Duloxetine Brands and Strength Options Available in India
In India, duloxetine is available in various brands and strengths, primarily as 20 mg, 30 mg, 40 mg, and 60 mg formulations, with the 30 mg and 60 mg doses being most commonly prescribed for neuropathic pain conditions. 1
Available Strengths and Dosing Recommendations
- Duloxetine is commonly available in 20 mg, 30 mg, 40 mg, and 60 mg capsule formulations in the Indian market 1
- The recommended starting dose is typically 30 mg once daily for one week before increasing to the therapeutic dose of 60 mg once daily 1
- For neuropathic pain conditions, 60 mg once daily is considered the standard effective dose, with clinical trials showing this dose to be as effective as 60 mg twice daily 1
- Maximum recommended dose is generally 120 mg per day, though this higher dose doesn't typically show significantly greater efficacy than 60 mg daily 2, 3
Clinical Applications in India
- Duloxetine is primarily prescribed for diabetic peripheral neuropathic pain, with strong evidence supporting its efficacy at 60 mg daily dosing 1
- It's also used for fibromyalgia, chronic musculoskeletal pain, major depressive disorder, and generalized anxiety disorder 4, 2
- The drug is considered a first-line treatment for neuropathic pain in diabetes according to clinical practice guidelines 1
- In India, duloxetine is often prescribed alongside pregabalin or gabapentin for enhanced pain relief in difficult cases 1
Administration and Tolerability Considerations
- Starting at 30 mg once daily for one week before increasing to 60 mg once daily can reduce the incidence of nausea, which is the most common adverse effect 1
- Duloxetine can be administered without regard to food or time of day 4
- The drug has a half-life of approximately 12 hours, allowing for once-daily dosing 5
- Unlike some other antidepressants, duloxetine does not typically produce clinically important electrocardiographic or blood pressure changes 1
Common Side Effects and Precautions
- Most common adverse effects include nausea, dry mouth, headache, constipation, dizziness, and fatigue 4, 5
- Side effects are generally dose-dependent, with higher rates at 120 mg compared to 60 mg daily 3, 6
- Duloxetine is contraindicated in patients with severe hepatic and renal impairment 1
- The drug should not be used in combination with CYP1A2 inhibitors or nonselective, irreversible monoamine oxidase inhibitors 5
Practical Prescribing Tips
- For optimal tolerability, initiate treatment with 30 mg once daily for one week before increasing to the therapeutic dose of 60 mg once daily 1
- If treating elderly patients, consider starting at lower doses and titrating more slowly to minimize adverse effects 1
- When discontinuing treatment, taper gradually to minimize withdrawal symptoms, which can include nausea and dizziness 4, 6
- Regular monitoring for improvement in pain scores and functional status is recommended to assess treatment efficacy 1