Combinations of SNRIs and MAOIs may lead to serious, sometimes fatal, reactions including very high body temperature, muscle rigidity, rapid fluctuations of heart rate and blood pressure, extreme agitation progressing to delirium , and coma. Similar reactions may occur if duloxetine is combined with antipsychotics, tricyclic antidepressants or other drugs that affect serotonin in the brain. Examples include tryptophan , sumatriptan Imitrex , lithium , linezolid Zyvox , tramadol Ultram , and St.
Fluoxetine Prozac , Serafem , paroxetine Paxil , Paxil CR , Pexeva , fluvoxamine Luvox , and quinidine increase blood levels of duloxetine by reducing its metabolism in the liver. Such combinations may increase adverse effects of duloxetine. Combining duloxetine with aspirin , nonsteroidal antiinflammatory drugs NSAIDs , warfarin Coumadin or other drugs that are associated with bleeding may increase the risk of bleeding, because duloxetine itself is associated with bleeding.
Duloxetine has an enteric coating that prevents dissolution until it reaches a segment of the gastrointestinal that has a pH higher than 5. If you have any questions, ask your doctor or pharmacist. Take this medication by mouth as directed by your doctor, usually 1 or 2 times a day with or without food. If you have nausea , it may help to take this drug with food. Swallow the capsule whole. Do not crush or chew the capsule or mix the contents with food or liquid.
Doing so can release all of the drug at once, increasing the risk of side effects. The dosage is based on your medical condition and response to treatment. To reduce your risk of side effects, your doctor may direct you to start this medication at a low dose and gradually increase your dose. Follow your doctor's instructions carefully. Take this medication regularly to get the most benefit from it. To help you remember, take it at the same time s each day.
It is important to continue taking this medication as prescribed even if you feel well. Do not stop taking this medication without consulting your doctor. Some conditions may become worse when this drug is suddenly stopped. Also, you may experience symptoms such as dizziness , confusion , mood swings , headache , tiredness , diarrhea , sleep changes, and brief feelings similar to electric shock.
While duloxetine has demonstrated improvement in depression-related symptoms compared to placebo , comparisons of duloxetine to other antidepressant medications have been less successful.
Additionally, the review found evidence that duloxetine has increased side effects and reduced tolerability compared to other antidepressants. It thus did not recommend duloxetine as a first line treatment for major depressive disorder, given the then high cost of duloxetine compared to inexpensive off-patent antidepressants and lack of increased efficacy.
A review from the Annals of Internal Medicine lists duloxetine among the first line drug treatments, however, along with citalopram , escitalopram , sertraline , paroxetine , and venlafaxine. The average daily pain was measured using an point scale, and duloxetine treatment resulted in an additional 1—1.
Most of the response was achieved in the first two weeks on the medication. Duloxetine slightly increased the fasting serum glucose ; this effect was deemed to be of "minimal clinical significance", however. A systematic review noted that tricyclic antidepressants imipramine and amitriptyline , traditional anticonvulsants and opioids have better efficacy than duloxetine.
Duloxetine, tricyclic antidepressants and anticonvulsants have similar tolerability while the opioids caused more side effects. The reviewer saw no reason to prescribe duloxetine in practice. The authors noted that the evidence in favor of duloxetine is much more solid, however. Food and Drug Administration approved duloxetine to treat chronic musculoskeletal pain, including discomfort from osteoarthritis and chronic lower back pain.
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