Duloxetine

Drug Name
Duloxetine

Brand Name(s)
Cymbalta®

Drug Class
Prescription medication

Duloxetine is a second-line agent for treatment of osteoarthritis of the knee that has not responded to acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDs).

  • What types of arthritis is duloxetine used for?

    Duloxetine belongs to a group of medicines called “serotonin and norepinephrine reuptake inhibitors” (SNRIs).  Duloxetine may be used to treat depression and anxiety.  Duloxetine is also used to treat different types of pain, such as diabetic nerve pain, fibromyalgia pain, chronic low back pain, and chronic osteoarthritis knee pain.

    Duloxetine is a second-line agent for treatment of osteoarthritis of the knee that has not responded to acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDs). Duloxetine has also shown benefit as an add-on medication for people who have had a partial response to acetaminophen or NSAIDs.
    Duloxetine is not used to treat inflammatory arthritis.

  • How is duloxetine administered?

    Duloxetine is an oral capsule.

  • What is the typical dose and when do I take it?

    The recommended dose is 60 mg once daily to a maximum of 120 mg daily (higher doses are associated with a higher rate of adverse reactions).
     
    A common way to start duloxetine is with 30 mg once daily, with a dose increase to 60 mg in one to two weeks to allow your body time to adjust to the medication.

    A lower dose may be required if you have reduced kidney function.
     
    Cigarette smokers are likely to have lower levels of duloxetine in their system and may require higher dosing of duloxetine.  If you are a smoker, please discuss this with your healthcare provider.

  • How long will it take to work?

    You may notice improvement in your pain symptoms with duloxetine within one week.

  • When should I not take duloxetine and call my doctor?

    Duloxetine interacts with a number of other medications. Please speak with your healthcare provider about whether any of the other medications you currently take interact with duloxetine.
    Do not take duloxetine if you have an allergy to duloxetine. 
    Duloxetine should be avoided if you have serious liver or kidney diseases or if you consume substantial amounts of alcohol (three or more drinks per day). 
     
    Before taking duloxetine, tell your healthcare provider if you are pregnant or planning to become pregnant or are breastfeeding or planning to breastfeed. Currently there are no studies to assess the use of duloxetine during pregnancy and breastfeeding.  Your healthcare provider will discuss the risks and benefits of taking duloxetine while you are pregnant.

  • What are the side effects of duloxetine?

    Nausea, constipation, dry mouth, fatigue, dizziness, drowsiness, headache (rarely), increased blood pressure/heart rate, sweating and decreased appetite.  If any of these symptoms become bothersome, please speak to your healthcare provider.

    Suicidal thoughts or behavior, and self-injury have been very rarely reported in patients taking SNRI medications, like duloxetine.  Discuss these risks with your healthcare provider prior to starting duloxetine.  Contact your healthcare provider if you experience worsening depression or thoughts of suicide while taking duloxetine.

    Do not discontinue or reduce your dosage of duloxetine without speaking with your healthcare provider.  Duloxetine should be discontinued slowly, typically over a week or two.

  • What helps to reduce side effects?

    Initial side effects with duloxetine usually diminish 1 to 2 weeks after starting duloxetine.

    Do not exceed the maximum recommended daily dose of duloxetine. Gradual dosage increases may help reduce some of the side effects. To reduce stomach upset, consider taking duloxetine with food.

    If you experience drowsiness and sedation while taking duloxetine please be cautious about operating hazardous machinery, including automobiles, until your are reasonably certain that duloxetine therapy does not affect your ability to engage in such activities.

    People who are experiencing drowsiness and sedation may consider taking the medication closer to bedtime.

  • Do I need any monitoring while taking duloxetine?

    Routine blood tests or monitoring are normally not required while taking duloxetine. Your healthcare provider may meet with you regularly to ensure that duloxetine is adequately controlling your pain and not causing adverse effects.

    Your healthcare provider may also monitor your blood pressure to make sure duloxetine is not causing an increase.

This information was last updated January 2020, with expert advice from:

Jason Kielly, B.Sc. (Pharm.), Pharm.D.
Associate Professor, School of Pharmacy, Memorial University of Newfoundland
Clinical Pharmacist, Rheumatic Health Program, Eastern Health

Hamidreza Izadpanah , Pharm.D.

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