PsychRounds: The Psychiatry Podcast

[SNRI] - Duloxetine (Cymbalta)

10 snips
Jan 19, 2024
Dive into the fascinating world of Duloxetine, an SNRI used to tackle depression, anxiety, and chronic pain. Discover its unique properties compared to other medications and learn about dosing strategies and side effects. Gain insights into its clinical uses, including special considerations for children and patients with liver issues. The discussion also sheds light on the importance of medication adherence and how to effectively manage co-existing conditions.
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INSIGHT

Duloxetine's Dose-Dependent Effects

  • Duloxetine inhibits serotonin and norepinephrine reuptake but is more adrenergic than venlafaxine.
  • At lower doses, it acts mostly serotonergic; higher doses increase noradrenergic effects needed for pain management.
ADVICE

Dosing Tips for Duloxetine

  • Divide duloxetine dosing to reduce nausea, but dose more in the morning to avoid nighttime activation.
  • For example, a 90 mg dose could be split as 60 mg in the morning and 30 mg at night.
INSIGHT

CYP2D6 Interaction Risks

  • Duloxetine is a strong CYP2D6 inhibitor and substrate, causing drug interactions raising plasma levels.
  • This can lead to increased side effects or dangerous outcomes with other CYP2D6-metabolized drugs like amitriptyline.
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