe; not FDA-approved)		* Stress urinary incontinence (approved in Europe; not FDA-approved)
	\| dosing = '''Start:''' 30 mg PO daily × 1 week, then increase to 60 mg daily (target dose for most ~~indications~~).		\| dosing = '''Start:''' 30 mg PO daily × 1 week, then increase to 60 mg daily (target dose for most problems).
	'''Range:''' 60–120 mg/day. Higher doses (>60 mg) often add modest benefit at the cost of more side effects.		'''Range:''' 60–120 mg/day. Higher doses (>60 mg) often add modest benefit at the cost of more side effects.
	'''Renal/hepatic:''' avoid in CrCl <30 mL/min or significant hepatic impairment.		'''Renal/hepatic:''' avoid in CrCl <30 mL/min or significant hepatic impairment.

MDElliottMD: Comprehensive categorization: +Serotonin–Norepinephrine Reuptake Inhibitors (SNRIs), Antidepressants

2026-05-15T18:42:06Z

Comprehensive categorization: +Serotonin–Norepinephrine Reuptake Inhibitors (SNRIs), Antidepressants

← Older revision		Revision as of 18:42, 15 May 2026
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	\| references =		\| references =
	}}		}}
			[[Category:Serotonin–Norepinephrine Reuptake Inhibitors (SNRIs)]]
			[[Category:Antidepressants]]

MDElliottMD: Pharmacopedia: add

2026-05-14T03:30:50Z

Pharmacopedia: add <pharmaInteractions/>

← Older revision		Revision as of 03:30, 14 May 2026
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	* '''Anticoagulants / antiplatelets / NSAIDs''' — additive bleeding risk		* '''Anticoagulants / antiplatelets / NSAIDs''' — additive bleeding risk
	* '''CYP2D6 substrates''' — duloxetine is a moderate CYP2D6 inhibitor; can elevate levels of metoprolol, propafenone, flecainide, certain TCAs		* '''CYP2D6 substrates''' — duloxetine is a moderate CYP2D6 inhibitor; can elevate levels of metoprolol, propafenone, flecainide, certain TCAs
			<pharmaInteractions/>
	\| pregnancy_details = Category C. Third-trimester use associated with persistent pulmonary hypertension of the newborn (PPHN) and neonatal adaptation syndrome (jitteriness, feeding difficulty, respiratory distress). Risk-benefit decision; if continuation is needed, sertraline is often preferred among SNRIs/SSRIs in pregnancy. Excreted in breast milk in low amounts.		\| pregnancy_details = Category C. Third-trimester use associated with persistent pulmonary hypertension of the newborn (PPHN) and neonatal adaptation syndrome (jitteriness, feeding difficulty, respiratory distress). Risk-benefit decision; if continuation is needed, sertraline is often preferred among SNRIs/SSRIs in pregnancy. Excreted in breast milk in low amounts.
	\| monitoring = * Blood pressure at initiation and dose changes		\| monitoring = * Blood pressure at initiation and dose changes

MDElliottMD: Pharmacopedia: remove contraindications parameter

2026-05-14T02:40:32Z

Pharmacopedia: remove contraindications parameter

← Older revision		Revision as of 02:40, 14 May 2026
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	* '''Urinary hesitancy'''		* '''Urinary hesitancy'''
	* '''Discontinuation syndrome''' — among the more pronounced of the SNRI/SSRI class; dizziness, paresthesias ("brain zaps"), irritability, nausea		* '''Discontinuation syndrome''' — among the more pronounced of the SNRI/SSRI class; dizziness, paresthesias ("brain zaps"), irritability, nausea
	~~\| contraindications = * Concurrent MAOI use (within 14 days)~~
	* Severe hepatic impairment
	* Severe renal impairment (CrCl <30 mL/min)
	* Uncontrolled narrow-angle glaucoma
	* Heavy alcohol use (hepatotoxicity risk)
	\| interactions = * '''MAOIs''' — serotonin syndrome; contraindicated		\| interactions = * '''MAOIs''' — serotonin syndrome; contraindicated
	* '''CYP1A2 inhibitors''' (ciprofloxacin, fluvoxamine, enoxacin) — substantially increase duloxetine levels; avoid combination		* '''CYP1A2 inhibitors''' (ciprofloxacin, fluvoxamine, enoxacin) — substantially increase duloxetine levels; avoid combination

MDElliottMD: Created page with "{{MedTemplate | generic = Duloxetine | brand = Cymbalta, Drizalma Sprinkle, Irenka, Yentreve | structure = Duloxetine.svg | classes = SNRI, Antidepressant, Anxiolytic | mechanism = Serotonin–norepinephrine reuptake inhibition (balanced) | uses = Depression, anxiety, neuropathic pain, fibromyalgia, chronic musculoskeletal pain | formula = C₁₈H₁₉NOS | routes = Oral | o..."

2026-05-11T07:40:34Z

Created page with "{{MedTemplate | generic = Duloxetine | brand = Cymbalta, Drizalma Sprinkle, Irenka, Yentreve | structure = Duloxetine.svg | classes = SNRI, Antidepressant, Anxiolytic | mechanism = Serotonin–norepinephrine reuptake inhibition (balanced) | uses = Depression, anxiety, neuropathic pain, fibromyalgia, chronic musculoskeletal pain | formula = C18H19NOS | routes = Oral | o..."

New page

{{MedTemplate
| generic = Duloxetine
| brand = Cymbalta, Drizalma Sprinkle, Irenka, Yentreve
| structure = Duloxetine.svg
| classes = SNRI, Antidepressant, Anxiolytic
| mechanism = Serotonin–norepinephrine reuptake inhibition (balanced)
| uses = Depression, anxiety, neuropathic pain, fibromyalgia, chronic musculoskeletal pain
| formula = C18H19NOS
| routes = Oral
| onset = Mood: 2–4 weeks. Pain: often within 1–2 weeks.
| duration = Chronic daily dosing
| halflife = ~12 hours
| bioavailability = ~50% (highly variable)
| pregnancy = Category C
| legal = Rx-only
| intro = '''Duloxetine''' is a serotonin–norepinephrine reuptake inhibitor (SNRI) with a relatively balanced affinity for the serotonin (SERT) and norepinephrine (NET) transporters, distinguishing it from venlafaxine, which is primarily serotonergic at low doses. Beyond its psychiatric indications, duloxetine is one of the most commonly prescribed agents for chronic pain syndromes — particularly diabetic peripheral neuropathy and fibromyalgia — where its norepinephrine activity in descending inhibitory pain pathways is thought to underlie analgesic efficacy.
| pharmacokinetics = Well-absorbed orally with ~50% bioavailability, though substantial interindividual variability. Extensive first-pass metabolism, primarily via '''CYP1A2''' (major) and CYP2D6 (minor). Highly protein-bound (>90%). Half-life ~12 hours; steady state in ~3 days. No active metabolites of clinical significance. Capsules are enteric-coated — should not be crushed or chewed.
| pharmacodynamics = Inhibits reuptake of both serotonin and norepinephrine at the synaptic cleft via SERT and NET. The serotonergic and noradrenergic effects are relatively balanced across the clinical dose range (60–120 mg/day), unlike venlafaxine. Modest indirect dopaminergic activity in the prefrontal cortex (via NET inhibition, since DA reuptake in PFC depends partly on NET). Minimal affinity for muscarinic, histaminic, or alpha-adrenergic receptors.
| indications = * Major depressive disorder
* Generalized anxiety disorder
* Diabetic peripheral neuropathic pain
* Fibromyalgia
* Chronic musculoskeletal pain (osteoarthritis, chronic low back pain)
* Stress urinary incontinence (approved in Europe; not FDA-approved)
| dosing = '''Start:''' 30 mg PO daily × 1 week, then increase to 60 mg daily (target dose for most indications).
'''Range:''' 60–120 mg/day. Higher doses (>60 mg) often add modest benefit at the cost of more side effects.
'''Renal/hepatic:''' avoid in CrCl <30 mL/min or significant hepatic impairment.
'''Discontinuation:''' taper gradually over ≥2 weeks; abrupt cessation produces notable discontinuation syndrome.
| effects = ''Therapeutic:'' improved mood, reduced anxiety, reduced neuropathic and musculoskeletal pain.
''Common adverse:'' nausea (~25%, usually improves over 1–2 weeks), dry mouth, somnolence, fatigue, constipation, decreased appetite, hyperhidrosis, sexual dysfunction, insomnia.
| adverse = * '''Hepatotoxicity''' — rare but well-documented; avoid in significant alcohol use or chronic liver disease
* '''Elevated blood pressure''' — dose-dependent; monitor especially at doses >60 mg
* '''Serotonin syndrome''' — especially with concurrent serotonergic agents
* '''Suicidality warning''' in patients under 25
* '''Hyponatremia / SIADH''' — especially in elderly
* '''Bleeding risk''' — additive with anticoagulants/NSAIDs
* '''Mydriasis / angle-closure glaucoma''' — caution in untreated narrow-angle glaucoma
* '''Urinary hesitancy'''
* '''Discontinuation syndrome''' — among the more pronounced of the SNRI/SSRI class; dizziness, paresthesias ("brain zaps"), irritability, nausea
| contraindications = * Concurrent MAOI use (within 14 days)
* Severe hepatic impairment
* Severe renal impairment (CrCl <30 mL/min)
* Uncontrolled narrow-angle glaucoma
* Heavy alcohol use (hepatotoxicity risk)
| interactions = * '''MAOIs''' — serotonin syndrome; contraindicated
* '''CYP1A2 inhibitors''' (ciprofloxacin, fluvoxamine, enoxacin) — substantially increase duloxetine levels; avoid combination
* '''Other serotonergic agents''' — triptans, tramadol, linezolid, lithium, St. John's wort
* '''Anticoagulants / antiplatelets / NSAIDs''' — additive bleeding risk
* '''CYP2D6 substrates''' — duloxetine is a moderate CYP2D6 inhibitor; can elevate levels of metoprolol, propafenone, flecainide, certain TCAs
| pregnancy_details = Category C. Third-trimester use associated with persistent pulmonary hypertension of the newborn (PPHN) and neonatal adaptation syndrome (jitteriness, feeding difficulty, respiratory distress). Risk-benefit decision; if continuation is needed, sertraline is often preferred among SNRIs/SSRIs in pregnancy. Excreted in breast milk in low amounts.
| monitoring = * Blood pressure at initiation and dose changes
* LFTs at baseline and if symptoms develop; avoid in heavy alcohol use
* Mood and suicidality, particularly first 4 weeks
* Sodium in elderly patients
* Response and adverse effects at each follow-up
| counseling = * Take with or without food, at the same time each day.
* '''Swallow the capsule whole''' — do not crush or chew (enteric-coated).
* Full mood effect emerges over 2–4 weeks; pain relief is often faster.
* '''Do not stop abruptly''' — taper gradually to minimize discontinuation symptoms.
* Avoid heavy alcohol use due to liver toxicity risk.
* Report symptoms of serotonin syndrome (agitation, hyperthermia, tremor, diarrhea) or hepatotoxicity (jaundice, dark urine, upper abdominal pain).
| anecdotes =
| seealso = [[Venlafaxine]], [[Desvenlafaxine]], [[Levomilnacipran]], [[Milnacipran]], [[Fluoxetine]], [[Sertraline]]
| references =
}}

← Older revision		Revision as of 03:16, 19 May 2026
Line 14:		Line 14:
	\| pregnancy = Category C		\| pregnancy = Category C
	\| legal = Rx-only		\| legal = Rx-only
	\| intro = '''Duloxetine''' is a serotonin–norepinephrine reuptake inhibitor (SNRI) with a relatively balanced affinity for the serotonin (SERT) and norepinephrine (NET) transporters, distinguishing it from venlafaxine, which is primarily serotonergic at low doses. Beyond its psychiatric problems, duloxetine is one of the most commonly prescribed agents for chronic pain syndromes — particularly diabetic peripheral neuropathy and fibromyalgia — where its norepinephrine activity in descending inhibitory pain pathways is thought to underlie analgesic efficacy.		\| intro = '''Duloxetine''' is a serotonin–norepinephrine reuptake inhibitor (SNRI) with a relatively balanced affinity for the serotonin (SERT) and norepinephrine (NET) transporters, distinguishing it from venlafaxine, which is primarily serotonergic at low doses. Beyond its psychiatric problems, duloxetine is one of the most commonly prescribed agents for chronic pain syndromes, particularly diabetic peripheral neuropathy and fibromyalgia, where its norepinephrine activity in descending inhibitory pain pathways is thought to underlie analgesic efficacy.
	\| pharmacokinetics = Well-absorbed orally with ~50% bioavailability, though substantial interindividual variability. Extensive first-pass metabolism, primarily via '''CYP1A2''' (major) and CYP2D6 (minor). Highly protein-bound (>90%). Half-life ~12 hours; steady state in ~3 days. No active metabolites of clinical significance. Capsules are enteric-coated — should not be crushed or chewed.		\| pharmacokinetics = Well-absorbed orally with ~50% bioavailability, though substantial interindividual variability. Extensive first-pass metabolism, primarily via '''CYP1A2''' (major) and CYP2D6 (minor). Highly protein-bound (>90%). Half-life ~12 hours; steady state in ~3 days. No active metabolites of clinical significance. Capsules are enteric-coated, should not be crushed or chewed.
	\| pharmacodynamics = Inhibits reuptake of both serotonin and norepinephrine at the synaptic cleft via SERT and NET. The serotonergic and noradrenergic effects are relatively balanced across the clinical dose range (60–120 mg/day), unlike venlafaxine. Modest indirect dopaminergic activity in the prefrontal cortex (via NET inhibition, since DA reuptake in PFC depends partly on NET). Minimal affinity for muscarinic, histaminic, or alpha-adrenergic receptors.		\| pharmacodynamics = Inhibits reuptake of both serotonin and norepinephrine at the synaptic cleft via SERT and NET. The serotonergic and noradrenergic effects are relatively balanced across the clinical dose range (60–120 mg/day), unlike venlafaxine. Modest indirect dopaminergic activity in the prefrontal cortex (via NET inhibition, since DA reuptake in PFC depends partly on NET). Minimal affinity for muscarinic, histaminic, or alpha-adrenergic receptors.
	\| indications = * Major depressive disorder		\| indications = * Major depressive disorder
Line 29:		Line 29:
	\| effects = ''Therapeutic:'' improved mood, reduced anxiety, reduced neuropathic and musculoskeletal pain.		\| effects = ''Therapeutic:'' improved mood, reduced anxiety, reduced neuropathic and musculoskeletal pain.
	''Common adverse:'' nausea (~25%, usually improves over 1–2 weeks), dry mouth, somnolence, fatigue, constipation, decreased appetite, hyperhidrosis, sexual dysfunction, insomnia.		''Common adverse:'' nausea (~25%, usually improves over 1–2 weeks), dry mouth, somnolence, fatigue, constipation, decreased appetite, hyperhidrosis, sexual dysfunction, insomnia.
	\| adverse = * '''Hepatotoxicity''' — rare but well-documented; avoid in significant alcohol use or chronic liver disease		\| adverse = * '''Hepatotoxicity''', rare but well-documented; avoid in significant alcohol use or chronic liver disease
	* '''Elevated blood pressure''' — dose-dependent; monitor especially at doses >60 mg		* '''Elevated blood pressure''', dose-dependent; monitor especially at doses >60 mg
	* '''Serotonin syndrome''' — especially with concurrent serotonergic agents		* '''Serotonin syndrome''', especially with concurrent serotonergic agents
	* '''Suicidality warning''' in patients under 25		* '''Suicidality warning''' in patients under 25
	* '''Hyponatremia / SIADH''' — especially in elderly		* '''Hyponatremia / SIADH''', especially in elderly
	* '''Bleeding risk''' — additive with anticoagulants/NSAIDs		* '''Bleeding risk''', additive with anticoagulants/NSAIDs
	* '''Mydriasis / angle-closure glaucoma''' — caution in untreated narrow-angle glaucoma		* '''Mydriasis / angle-closure glaucoma''', caution in untreated narrow-angle glaucoma
	* '''Urinary hesitancy'''		* '''Urinary hesitancy'''
	* '''Discontinuation syndrome''' — among the more pronounced of the SNRI/SSRI class; dizziness, paresthesias ("brain zaps"), irritability, nausea		* '''Discontinuation syndrome''', among the more pronounced of the SNRI/SSRI class; dizziness, paresthesias ("brain zaps"), irritability, nausea
	\| interactions = * '''MAOIs''' — serotonin syndrome; contraindicated		\| interactions = * '''MAOIs''', serotonin syndrome; contraindicated
	* '''CYP1A2 inhibitors''' (ciprofloxacin, fluvoxamine, enoxacin) — substantially increase duloxetine levels; avoid combination		* '''CYP1A2 inhibitors''' (ciprofloxacin, fluvoxamine, enoxacin), substantially increase duloxetine levels; avoid combination
	* '''Other serotonergic agents''' — triptans, tramadol, linezolid, lithium, St. John's wort		* '''Other serotonergic agents''', triptans, tramadol, linezolid, lithium, St. John's wort
	* '''Anticoagulants / antiplatelets / NSAIDs''' — additive bleeding risk		* '''Anticoagulants / antiplatelets / NSAIDs''', additive bleeding risk
	* '''CYP2D6 substrates''' — duloxetine is a moderate CYP2D6 inhibitor; can elevate levels of metoprolol, propafenone, flecainide, certain TCAs		* '''CYP2D6 substrates''', duloxetine is a moderate CYP2D6 inhibitor; can elevate levels of metoprolol, propafenone, flecainide, certain TCAs
	<pharmaInteractions/>		<pharmaInteractions/>
	\| pregnancy_details = Category C. Third-trimester use associated with persistent pulmonary hypertension of the newborn (PPHN) and neonatal adaptation syndrome (jitteriness, feeding difficulty, respiratory distress). Risk-benefit decision; if continuation is needed, sertraline is often preferred among SNRIs/SSRIs in pregnancy. Excreted in breast milk in low amounts.		\| pregnancy_details = Category C. Third-trimester use associated with persistent pulmonary hypertension of the newborn (PPHN) and neonatal adaptation syndrome (jitteriness, feeding difficulty, respiratory distress). Risk-benefit decision; if continuation is needed, sertraline is often preferred among SNRIs/SSRIs in pregnancy. Excreted in breast milk in low amounts.
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	* Response and adverse effects at each follow-up		* Response and adverse effects at each follow-up
	\| counseling = * Take with or without food, at the same time each day.		\| counseling = * Take with or without food, at the same time each day.
	* '''Swallow the capsule whole''' — do not crush or chew (enteric-coated).		* '''Swallow the capsule whole''', do not crush or chew (enteric-coated).
	* Full mood effect emerges over 2–4 weeks; pain relief is often faster.		* Full mood effect emerges over 2–4 weeks; pain relief is often faster.
	* '''Do not stop abruptly''' — taper gradually to minimize discontinuation symptoms.		* '''Do not stop abruptly''', taper gradually to minimize discontinuation symptoms.
	* Avoid heavy alcohol use due to liver toxicity risk.		* Avoid heavy alcohol use due to liver toxicity risk.
	* Report symptoms of serotonin syndrome (agitation, hyperthermia, tremor, diarrhea) or hepatotoxicity (jaundice, dark urine, upper abdominal pain).		* Report symptoms of serotonin syndrome (agitation, hyperthermia, tremor, diarrhea) or hepatotoxicity (jaundice, dark urine, upper abdominal pain).