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SNRI (Serotonin-Noradrenaline Reuptake Inhibitor)

Duloxetine 30–60mg

Brand names: Cymbalta, Yentreve

Used in: Depression & Anxiety

Duloxetine is a serotonin-noradrenaline reuptake inhibitor (SNRI) used in the orthopaedic setting for chronic musculoskeletal pain and diabetic peripheral neuropathic pain, and at the higher of these doses also for depression and generalised anxiety.

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

Clinical monograph

How it works

It potentiates descending inhibitory pain pathways and central monoaminergic neurotransmission by inhibiting reuptake of serotonin and noradrenaline.

Prescribing in practice

  • Do not stop abruptly — taper to avoid a discontinuation syndrome of dizziness, paraesthesia, anxiety and sleep disturbance.
  • Avoid combining with MAOIs and use caution with other serotonergic drugs (triptans, tramadol, SSRIs) because of serotonin syndrome risk.
  • Contraindicated in uncontrolled hypertension and significant hepatic impairment; can raise blood pressure and is not recommended in severe renal impairment.

Monitoring

Monitor blood pressure, mood and for emergent suicidal ideation early in treatment or after dose changes.

Counselling the patient

  • Pain benefit may take a couple of weeks to build up.
  • Do not stop suddenly; speak to your prescriber about reducing gradually.
  • Report worsening mood, agitation or thoughts of self-harm.

Evidence & guidelines

NICE recommends duloxetine as a first-line option for neuropathic pain and for chronic primary pain in adults.

Reference: NICE NG226 (Osteoarthritis 2022); NICE NG59 (Low Back Pain 2016); NICE NG193 (Neuropathic Pain); Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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