Duloxetine is available by prescription in the United States.
Addictive Potential: Low more…
Emergency Room Visits Yearly: Unknown
Mandatory Minimum Sentence: Not Scheduled, Does Not Apply; Legal by Prescription
Mechanism of Action: Increases the Neurotransmitters Serotonin, Norepinephrine, and Dopamine
Duloxetine (Cymbalta, Yentreve) is a serotonin-norepinephrine reuptake inhibitor manufactured and marketed by Eli Lilly. It is effective for major depressive disorder but appears to be inferior to the more popular antidepressants sertraline and escitalopram; it is as effective as venlafaxine in generalised anxiety disorder, it is a well tolerated and is considered a first line treatment strategy. Duloxetine failed the US approval for stress urinary incontinence amidst the concerns about liver toxicity and suicidal events; however, it was approved for this indication in Europe and Canada. Duloxetine alleviates pain associated with diabetic neuropathy and fibromyalgia; however, its efficacy relative to the established treatments, such as anticonvulsants and tricyclic antidepressants, has not been established.
A large number of side effects occurring during duloxetine treatment and lack of clear advantage over existing medications prompted critical reviews concluding that duloxetine “should not be used” for stress urinary incontinence and “currently has no place in the treatment of depression or diabetic neuropathy” as well.
Side Effects and Adverse Reactions:
Nausea, somnolence, insomnia, and dizziness are the main side effects, reported by about 10% to 20% of patients.
In a trial for mild major depressive disorder (MDD), the most commonly reported treatment-emergent adverse events among duloxetine-treated patients were nausea (34.7%), dry mouth (22.7%), headache (20.0%) and dizziness (18.7%), and except for headache, these were reported significantly more often than in the placebo group.
Other side-effects include:
Decreased appetite and weight loss
Disturbances of the gastrointestinal tract, such as nausea, constipation, diarrhea, indigestion, vomiting and profuse bleeding
Anxiety, nervousness, agitation
Decreased sex drive or difficulty achieving orgasm
Impotence or delayed ejaculation
Difficulty passing urine
Increase in blood pressure or heart rate
Cold hands or feet
Inflammation of the liver or hepatitis leading to cirrhosis if left unchecked.
Weight gain or loss
Clenching of teeth and the jaw muscles
Duloxetine and SSRIs have been shown to cause sexual side effects in some patients, both males and females. Although usually reversible, these sexual side effects can sometimes last for months, years, or longer, even after the drug has been completely withdrawn. This disorder is known as post-SSRI sexual dysfunction.
Many psychoactive SNRI medications can cause withdrawal symptoms upon discontinuation from administration.
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