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SNRI Antidepressant Pregnancy: Avoid in pregnancy; neonatal adaptation syndrome reported

Duloxetine

Brand names: Cymbalta, Yentreve

Adult dose

Dose: 30-60 mg once daily
Route: Oral
Frequency: Once daily
Max: 120 mg/day
Depression and GAD: 60 mg once daily. Neuropathic pain: 60-120 mg/day. Stress urinary incontinence (women): 40 mg twice daily

Paediatric dose

Dose: Seek specialist opinion N/A/kg
Route: Oral
Frequency: Seek specialist opinion
Max: Seek specialist opinion
Seek specialist opinion

Dose adjustments

Renal

Avoid if eGFR under 30

Hepatic

Contraindicated in hepatic impairment

Paediatric weight-based calculator

Seek specialist opinion

Clinical pearls

  • Useful in elderly with comorbid depression and neuropathic pain (diabetic peripheral neuropathy) or stress urinary incontinence — triple benefit from one drug
  • Hyponatraemia (SIADH) risk in elderly — check sodium at baseline and within 2-4 weeks of starting, particularly in patients on diuretics
  • MHRA: SNRI class associated with increased bleeding risk (especially GI) — consider gastroprotection if on NSAIDs or anticoagulants
  • Blood pressure: duloxetine can raise BP — monitor in hypertensive patients
  • Taper on discontinuation — do not stop abruptly (discontinuation syndrome: dizziness, nausea, paraesthesia)

Contraindications

  • Uncontrolled narrow-angle glaucoma
  • Concurrent MAOI use
  • Severe renal or hepatic impairment
  • Uncontrolled hypertension

Side effects

  • Nausea (very common — take with food)
  • Dizziness
  • Dry mouth
  • Insomnia
  • Hypertension
  • Hyponatraemia (SIADH — elderly risk)
  • Urinary retention
  • Sweating

Interactions

  • MAOIs (serotonin syndrome — avoid; 14-day washout)
  • Linezolid (serotonin syndrome)
  • Tramadol (serotonin syndrome)
  • Warfarin (increased bleeding risk)
  • CYP1A2 inhibitors — fluvoxamine, ciprofloxacin (increase duloxetine levels)

Monitoring

  • Blood pressure
  • Sodium (baseline, 4 weeks, and if symptomatic)
  • Liver function
  • Mood and suicide risk
  • Urinary symptoms

Reference: BNFc; BNF 90; NICE CG173 (Neuropathic Pain); NICE CG90 (Depression); MHRA Drug Safety Update. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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