Another Name for Duloxetine
Cymbalta is another name for duloxetine, which is classified as a selective serotonin and norepinephrine reuptake inhibitor (SSNRI or SNRI). 1, 2
Classification and Pharmacology
- Duloxetine is a potent and selective inhibitor of serotonin and norepinephrine transporters with a weak inhibition of dopamine transporters 3
- It belongs to the SNRI class of medications, which includes other drugs such as venlafaxine, desvenlafaxine, and levomilnacipran 4
- Unlike some other psychoactive medications, duloxetine is not a controlled substance and does not appear in any of the five controlled substance schedules (I-V) 1
Brand Names and Formulations
- Cymbalta is the most common brand name for duloxetine in the United States 2
- Duloxetine is available in various strengths, primarily as 20 mg, 30 mg, 40 mg, and 60 mg capsule formulations 5
Clinical Applications
Duloxetine (Cymbalta) is FDA-approved for multiple conditions:
- Major depressive disorder 6
- Generalized anxiety disorder in children and adolescents 7 years and older 4
- Diabetic peripheral neuropathic pain 7, 8
- Fibromyalgia 4
- Chronic musculoskeletal pain, including chronic low back pain and osteoarthritis pain 4
Pharmacokinetics
- Absorption begins two hours after oral administration, reaching maximum plasma concentration in six hours 2
- Half-life is approximately 12 hours, allowing for once-daily dosing 3, 2
- Duloxetine is extensively metabolized in the liver by CYP1A2 and CYP2D6 enzymes 3
Dosing Considerations
- Typical starting dose is 30 mg once daily for one week, then increased to 60 mg once daily 1, 5
- Maximum recommended dose is 60 mg twice daily (120 mg/day) 1
- For elderly patients, lower starting doses and slower titration may be appropriate 5
Important Considerations
- Duloxetine should be tapered when discontinuing to prevent withdrawal symptoms, especially after treatment longer than 3 weeks 1
- Common adverse effects include nausea, dry mouth, headache, constipation, dizziness, and fatigue 1, 3
- Serious but rare adverse effects may include hepatic failure, severe skin reactions, suicidal thinking, and serotonin syndrome 4, 1
Clinical Pearls
- Starting at a lower dose (30 mg daily) for one week before increasing to the therapeutic dose can reduce the incidence of nausea, which is the most common adverse effect 5
- Duloxetine may be administered without regard to food or time of day 3
- Duloxetine is contraindicated in patients with severe hepatic and renal impairment 5