Drug reference

Duloxetine

Serotonin-norepinephrine reuptake inhibitor (SNRI) · Antidepressant

Also known as Duloxetine Hydrochloride, Cymbalta, Dulojoy, Duwell, Depralin, Duxet

START

30 mg OD x 1 week then increase to 60 mg OD; take with food to reduce nausea; screen for bipolar disorder and suicide risk

TYPICAL MAX

120 mg/day (60 mg BD)

STOP IF

Jaundice, signs of liver failure, severe rash, serotonin syndrome, suicidal ideation

WATCH

Mood/suicide risk (especially first 4 weeks and in young adults), LFTs if symptoms, BP (orthostatic), sodium (especially elderly), eye symptoms (glaucoma)

CDSCO approvedSchedule HJan AushadhiATC N06AX21

Dose laddermg/d

Renal dose adjustmenteGFR mL/min/1.73m²

KDIGO 2024 + manufacturer label

Pharmacokineticsplasma · t hours

ONSET: 1.5h · absorption onset
PEAK: 6h · Peak plasma concentration
t½: 12h · Elimination half-life
DURATION: 1d · Once-daily dosing

EXCRETION

Renal (70%, metabolites)

route + CYP

INTERACTIONS

12 major

incl. contraindicated

PREGNANCY

Avoid in third trimester; risk of neonatal withdrawal and PPHN; use only if benefits outweigh risks in first/second trimester

FDA category + note

Top interactionssee all 12 →

LinezolidContraindicatedDatabaseDDInter
MaoisContraindicatedDatabaseKimi deep-research + Cla
Monoamine Oxidase Inhibitors (maois)ContraindicatedDatabase
ThioridazineContraindicatedDatabaseKimi deep-research + Cla

Available in India

304 branded formulations and 20 fixed-dose combinations. Look up specific brands in the Drugs workspace.

Jan Aushadhi — generic available at GoI pharmacies

Mechanism

Potent inhibitor of serotonin and norepinephrine reuptake transporters (SERT and NET), with weak dopamine reuptake inhibition. Enhances descending inhibitory pain pathways in CNS and PNS, providing antidepressant and analgesic effects. Minimal affinity for muscarinic, histaminergic, and adrenergic receptors.

Indications

Major depressive disorderGeneralized anxiety disorderDiabetic peripheral neuropathic painFibromyalgiaChronic musculoskeletal pain (chronic low back pain, osteoarthritis pain)

Dosing

Adult: Start 30-60 mg OD; may increase to 60-120 mg OD based on response. Usual effective dose: 60 mg OD
Pediatric: GAD (7-17 years): 30 mg OD x 2 weeks then 60 mg OD; max 120 mg/day
Renal adjustment: eGFR 30-59: use with caution; eGFR <30: avoid
Hepatic adjustment: Contraindicated in hepatic impairment (risk of hepatotoxicity)
Geriatric: Start 30 mg OD; titrate slowly; monitor for hyponatremia and falls
Max dose: 120 mg/day

Pharmacokinetics

Onset

Depression/anxiety: 2-4 weeks; Pain: 1-2 weeks

Peak effect

6 hours (Tmax)

Duration

24 hours

Half-life

12 hours

Bioavailability

~50% (first-pass metabolism)

Protein binding

>90%

Metabolism

Hepatic CYP1A2 and CYP2D6 (extensive first-pass)

Excretion

Renal (70%, as metabolites); fecal (20%)

Contraindications

Concomitant MAOIs or within 14 days of MAOI discontinuation
Uncontrolled narrow-angle glaucoma (may cause mydriasis)
Severe renal impairment (eGFR <30 mL/min)
Hepatic impairment
Concomitant thioridazine or pimozide

Side effects

Common

NauseaDry mouthConstipationDecreased appetiteFatigueSomnolenceInsomniaHeadacheDizzinessDiaphoresis

Serious

Suicidal ideation (black box warning for patients <24 years)
Hepatotoxicity / liver failure
Serotonin syndrome
Hyponatremia / SIADH
Bleeding events (platelet serotonin depletion)
Severe discontinuation syndrome
Orthostatic hypotension and syncope
Angle-closure glaucoma

Pregnancy & lactation

Pregnancy

Avoid in third trimester; risk of neonatal withdrawal and PPHN; use only if benefits outweigh risks in first/second trimester

Lactation

Excreted in breast milk; use with caution during breastfeeding; monitor infant for sedation and poor feeding

Drug interactions

Linezolid

Contraindicated

Database

Serotonin syndrome risk.

Contraindicated. Use alternative antibiotic.

Source: DDInter

Maois

Contraindicated

Database

Risk of serotonin syndrome, hyperthermia, seizures, death

Must wait 14 days between MAOI and duloxetine

Source: Kimi deep-research + Cla

Monoamine Oxidase Inhibitors (maois)

Contraindicated

Database

Risk of serotonin syndrome (hyperthermia, rigidity, myoclonus, autonomic instability, mental status changes)

Contraindicated. A washout period of at least 14 days is required between discontinuing an MAOI and starting duloxetine, and at least 5 days between discontinuing duloxetine and starting an MAOI.

Thioridazine

Contraindicated

Database

CYP2D6 inhibition increases levels of these drugs; QT prolongation risk

Avoid combination

Source: Kimi deep-research + Cla

Alfentanil

Severe

Database

Drug interaction classified as: synergy

Source: DDInter

Almotriptan

Severe

Database

Drug interaction classified as: synergy

Source: DDInter

Amitriptyline

Severe

Database

Increased plasma concentrations of amitriptyline and its active metabolite nortriptyline, leading to increased risk of anticholinergic effects, sedation, cardiac conduction abnormalities, and seizures.

Avoid concomitant use if possible. If co-administration is necessary, significantly reduce amitriptyline dose (e.g., by 50-75%) and monitor for adverse effects and therapeutic drug levels. Consider alternative antidepressants.

Source: DDInter

Amoxapine

Severe

Database

Drug interaction classified as: synergy

Source: DDInter

Amphetamine

Severe

Database

Drug interaction classified as: synergy.

Source: DDInter

Benzphetamine