Duloxetine
SNRI with FDA approval for MDD, GAD, diabetic peripheral neuropathy, fibromyalgia, chronic musculoskeletal pain. | Compound
Aliases (2)
▸ Overview TL;DR
SNRI with FDA approval for MDD, GAD, diabetic peripheral neuropathy, fibromyalgia, chronic musculoskeletal pain. Cleaner withdrawal than venlafaxine but still notable. Hepatotoxicity risk in heavy drinkers. Not relevant to Dylan.
▸ Mechanism of action
Balanced 5-HT and NE reuptake inhibition across the clinical dose range (vs venlafaxine which is dose-tiered). Descending noradrenergic pathways from locus coeruleus modulate dorsal horn pain signals → analgesic effect independent of mood improvement.
▸ Pharmacokinetics No data
▸ What to expect Generic
- 1Week 1Tolerability and dose-response.
- 2Week 2-4Early effect window.
- 3Week 4-8Peak benefit assessment.
- 4Week 8+Cycle decision point.
▸ Side effects + safety
- Common (>10%): Nausea (often improves), dry mouth, fatigue, sexual dysfunction, sweating, constipation.
- Less common (1-10%): Insomnia, ↑ BP (less than venlafaxine), tremor, dizziness.
- Rare-serious (<1%): Hepatotoxicity (avoid in heavy drinkers, hepatic disease), serotonin syndrome, hyponatremia, suicidal ideation <25 yo, Stevens-Johnson syndrome (very rare).
- Specific watch periods: LFTs at baseline + as indicated; hepatotoxicity risk amplified by alcohol use.
▸References5 sources
PMID 29477251
2018Cipriani 2018 network MA.
PMID 24452986
Duloxetine for chronic pain Cochrane review.
PMID 21205111
Duloxetine hepatotoxicity case series.
PMID 30032535
Antidepressant discontinuation severity.
PMID 19909529
Duloxetine for fibromyalgia.