Duloxetine
An SNRI used for depression, generalized anxiety disorder, diabetic nerve pain, fibromyalgia and chronic musculoskeletal pain.
Drug card
- Class
- SNRI
- How it works
- Blocking reuptake of both serotonin and norepinephrine
- Used for
- Depression
- Generalized anxiety disorder
- Diabetic nerve pain
- Fibromyalgia
- Known for
- Nausea
- Liver injury, occasionally fatal
- Its name
- -oxetine means a selective reuptake inhibitor (fluoxetine type)
Study it as a flashcard, and it comes back before you forget it.
Mechanism of action
How does duloxetine work?
Duloxetine potently blocks serotonin and norepinephrine reuptake and is a weaker blocker of dopamine reuptake; boosting both transmitters in the CNS is thought to underlie its effects on mood and on pain. It has no significant affinity for adrenergic, cholinergic or histamine receptors. CYP1A2 and CYP2D6 clear it, and it moderately inhibits CYP2D6.
Like other serotonin-norepinephrine reuptake inhibitors: SNRIs block both the serotonin transporter (SERT) and the norepinephrine transporter (NET), so both transmitters stay longer in the synapse. The added norepinephrine effect is thought to help with nerve pain, and it can also push blood pressure up. Like SSRIs, they have no significant affinity for muscarinic, histamine or α1 receptors, so they lack the sedating and anticholinergic burden of tricyclics.
Uses
What is duloxetine used for?
- Depression
- Generalized anxiety disorder
- Diabetic nerve pain
- Fibromyalgia
- Chronic musculoskeletal pain
Side effects
Side effects of duloxetine
- NauseaKnown for
- Liver injury, occasionally fatalKnown forSerious
- Dry mouth
- Drowsiness
- Constipation
- Loss of appetite
- Heavy sweating
- Dizziness on standing, falls and faintingSerious
- Raised blood pressureSerious
- Urinary hesitation or retention
- Severe skin reactions, such as Stevens-Johnson syndromeSerious
- Serotonin syndromeSerious
Known for marks what an exam expects you to know it for.
Watch for
Cautions and what sets it apart
- Avoid with heavy alcohol use or chronic liver disease, and stop it if jaundice or other signs of liver damage appear.
- Avoid potent CYP1A2 inhibitors such as fluvoxamine, which raise its levels several-fold, and thioridazine.
- Leave 5 days after stopping duloxetine before an MAOI, and 14 days after an MAOI before duloxetine.
- Check blood pressure before and during treatment.
Good to know: Besides depression and anxiety, it is licensed for three pain conditions: diabetic peripheral nerve pain, fibromyalgia and chronic musculoskeletal pain.
Remember it
A way to remember it
The extra N brings nerve-pain relief and a blood pressure check.
Blocking norepinephrine reuptake as well as serotonin is why duloxetine treats diabetic nerve pain and fibromyalgia, and why SNRIs can raise blood pressure, which is measured before and during treatment.
Written for biofideX
Its name
-oxetine means selective reuptake inhibitor (fluoxetine type)
Fluoxetine is an SSRI, duloxetine an SNRI, and atomoxetine, used for ADHD, blocks norepinephrine reuptake alone. Sertraline and citalopram are SSRIs that lack the stem.
- Every drug name stem
Its class
Serotonin-norepinephrine reuptake inhibitors
Other serotonin-norepinephrine reuptake inhibitors with a card:
Easily mixed up with selective serotonin reuptake inhibitors and tricyclic antidepressants.
Sources
Checked against
Written for biofideX in plain words, after checking these references:
For learning pharmacology, not for treatment decisions: no doses are given, and a prescriber, pharmacist or the product's own label is the word on any one patient. Spotted a mistake? Tell us and we'll correct it.
Depression, anxiety and sleep
Duloxetine is one of 15 drugs practiced together here: their classes, how they work, what they treat and what they're known for.
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