Balanced SNRI·Psychiatry - Antidepressants

DULoxetine

Major Depressive Disorder, GAD, Diabetic Peripheral Neuropathy, Fibromyalgia

Authority requiredPBSSNRICymbalta, Andepra30 mg EC+2

No source link confirmed for this record yet. Its own source notes are under Additional.

At a glance

Max Dose

120 mg/day

Half-life

12 h

Neuropathy

INDICATED

Caution: Hepatic

AVOID IN CIRRHOSIS

Cautions

Avoid / Cautions

Hepatic impairment, concurrent MAOI use, uncontrolled narrow-angle glaucoma. Pregnancy Category B3.

Where it stands

Rapid Summary

Overview

Potent, balanced SNRI. Uniquely blocks serotonin and noradrenaline equally across all doses (unlike Venlafaxine). Excellent for major depression coupled with chronic pain/neuropathy.

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.

Formulation & Access

Brand Names

Cymbalta, Andepra

Oral Routes

Do not crush

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).

Indications & Use

Primary

PBSTGA

Major Depressive Disorder, GAD, Diabetic Peripheral Neuropathy, Fibromyalgia.

Off-Label

OFF

Stress urinary incontinence in women.

Clinical Place

The gold-standard antidepressant for a patient presenting with both severe depression and chronic nerve pain.

Quick reference

Class & Role

Balanced SNRI — Potent, balanced SNRI.

Route / Formulation

Enteric-coated pellets in capsules (30 mg, 60 mg). Do NOT crush or open (drug is destroyed by stomach acid). (Cymbalta, Andepra)

Usual Dose & Max

Start PO 30 mg OD. Titrate to 60 mg OD after 1-2 weeks. Max 120 mg/day.

Key Indication Doses

Depression / GAD: Start PO 30 mg OD. Titrate to 60 mg OD after 1-2 weeks. Max 120 mg/day. Diabetic Neuropathy / Fibromyalgia: PO 60 mg OD. Renal Impairment: Avoid entirely if eGFR < 30.

Best Uses

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.

Key Risks

Gastrointestinal: Nausea (extremely common, 25% of patients), dry mouth, constipation. Hepatic: Severe transaminitis, jaundice, hepatic failure. Neurological: Insomnia, somnolence, dizziness. Discontinuation syndrome (brain zaps). Cardiovascular: Mild hypertension (less severe than Venlafaxine).

Key Interactions

MAOIs, Tramadol (Fatal Serotonin Syndrome). Potent CYP1A2 inhibitors (Ciprofloxacin, Fluvoxamine) massively spike Duloxetine levels causing severe toxicity. Moderate inhibitor of CYP2D6.

Monitoring

Baseline and routine LFTs. Stop drug if enzymes rise. Check U&E (sodium) in the elderly for SIADH. Monitor BP periodically.

Clinical Pearl

Duloxetine causes fierce nausea because it spikes serotonin in the gut. Taking the capsule in the middle of a heavy meal dramatically blunts this. The nausea usually disappears after 7-10 days.

Access

Authority requiredCymbalta, Andepra30 mg EC

Brand: Cymbalta, Andepra
PBS status: Authority required
Formulation: Enteric-coated pellets in capsules (30 mg, 60 mg). Do NOT crush or open (drug is destroyed by stomach acid).

From this page

No calculator, monitoring schedule or factsheet is linked to this medicine page yet.

Balanced SNRI·Psychiatry - Antidepressants

DULoxetine

Major Depressive Disorder, GAD, Diabetic Peripheral Neuropathy, Fibromyalgia

Authority requiredPBSSNRICymbalta, Andepra30 mg EC+2

No source link confirmed for this record yet. Its own source notes are under Additional.

At a glance

Max Dose

120 mg/day

Half-life

12 h

Neuropathy

INDICATED

Caution: Hepatic

AVOID IN CIRRHOSIS

Cautions

Avoid / Cautions

Hepatic impairment, concurrent MAOI use, uncontrolled narrow-angle glaucoma. Pregnancy Category B3.

Where it stands

Rapid Summary

Overview

Potent, balanced SNRI. Uniquely blocks serotonin and noradrenaline equally across all doses (unlike Venlafaxine). Excellent for major depression coupled with chronic pain/neuropathy.

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.

Formulation & Access

Brand Names

Cymbalta, Andepra

Oral Routes

Do not crush

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).

Indications & Use

Primary

PBSTGA

Major Depressive Disorder, GAD, Diabetic Peripheral Neuropathy, Fibromyalgia.

Off-Label

OFF

Stress urinary incontinence in women.

Clinical Place

The gold-standard antidepressant for a patient presenting with both severe depression and chronic nerve pain.

Quick reference

Class & Role

Balanced SNRI — Potent, balanced SNRI.

Route / Formulation

Enteric-coated pellets in capsules (30 mg, 60 mg). Do NOT crush or open (drug is destroyed by stomach acid). (Cymbalta, Andepra)

Usual Dose & Max

Start PO 30 mg OD. Titrate to 60 mg OD after 1-2 weeks. Max 120 mg/day.

Key Indication Doses

Depression / GAD: Start PO 30 mg OD. Titrate to 60 mg OD after 1-2 weeks. Max 120 mg/day. Diabetic Neuropathy / Fibromyalgia: PO 60 mg OD. Renal Impairment: Avoid entirely if eGFR < 30.

Best Uses

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.

Key Risks

Key Interactions

MAOIs, Tramadol (Fatal Serotonin Syndrome). Potent CYP1A2 inhibitors (Ciprofloxacin, Fluvoxamine) massively spike Duloxetine levels causing severe toxicity. Moderate inhibitor of CYP2D6.

Monitoring

Baseline and routine LFTs. Stop drug if enzymes rise. Check U&E (sodium) in the elderly for SIADH. Monitor BP periodically.

Clinical Pearl

Duloxetine causes fierce nausea because it spikes serotonin in the gut. Taking the capsule in the middle of a heavy meal dramatically blunts this. The nausea usually disappears after 7-10 days.

Access

Authority requiredCymbalta, Andepra30 mg EC

Brand: Cymbalta, Andepra
PBS status: Authority required
Formulation: Enteric-coated pellets in capsules (30 mg, 60 mg). Do NOT crush or open (drug is destroyed by stomach acid).

From this page

No calculator, monitoring schedule or factsheet is linked to this medicine page yet.