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Balanced SNRI·Psychiatry - Antidepressants
Major Depressive Disorder, GAD, Diabetic Peripheral Neuropathy, Fibromyalgia
Max Dose
120 mg/day
Half-life
12 h
Neuropathy
INDICATED
Hepatic
AVOID IN CIRRHOSIS
Overview
Potent, balanced SNRI. Uniquely blocks serotonin and noradrenaline equally across all doses (unlike Venlafaxine). Excellent for major depression coupled with chronic pain/neuropathy.
Maximum Dose
Max 120 mg/day (Benefits usually plateau at 60 mg/day).
Clinical Focus
Heavily hepatically metabolised. High risk of drug-induced liver injury. Strictly avoid in patients with heavy alcohol use or cirrhosis.
Bottom Line
Duloxetine is an SNRI effective for depression, GAD, neuropathic pain, and fibromyalgia, but causes nausea initially and has a severe discontinuation syndrome similar to venlafaxine.
Brand Names
Cymbalta, Andepra
Oral Routes
Enteric-coated pellets in capsules (30 mg, 60 mg). Do NOT crush or open (drug is destroyed by stomach acid).
Prescribing & PBS
Authority Required (PBS).
Primary
Major Depressive Disorder, GAD, Diabetic Peripheral Neuropathy, Fibromyalgia.
Off-Label
Stress urinary incontinence in women.
Clinical Place
The gold-standard antidepressant for a patient presenting with both severe depression and chronic nerve pain.