#40: duloxetine (Cymbalta) | Beneficial As An Antidepressant and Pain Medication

Duloxetine is used in a wide variety of indications. It can be used in treating fibromyalgia, chronic musculoskeletal pain, and neuropathic pain due to diabetes mellitus. It is also used in treating mood disorders such as generalized anxiety disorder and major unipolar depressive disorder. The general dosing range for duloxetine is 30-60 mg PO qd. Although the max dose is 120 mg per day, therapeutic benefits do not appear evident past 60 mg per day. Duloxetine works through strong inhibition of neuronal serotonin and norepinephrine reuptake along with weak inhibition of dopamine reuptake. There is reduced bioavailability in patients who smoke cigarettes with a 33% reduction of bioavailability. When discontinuing therapy duloxetine should be titrated down over 2-4 weeks. There is a black box warning for suicidality and risks vs benefits should be weighted when being used in children and adolescents. When taking duloxetine capsules should be taken whole and should not be opened.

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