Duloxetine is an antidepressant and works by increasing levels of norepinephrine and serotonin to increase drive and improve mood. Duloxetine is therefore used primarily in the treatment of depression. Another major area of application is stress incontinence in women, as the active ingredient strengthens the bladder and pelvic floor muscles. Learn more about the effects, side effects, and dosage of duloxetine.
Other uses of duloxetine
Duloxetine is also used to treat diabetic polyneuropathy. Its analgesic effect helps relieve nerve pain (neuropathy) caused by diabetes. In the United States, duloxetine is also approved for the treatment of fibromyalgia, a muscle pain syndrome. In Germany, its use in this indication was rejected by the European Medicines Agency (EMA) in 2008.
Dosing and stopping duloxetine
How many capsules of duloxetine one should take daily must be decided by the attending physician. As a rule, this will be a psychiatric specialist. The amount of dose depends on age, gender, height, weight, and also smoking status. A typical starting dose is 60 mg once daily followed by a continuous increase up to a maintenance dose of 120 mg. It is important not to discontinue the drug summarily, but to taper off, otherwise serious side effects may occur.
Side effects of duloxetine
The most common side effects of duloxetine include:
- Nausea
- Vomiting
- Diarrhea and constipation
- Headache
- A dry mouth
- Loss of appetite
In addition, visual disturbances, a tremor and sleep disturbances may occur. The increased level of norepinephrine may further cause sweating and hot flashes, blood pressure increases, urinary retention and erectile dysfunction. A particularly critical side effect results from the drug’s initial increase in drive. Since this effect sets in before the mood-lifting effect, there is a risk of suicide attempts in the first two weeks after starting therapy, which is why one should be closely supervised by a specialist during this time.
Drug interactions with duloxetine
Duloxetine should not be combined with certain other antidepressants that also lead to an increase in the level of serotonin. There is otherwise a risk of life-threatening serotonin syndrome, which manifests itself as palpitations, fever, and nausea. Simultaneous use of centrally depressant substances such as benzodiazepines, opiates, and alcohol should also be avoided.
Contraindications of the active ingredient
The following contraindications should be noted when taking duloxetine:
- MAO inhibitors such as selegelin or tranylcypromine.
- Serotonergic medications, for example venlafaxine, fluoxetine, citalopram.
- Certain antibiotics such as ciprofloxacin or enoxacin.
- St. John’s wort
- Liver and kidney dysfunction
- An allergy to the active substance duloxetine.
- Children younger than 18 years
- Uncontrolled hypertension
In pregnancy and lactation, there is no absolute contraindication, however, no recommendation for use, as there are no studies for duloxetine in these circumstances.
Notes on the intake of duloxetine.
Duloxetine capsules should be taken independently of meals. Regarding the duration of intake, it should be noted that duloxetine should be taken for at least six months to observe an effect. Duloxetine is a so-called “serotonin-norepinephrine reuptake inhibitor” (SNRI). The SNRI group of drugs, which includes venlafaxine, among others, are active in the central nervous system. Here, a complex interaction of a wide variety of hormones and messenger substances (neurotransmitters) takes place. The neurotransmitters serotonin and norepinephrine play an important role. Serotonin is found everywhere in the body and has various functions. In the brain, it is responsible for the feeling of happiness, among other things. Norepinephrine is a stress hormone that influences blood pressure and pulse. At the nerve cells it has a drive-increasing and activating effect.
Mechanism of action of duloxetine
In nerve cells, serotonin and norepinephrine are released into the so-called “synaptic cleft,” which is located between two communicating nerve cells.By docking to the receptors of the following nerve cell, the neurotransmitters unfold their effect. Duloxetine prevents reuptake of the two neurotransmitters back into the cell of origin, thus ensuring a sustained high concentration and an extended effect. The increase in concentration of norepinephrine stimulates pain-relieving neural pathways in the spinal cord, activating the body’s own pain relief system.
