Indications and Dosage:
Major Depressive Disorder (MDD):
-
- Administration: By mouth.
- Adult Dosage: 60 mg once daily.
Generalized Anxiety Disorder (GAD):
-
- Administration: By mouth.
- Adult Dosage: Start with 30 mg once daily, increase to 60 mg if necessary; can go up to a maximum of 120 mg per day.
Diabetic Neuropathy:
-
- Administration: By mouth.
- Adult Dosage: 60 mg once daily, discontinue if no adequate response after 2 months; review treatment at least every 3 months.
Moderate to Severe Stress Urinary Incontinence:
-
- Administration: By mouth.
- Adult Dosage (Female): Start with 20 mg twice daily for 2 weeks to minimize side effects, then increase to 40 mg twice daily; reassess benefit and tolerability after 2–4 weeks.
Cautions:
- General: Use with caution in patients with a history of bleeding disorders, cardiac disease, mania, seizures, hypertension, raised intra-ocular pressure, or susceptibility to angle-closure glaucoma.
Side Effects:
- Common: Anxiety, decreased appetite, constipation, diarrhea, dizziness, drowsiness, dry mouth, gastrointestinal discomfort, headache, muscle complaints, nausea, sleep disorders, and more.
- Uncommon: Apathy, arrhythmias, disorientation, dysphagia, hyperglycemia, and more.
- Rare: Angioedema, cutaneous vasculitis, galactorrhea, glaucoma, hallucinations, hypertensive crisis.
Pregnancy and Breastfeeding:
- Pregnancy: Use only if potential benefit outweighs risk due to toxicity found in animal studies.
- Breastfeeding: The drug is present in milk; manufacturers advise against use while nursing.
Hepatic and Renal Impairment:
- Hepatic: Avoid use in patients with hepatic impairment.
- Renal: Avoid use if creatinine clearance is less than 30 mL/minute.
Discontinuation:
- Abrupt discontinuation or dose reduction can lead to nausea, vomiting, headache, anxiety, and other symptoms; gradually reduce the dose over at least 1–2 weeks.
Medicinal Forms:
- Available as gastro-resistant capsules in various dosages (20 mg, 30 mg, 60 mg, etc.), with specific drug tariff costs associated with each.
National Funding/Access:
- SMC Decisions: Duloxetine (Cymbalta) is recommended with restrictions for diabetic peripheral neuropathic pain in adults.