SNRIs and You: Duloxetine

By | February 4, 2012

Duloxetine was developed as an antidepressant, but is used more commonly in the treatment of a number of chronic pain conditions.

Duloxetine, marketed in the US as Cymbalta by Eli Lilly, is an antidepressant of the serotonin norepinephrine reuptake inhibitor (SNRI) class, which has received FDA approval for a number of chronic pain syndromes. While moderately effective in the treatment of major depression I rarely use it for this purpose at Schlesinger Pain Centers. Duloxetine like the other SNRIs is effective in the treatment of diabetic peripheral neuropathy and a variety of neuropathic disorders as well as fibromyalgia and it is for these purposes I find it most useful.  As with other members of the class it seems to be most effective when combined with a tricyclic antidepressant.

 

Major side effects include nausea, somnolence, insomnia and dry mouth. As with other SNRIs, sexual side effects and weight gain are less common than with other antidepressants. Serotonin syndrome has been reported but is rare. MAO inhibitors are contraindicated and drugs such as dextromethorphan, tramadol, tapentadol, meperidine and even the triptans should be use with caution.

The elimination half-life of duloxetine is 12 hours allowing for either once or twice a day dosing, an advantage over other drugs in its class. Unfortunately its price makes Cymbalta inaccessible to many of my patients. As with other serotonin norepinephrine reuptake inhibitors, the drug should be started and discontinued slowly to minimize side effects.


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