Duloxetine

SOURCE: UK SPC (eMC) for Cymbalta 30 mg hard gastro-resistant capsules, §4.2 (https://www.medicines.org.uk/emc/product/3880/smpc). MDD: therapeutic response is usually seen after 2-4 weeks; after consolidation of the antidepressive response, continue for several months to avoid relapse; in responders with a history of repeated episodes, further long-term treatment at 60-120 mg/day could be considered. GENERALISED ANXIETY DISORDER: recommended starting dose 30 mg once daily; increase to 60 mg (the usual maintenance dose in most patients) if response is insufficient; with co-morbid MDD start and maintain at 60 mg once daily; doses up to 120 mg/day are efficacious, and escalation to 90 mg or 120 mg may be considered based on clinical response and tolerability. DIABETIC PERIPHERAL NEUROPATHIC PAIN: starting and recommended maintenance dose 60 mg daily; up to 120 mg per day in evenly divided doses has been evaluated for safety; evaluate response at 2 months (additional response after that is unlikely) and reassess therapeutic benefit at least every three months. DISCONTINUATION: avoid abrupt discontinuation - reduce the dose gradually over at least one to two weeks to reduce withdrawal reactions; if intolerable symptoms occur, consider resuming the previous dose and then decreasing more gradually. HEPATIC: must not be used in patients with liver disease resulting in hepatic impairment. ELDERLY CROSS-CHECK (US labelling, to verify against the UK SPC - not UK-approved dosing): the US label gives a geriatric-specific GAD regimen of 30 mg once daily for 2 weeks before considering an increase to the target 60 mg/day, and notes that SSRIs/SNRIs have been associated with clinically significant hyponatraemia in geriatric patients and that duloxetine-treated patients reported a higher rate of falls than placebo, proportional to underlying falls risk. §4.5 was not present in the fetched eMC bundle, so the interaction list below draws on §4.3/§4.4 plus the US label.