DULoxetine
(Cymbalta, Drizalma Sprinkle) - Antidepressant
Indication
: major depressive disorder, generalized anxiety, chronic
musculoskeletal pain
Action
: Inhibits serotonin and norepinephrine reuptake in the CNS. Decreases
pain and symptoms of anxiety.
Contraindications
: Hypersensitivity, severe renal impairment (CCR <30
mL/min), Hepatic impairment or substantial alcohol use (increase risk of hepatitis.
Precautions
: History of the following: suicide attempt, mania, seizure disorder.
Diabetes, angle-closure glaucoma, GERI: increase risk of orthostatic hypotension
and falls
Side Effects
: CNS: neuroleptic malignant syndrome, seizures, suicidal thoughts,
fatigue, drowsiness, insomnia, activation of mania, dizziness, fainting falls,
nightmares. CV: increase BP, orthostatic hypotension. DERM: Erythema
multiforme, stevens-johnson syndrome, increase sweating, pruritus, rash. EENT:
blurred vision, increase intraocular pressure. F&E: Hyponatremia. GI:
Hepatotoxicity, pancreatitis, decreased appetite, constipation, dry mouth, nausea,
diarrhea, increased liver enzymes, gastritis, vomiting. GU: dysuria, abnormal
orgasm, erectile dysfunction, decrease libido, urinary retention. NEURO: tremor.
MISC: Serotonin syndrome.
Interactions:
DRUGS: MAOI/ like drugs wait 5 days until start and monitor for s/s
of serotonin syndrome. Increase risk of bleeding with aspirin, NSAIDs, or
warfarin. NATURAL: St.John’s wort increased serotonin syndrome.
Route/Dosage
:
Assessment
:
-
Monitor BP during therapy
-
Monitor appetite and nutritional intake, weigh weekly.
-
Monitor for notable changes in behavior
-
Assess for serotonin syndrome
-
Assess for rash periodically during therapy
-
Assess mental status
-
Assess intensity, quality and location of pain during therapy.
*PO may administer w/o meals.
*no alcohol
*May cause drowsiness, advise pt to to make position changes slowly to min
orthostatic hypotension and falls.
ROUTE
ONSET
PEAK
DURATION
Half-life:
12 hr
PO
unknown
6 hr
12 hr
Major Depressive disorder
PO Adults
40-60 mg/day
Generalized Anxiety Disorder
PO (A >65yr)
PO (A <65yr)
30 mg/day for 2wk →
maintenance dose of
60-120 mg/day
Diabetic Peripheral Neuropathic
Pain
PO Adults
60 mg/day
Fibromyalgia
PO Adults
30 mg/ day for 1wk →
increase to 60 mg/day
Chronic MSK Pain
PO Adults
60 mg/day

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