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    DEA Class;  Rx

    Common Brand Names; Cymbalta, Irenka, Drizalma Sprinkle

    • Antidepressants, SNRIs; 
    • Fibromyalgia Agents

    Oral serotonin norepinephrine reuptake inhibitor (SNRI) antidepressant
    Indicated for depression, diabetic peripheral neuropathy, and chronic musculoskeletal pain in adults; approved for fibromyalgia in adults and adolescents 13 years and older and generalized anxiety disorder in adults and pediatric patients 7 years and older
    Increased risk of suicidality during the initial stages of treatment in pediatric and young adult patients

    Indicated for major depressive disorder (MDD)

    Indicated for diabetic peripheral neuropathy/neuropathic pain

    Indicated for generalized anxiety disorder (GAD)

    Indicated for fibromyalgia

    Indicated for chronic musculoskeletal pain, including discomfort from osteoarthritis and chronic lower back pain

    Concomitant use of duloxetine with MAOIs intended to treat psychiatric disorders

    Use of duloxetine within 14 days of MAOI discontinuation

    Initiating duloxetine in patients who are being treated with linezolid or IV methylene blue

    • Nausea (23-25%)
    • Dry mouth (13-15%)
    • Headache (13-14%)
    • Somnolence (10-12%)
    • Fatigue (9-11%)
    • Constipation (9-10%)
    • Dizziness (9-10%)
    • Insomnia (9-10%)
    • Diarrhea (9-10%)
    • Anorexia (8%)
    • Decreased appetite (7-8%)
    • Abdominal pain (4-6%)
    • Hyperhidrosis (6%)
    • Agitation (5%)
    • Nasopharyngitis (5%)
    • Vomiting (3-5%)
    • Male sexual dysfunction (2-5%)
    • Erectile dysfunction (4%)
    • Decreased libido (4%)
    • Musculoskeletal pain (4%)
    • Upper respiratory tract infection (URTI) (4%)
    • Decreased libido (3-4%)
    • Musculoskeletal pain (3-4%)
    • Abnormal orgasm (2-3%)
    • Agitation (3%)
    • Anxiety (3%)
    • Blurred vision (3%)
    • Cough (3%)
    • Influenza (3%)
    • Muscle spasms (2-3%)
    • Tremor (3%)
    • Abnormal dreams (2%)
    • Dyspepsia (2%)
    • Hot flushes (2%)
    • Oropharyngeal pain (2%)
    • Palpitations (2%)
    • Paresthesia (2%)
    • Weight loss (2%)
    • Yawning (2%)
    • Blood pressure increase (2%)
    • Ejaculation delayed (2%)
    • Dysuria (>1%)
    • Gastritis (>1%)
    • Rash (>1%)

    Prior to initiating treatment with, screen patients for any personal or family history of bipolar disorder, mania, or hypomania

    Suicidality; monitor for clinical worsening and suicide risk, especially in children, adolescents and young adults (18-24 years) during early phases of treatment and alterations in dosage (see Black Box Warnings)

    Serotonin syndrome or neuroleptic malignant syndrome-like reactions may occur; discontinue and initiate supportive therapy; closely monitor patients concomitantly receiving triptans, antipsychotics and serotonin precursors

    Neonates exposed to serotonin-norepinephrine reuptake inhibitors (SNRIs) or selective serotonin reuptake inhibitors (SSRIs) late in 3rd trimester of pregnancy have developed complications necessitating prolonged hospitalization, respiratory support, and tube feeding

    Increased risk of hepatotoxicity, sometimes fatal; monitor for abdominal pain, hepatomegaly, elevated AST/ALT exceeding 20x ULN, and jaundice; cholestatic jaundice with minimal elevations of hepatic transaminases have also been reported; not recommended in patients with substantial alcohol use or chronic liver disease

    SSRIs and SNRIs may impair platelet aggregation and increase the risk of bleeding events, ranging from ecchymoses, hematomas, epistaxis, petechiae, and GI hemorrhage to life-threatening hemorrhage; concomitant use of aspirin, NSAIDs, warfarin, other anticoagulants, or other drugs known to affect platelet function may add to this risk

    Severe skin reactions (eg, erythema multiforme and Stevens-Johnson syndrome); discontinue at first appearance of blisters, peeling rash, mucosal erosions, or any other sign of hypersensitivity if no other etiology can be identified

    Orthostatic hypotension and syncope, especially during week 1 of therapy; monitor patients taking drugs that increase risk of orthostatic hypotension; consider dose reduction or discontinue therapy in patients who experience symptomatic orthostatic hypotension, falls and/or syncope

    Data from a postmarketing retrospective cohort study indicate that use in the month before delivery may be associated with an increased risk of postpartum hemorrhage

    Drug present in human milk in a published study, lactating women who were weaning their infants were given duloxetine


    120 mg/day PO.


    120 mg/day PO.


    120 mg/day PO for generalized anxiety disorder; 60 mg/day PO for fibromyalgia. Safety and efficacy for other indications have not been established.


    7 to 12 years: 120 mg/day PO for generalized anxiety disorder. Safety and efficacy for other indications have not been established.
    1 to 6 years: Safety and efficacy have not been established.


    capsule, delayed-release

    • 20mg (Cymbalta, Drizalma Sprinkle, generic)
    • 30mg (Cymbalta, Drizalma Sprinkle, generic)
    • 40mg (Drizalma Sprinkle, Irenka)
    • 60mg (Cymbalta, Drizalma Sprinkle, generic)