Duloxetine (Cymbalta)
SNRI antidepressant
- Major Depression2
- Generalized anxiety (approved children ≥ 7)1
- Binge eating3
- Chronic pain2
- Fibromyalgia
- Migraine prevention
- Improves cognition in depression
Features
Dosing
60 mg/d for depression, higher (to 120 mg) for anxiety, pain, and binge eating.
Also useful for urine incontinence (but can cause urinary retention). Acts as SNRI in all dose ranges. Half-life is short but all forms have XR built into them.
Child GAD: Start 30 mg qd, consider raise to 60 mg after 2 weeks, then raise by 30 mg increments if needed (max 120 mg).
INTERACTIONS: Raises meds metabolized by CYP 2D6 (antipsychotics, tricyclics).
Management
TOLERABILITY: Nausea, sexual dysfunction, sleep disruption, restless legs, urine retention.
RISKS: Osteopenia in post-menopausal women. Urine retention. Hepatotoxicity. Narrow-angle glaucoma. Hypotension in elderly. Hyponatremia. Serotonin syndrome. Mania.
EMR Text
Depression
Duloxetine use based on FDA approval in major depressive disorder.
Duloxetine side effects, including mania and hepatotoxicity, reviewed with patient.
Generalized Anxiety Disorders
Duloxetine use based on FDA approval in generalized anxiety disorder.
Duloxetine side effects, including mania and hepatotoxicity, reviewed with patient.
Social Anxiety Disorder
Duloxetine use based on controlled trials in social anxiety disorder (Simon NM et al, CNS Spectr. 2010;15(7):367-373).
Duloxetine side effects, including mania and hepatotoxicity, reviewed with patient.
Binge Eating
Duloxetine use based on controlled trials in binge eating disorder (Leombruni P et al, Hum Psychopharmacol. 2009;24(6):483-488).
Duloxetine side effects, including mania and hepatotoxicity, reviewed with patient.