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Duloxetine is clinically proven to be effective in the treatment of depressive episodes and in preventing their recurrence. This substance is especially beneficial for patients suffering from depression and suffering from pain and anxiety symptoms. In addition to treating depression, this substance is used in the treatment of generalized anxiety disorder and some pain disorders (especially painful diabetic neuropathy, but also fibromyalgia, chronic back pain, stress urinary incontinence, pain accompanying the course of osteoarthritis).
Duloxetine – action
Duloxetine is a serotonin and norepinephrine reuptake inhibitor. It causes an increase in the extracellular concentration of these substances in specific areas of the brain. It slightly inhibits the reuptake of the dopamine hormone.
The substance is well absorbed. The time required for the active substance to reach its maximum concentration in the patient’s blood is 6 hours. The absolute bioavailability of duloxetine is on average 50%. The drug is extensively metabolized and the products of this transformation are pharmacologically inactive. The half-life of the substance is 12 hours on average. Its metabolites are mainly excreted in the urine.
The effects of duloxetine are largely dependent on the age and sex of the patient and the smoking of the patient. The dose is not dependent on the gender of the patient. In the elderly, the amount of drug absorption increases by about 25%, and the half-life of the active substance increases.
Duloxetine – dosage
To treat depression, you are given 60-100 mg of duloxetine daily. If the therapy shows positive results after 2-4 weeks, it is continued for several months.
In patients with generalized anxiety disorder, the initial dose is 30 mg once a day, and if not correct, the dose is increased to 60 mg. The maximum dose is 120 mg.
To prevent pain in diabetic peripheral neuropathy, the usual dose is 60 mg per day with a maximum dose of 120 mg. Clinical response is assessed after two months of treatment, and treatment benefit is assessed every 3 months.
Taking the drug with food lengthens the time until it reaches its maximum concentration in the blood (up to 10 hours) and slightly reduces the percentage of the dose absorbed, which is not clinically significant.
Duloxetine – contraindications
The drug is not prescribed to patients under 18 years of age, as it has not been adequately studied.
Duloxetine should not be used in people with severe renal insufficiency. The use of duloxetine requires special care in people suffering from alcoholism (and other liver damage), people undergoing hypertension treatment and taking medications that alter homeostasis. Contraindications to the use of Duloxetine are: hypersensitivity to the preparation component and the simultaneous use of irreversible, non-selective MAO inhibitors. The drug must not be used with fluvoxamine, enoxacin, ciprofloxacin or other drugs that strongly inhibit the isoenzyme CYP1A2.
Particular caution should be exercised when using Duloxetine in people suffering from mania, bipolar disorder and seizures. Since the drug dilates the pupils, caution should be exercised in people with high intraocular pressure and in patients at risk of acute attacks of angle-closure glaucoma.
Duloxetine a alcohol
Alcohol increases the risk of hepatotoxic effects of duloxetine.
Duloxetine – discontinuation
Discontinuation symptoms can occur in some people when treatment is stopped, especially if treatment is stopped suddenly. Symptoms are usually moderate to mild. They generally resolve on their own within two weeks; however, sometimes they persist for 2-3 months or longer.
Duloxetine – side effects
The increase in the concentration of norepinephrine and serotonin in the sacral section of the spinal cord caused by duloxetine increases the tone of the urethra during urine accumulation, which in women causes a stronger closure of the urethra during physical exertion (therefore the drug can be used in women suffering from moderate or severe stress incontinence). urine, but this form of preparation is not available for purchase in Poland).
Duloxetine adjusts the pain threshold in patients suffering from diabetic neuropathic pain.
Duloxetine and venlafaxine
Duloxetine has a greater risk of raising blood pressure and of withdrawal symptoms than venlafaxine.
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