Is duloxetine (Cymbalta) effective for polyneuropathy caused by oxaliplatin?

From the Guidelines

Duloxetine is effective for treating polyneuropathy caused by oxaliplatin, with a moderate clinical benefit in patients with painful chemotherapy-induced peripheral neuropathy (CIPN) 1.

Key Points

• Duloxetine is typically prescribed at 30 mg daily for one week, then increased to 60 mg daily for maintenance therapy 1.
• The effect of duloxetine treatment has been shown to be more pronounced in CIPN due to platinum-based therapies, such as oxaliplatin, than in taxanes 1.
• Duloxetine works by increasing serotonin and norepinephrine levels in the central nervous system, which enhances descending pain inhibitory pathways 1.
• Common side effects include nausea, dizziness, dry mouth, constipation, and fatigue, which often improve after the first few weeks of treatment 1.
• Patients should be aware that duloxetine requires gradual discontinuation to avoid withdrawal symptoms, and it may take 2-4 weeks to experience meaningful pain relief 1.

Treatment Considerations

• Treatment duration is usually several months, with periodic reassessment of symptoms 1.
• Duloxetine is recommended for the treatment of neuropathic pain, with a grade of recommendation of I, B 1.
• Other options, such as venlafaxine, gabapentin, and pregabalin, may be considered if duloxetine is not effective or is contraindicated 1.

Conclusion Not Applicable - Direct Answer Only

Duloxetine is the most effective option for treating polyneuropathy caused by oxaliplatin, based on the current evidence 1.

From the Research

Effectiveness of Duloxetine for Polyneuropathy Caused by Oxaliplatin

• Duloxetine is effective in treating painful chemotherapy-induced peripheral neuropathy (CIPN) caused by oxaliplatin, as shown in a study published in the European journal of cancer care 2.
• The study found that duloxetine-treated patients with high emotional functioning are more likely to experience pain reduction, suggesting that emotional functioning may predict duloxetine response in patients with painful oxaliplatin-induced CIPN.
• Another study published in The Cochrane database of systematic reviews found that duloxetine is effective in treating painful diabetic peripheral neuropathy and fibromyalgia, but not central neuropathic pain 3.
• A review of six trials including 2220 participants found that duloxetine at 60 mg daily is effective in treating painful diabetic peripheral neuropathy in the short-term, with a risk ratio for 50% pain reduction at 12 weeks of 1.65 4.
• Duloxetine has also been shown to be safe and effective in reducing symptoms of diabetic peripheral neuropathic pain, with a dose of 60 mg/day being the recommended dose 5.
• A study published in Pharmaceuticals found that duloxetine, along with gabapentin, can prevent oxaliplatin- and paclitaxel-induced peripheral neuropathy by inhibiting extracellular signal-regulated kinase 1/2 (ERK1/2) phosphorylation in spinal cords of mice 6.

Key Findings

• Duloxetine is effective in treating painful CIPN caused by oxaliplatin.
• Emotional functioning may predict duloxetine response in patients with painful oxaliplatin-induced CIPN.
• Duloxetine is effective in treating painful diabetic peripheral neuropathy and fibromyalgia.
• The recommended dose of duloxetine for treating painful diabetic peripheral neuropathy is 60 mg/day.
• Duloxetine can prevent oxaliplatin- and paclitaxel-induced peripheral neuropathy by inhibiting ERK1/2 phosphorylation in spinal cords of mice.