Duloxetine is used to treat depression and anxiety.
This medicine is also used to treat fibromyalgia (a condition characterised by pain all over the body accompanied by tiredness, sleep, memory or mood problems), pain caused by nerve damage in people with diabetes, and long-term pain in the muscles, bones, joints, ligaments, tendons, and nerves.
Duloxetine may be used to treat other conditions as decided by your doctor.
Take Duloxetine exactly as directed by your doctor or according to the instructions on the label. Do not take more or less than instructed by your doctor.
You may take this medicine with or without food. Try to take it at the same time each day.
Duloxetine is available as a delayed-release or gastro-resistant capsule. Swallow the capsule whole with a glass of water. Do not open, chew, or crush the capsule.
Some brands of this medicine may be opened and the contents sprinkled over applesauce. The mixture must be swallowed immediately. Ask your doctor or pharmacist how you should take the medicine given to you.
Do not stop taking this medicine suddenly as it may worsen your condition. Your doctor will gradually reduce the dose before stopping it completely. Follow your doctor's instructions carefully.
Duloxetine must be taken regularly for it to be effective. Continue taking this medicine even when you feel better. Do not stop taking it unless instructed by the doctor.
Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and return to your normal dosing schedule.
DO NOT double a dose under any circumstances.
If you often forget to take your medicine, let your doctor and pharmacist know.
Alert your doctor if you have the following conditions:
- uncontrolled high blood pressure
- liver disease
- severe kidney disease
as Duloxetine may not be suitable for you.
Do not take Duloxetine if you are currently taking or have taken a medicine that is used to treat depression known as a monoamine oxidase inhibitor (MAOI) such as isocarboxazid, phenelzine and tranylcypromine in the last 14 days.
Do not take Duloxetine with medicines for mood disorders or methaemoglobinaemia (a blood disorder in which too little oxygen is delivered to the cells), other medicines used to treat depression or certain antibiotics. Please see the section "Can I take this with other medicines?" below for more information.
Inform your doctor if you have the following conditions:
- history of mania (feeling highly excited, being over-active and easily irritated or distracted) or bipolar disorder (mental condition that causes extreme mood changes between feeling very high and very low)
- history of seizures
- history of self-harm or having thoughts of self-harm
- increased pressure in the eye
- controlled high blood pressure or other heart diseases
- bleeding tendency or bleeding problems
- condition that may increase your risk of having low sodium levels in the blood e.g. dehydration (excessive water loss from the body)
- problem in emptying the contents of the stomach
- mild to moderate kidney disease
Let your doctor know if you are pregnant or breastfeeding.
Be sure to check with your doctor or pharmacist before giving Duloxetine to a child or the elderly. Children and elderly people may be more sensitive to the side effects.
Inform your doctor if you smoke or consume large amounts of alcohol.
Medicines for depression such as Duloxetine may increase the risk of suicidal thoughts and behaviour. As depression and some psychiatric disorders are themselves associated with an increased risk of suicide, it is important for you or your family members to monitor your condition, especially at the start of treatment and if your dosage is still being adjusted. If you experience new or sudden changes in mood, behaviour, thoughts or feelings or a worsening of your depression with suicidal thoughts or attempts, harm to self or harm to others, contact your doctor immediately.
Why is it important to keep my appointments with the doctor?
Keep your appointments with your doctor. Your doctor needs to monitor your condition and check your response to the medication regularly.
- Screening for personal or family history of mania or bipolar disorder must be done before treatment to know if this medicine is suited for you to take.
- Routine tests (e.g. liver and kidney functions, sugar levels in individuals with diabetes) may be done while you are being treated with this medicine. Your doctor will advise you about how often you need to have these tests.
- Your blood pressure may rise or fall to unsafe levels without you noticing it. Monitor your blood pressure before and during treatment.
- Regular monitoring for signs or symptoms of serotonin syndrome (drug reaction that results from excessive serotonin levels in the body) may also be needed.
What lifestyle changes should I make to cope with depression?
Regular exercise and eating a healthy diet will help increase energy and hormones in the body such as serotonin, endorphins and other feel-good chemicals that minimise mood swings. Get enough sleep, as lack of sleep may cause irritability, moodiness, sadness, and tiredness.
Duloxetine may cause drowsiness and dizziness. If affected, do not drive or take part in any activity in which you need to be alert.
This medicine may also cause your blood pressure to fall suddenly when you get up from a sitting or lying down position and you may feel giddy. To minimise this problem, stand up slowly.
Other side effects include any of the following: nausea, vomiting, dry mouth, constipation, diarrhoea, stomach pain, lack of appetite, weight loss, indigestion, stomach wind, headache, tiredness, blurred vision, ringing in the ears, dizziness with sensations of spinning, difficulty sleeping, abnormal dreams, yawning, muscle pain or spasm, rash, and pain when passing urine.
Some side effects may need immediate medical help. Alert your doctor quickly if you experience any of the following:
- signs and symptoms of serotonin syndrome e.g. agitation, confusion, hallucinations (seeing, hearing or feeling things that are not existent), fever, fast heartbeat, excessive sweating, muscle stiffness or spasms
- yellowing of the skin or eyes, abdominal pain, dark coloured urine, swelling in the legs and ankles
- having thoughts of self-harm
- unusual changes in mood or behaviour (being too depressed, agitated, or having compulsive and impulsive behaviour)
- signs and symptoms of low sodium levels in the blood e.g. headache, difficulty concentrating, memory problems, confusion, weakness, and unsteadiness
- unusual bleeding or bruising, passing out bloody or black as tar stools and vomiting blood or ground coffee-like material
- changes in sex drive
- rashes with peeling of the skin or blistering of the lips, mouth, or eyes accompanied by fever
Inform your doctor if any of these side effects do not go away or are severe, or if you experience other side effects.
Do not take Duloxetine if you are currently taking or have taken a medicine that is used to treat depression known as a monoamine oxidase inhibitor (MAOI) such as isocarboxazid, phenelzine and tranylcypromine in the last 14 days.
Do not take this medicine if you are taking or using any of these medicines:
- certain antibiotics e.g. ciprofloxacin, enoxacin, linezolid
- thioridazine (medicine for mood disorder)
- fluvoxamine (another medicine to treat depression)
- intravenous methylthioninium chloride [also known as methylene blue] (medicine used to treat methaemoglobinaemia)
Inform your doctor and pharmacist if you are taking any of these medicines:
- other medicines for depression e.g. sertraline, citalopram, amitriptyline, nortriptyline, desipramine
- strong painkillers e.g. tramadol, pethidine
- blood-thinning medicines e.g. warfarin, aspirin
- NSAIDs (medicines for pain and inflammation) e.g. ibuprofen, naproxen
- certain medicines for cold or allergy e.g. diphenhydramine
- medicines for migraine e.g. sumatriptan
- other medicines for mood disorders e.g. risperidone
- medicines to treat anxiety or sleep disorders e.g. diazepam
- phenobarbital (medicine for fits or seizures)
- metoprolol (medicine for high blood pressure)
- St. John's wort (herbal medicine)
This list does not include all medicines that may interact with Duloxetine.
Always notify your doctor and pharmacist if you are taking any other medicines, including herbal tonics such as traditional Chinese medicines, supplements, and medicines that you buy without a prescription.
Avoid alcohol. Consuming large amounts of alcohol is damaging to your liver.
Store in a cool, dry place away from the reach of children.
Protect from moisture.
Medicines must not be used past the expiry date.
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