Formulary
Duloxetine: Indications, Dosing, Side Effects and Interactions
Inhibits the re-uptake of serotonin and noradrenaline.
MedNext Academy | 3 min read
Duloxetine: Indications, Dosing, Side Effects and Interactions
Inhibits the re-uptake of serotonin and noradrenaline.
Drug action
Inhibits the re-uptake of serotonin and noradrenaline.
Indications and dose
**Major depressive disorder**
- **Adult** (By Mouth): 60 mg once daily, dose can be increased if necessary up to a maximum of 120 mg per day in patients who are responding to treatment and have a history of repeated episodes of major depression.
**Generalised anxiety disorder**
- **Adult** (By Mouth): Initially 30 mg once daily, usual maintenance 60 mg once daily, dose can be increased if necessary up to a maximum of 120 mg per day.
**Diabetic neuropathy**
- **Adult** (By Mouth): 60 mg once daily, discontinue if inadequate response after 2 months; review treatment at least every 3 months; dose can be increased if necessary up to a maximum of 120 mg daily in divided doses.
**Moderate to severe stress urinary incontinence**
- **Adult** (By Mouth): (female) 40 mg twice daily, patient should be assessed for benefit and tolerability after 2-4 weeks, alternatively initially 20 mg twice daily for 2 weeks, this can minimise side-effects, then increased to 40 mg twice daily, patient should be assessed for benefit and tolerability after 2-4 weeks.
Cautions
Bleeding disorders; cardiac disease; elderly; history of mania; history of seizures; hypertension (avoid if uncontrolled); raised intra-ocular pressure; susceptibility to angle-closure glaucoma
Side effects
Common or very common Anxiety; appetite decreased; constipation; diarrhoea; dizziness; drowsiness; dry mouth; fall; fatigue; flushing; gastrointestinal discomfort; gastrointestinal disorders; headache; muscle complaints; nausea; pain; palpitations; paraesthesia; sexual dysfunction; skin reactions; sleep disorders; sweat changes; tinnitus; tremor; urinary disorders; vision disorders; vomiting; weight changes; yawning Uncommon Apathy; arrhythmias; behaviour abnormal; burping; chills; concentration impaired; disorientation; dysphagia; ear pain; feeling abnormal; gait abnormal; haemorrhage; hepatic disorders; hyperglycaemia; increased risk of infection; malaise; menstrual disorder; movement disorders; mydriasis; peripheral coldness; photosensitivity reaction; postural hypotension; suicidal behaviours; syncope; taste altered; temperature sensation altered; testicular pain; thirst; throat tightness; vertigo Rare or very rare Angioedema; cutaneous vasculitis; dehydration; galactorrhoea; glaucoma; hallucination; hyperprolactinaemia; hypertensive crisis; hyponatraemia; hypothyroidism; interstitial lung disease; mania; menopausal symptoms; oral disorders; pneumonia eosinophilic; seizure; serotonin syndrome; SIADH; Stevens-Johnson syndrome; urine odour abnormal Frequency not known Stress cardiomyopathy Side-effects, further information Symptoms of sexual dysfunction may persist after treatment has stopped.
Interactions
**Other interactions (9):**
- However, Serotonin Syndrome has been reported during combined use of triptans, and SSRIs (e.g.
- Examples of medicinal products that may increase haloperidol plasma concentrations (based on clinical experience or drug interaction mechanism) include: CYP3A4 inhibitors - alprazolam,...
- Antidepressants Drug interaction studies in healthy adults demonstrated no pharmacokinetic interactions between sodium oxybate (single dose of 2.25 g) and the antidepressants protriptyline...
- No additional effect on sleepiness was observed when comparing single doses of sodium oxybate alone (2.25 g) and sodium oxybate (2.25 g) in combination with duloxetine (60 mg at steady state).
- Therefore, medicinal products metabolised by CYP1A2 (such as duloxetine, alosetron, theophylline and tizanidine) should be used with caution during treatment, as it could lead to the reduction of...
- Duloxetine In clinical studies, it was demonstrated that concomitant use of duloxetine with strong inhibitors of the CYP450 1A2 isozyme such as fluvoxamine, may result in an increase of AUC and C...
Pregnancy
Toxicity in animal studies-avoid in patients with stress urinary incontinence; in other conditions use only if potential benefit outweighs risk. Risk of neonatal withdrawal symptoms if used near term.
Breast feeding
Present in milk-manufacturer advises avoid.
Hepatic impairment
Manufacturer advises avoid.
Renal impairment
Avoid if creatinine clearance less than 30 mL/minute, M see Prescribing in renal impairment .
Medicinal forms
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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