The recommended starting omnadren cycle dose of duloxetine is 60 mg 1 time per day regardless of the meal. In some patients, to achieve a good result it is necessary to increase the dose of 60 mg 1 time per day to a maximum dose of 120 mg per day in two divided doses. Systematic evaluation of the drug in doses above 120 mg have not been evaluated.
Patients with renal insufficiency: initial dose is 30 mg 1 time per day in patients with severely impaired renal function .
Patients with hepatic impairment: should reduce the initial dose of the drug or reduce the dosing frequency in patients with cirrhosis.
The most frequent ‘(≥ 10%) were observed in clinical studies:
dizziness (excluding vertigo), dry mouth, nausea, constipation, sleep disorders (insomnia or drowsiness), and headache. Headache was observed less frequently than with placebo.
Less often (by ≥ 1 to <10%) had diarrhea, vomiting, tremors, loss of appetite, weight loss, weakness, sweating, flushing, blurred vision, anorgasmia, decreased libido, delayed and abnormal ejaculation and erectile dysfunction.
Dizziness, nausea, headache observed as a frequent adverse effects of the abolition of duloxetine.
Influence of the concentration of glucose in patients with painful diabetic neuropathy form: there may be a slight increase in fasting blood glucose levels in patients receiving duloxetine.
A few cases of overdose with single-step ingestion of up to 1400 mg of the drug, did not have fatal consequences. Overdose may be accompanied by the following symptoms: tremors, clonic convulsions, ataxia, vomiting and loss of appetite.
Treatment of an overdose. A specific antidote is not known. It is recommended to monitor cardiac activity and to monitor vital signs, in addition to carrying out symptomatic and supportive treatment.
Interaction with other drugs
Drugs metabolized .
Concomitant use of duloxetine (60 mg 2 times daily) had no significant effect on the pharmacokinetics of theophylline metabolizing . Duloxetine is unlikely to have a clinically significant effect on the metabolism substrates.
Due to the fact that is involved in the metabolism of duloxetine, duloxetine simultaneous with potential inhibitors, may lead to increased concentrations of duloxetine. Strong inhibitor fluvoxamine (100 mg 1 time per day) reduced the average plasmatic clearance of duloxetine by about 77%. Caution should be exercised in the appointment of duloxetine with inhibitors (eg, some quinolone antibiotics) and to use lower doses of duloxetine.
Drugs metabolized .
Duloxetine is a moderate inhibitor . When the duloxetine dose of 60 mg 2 times a day with a single dose of desipramine, substrate desipramine increased 3 times. Simultaneous administration of duloxetine (40 mg, 2 times a day) increased the AUC of tolterodine stable part (2 mg 2 times a day) by 71%, but had no effect on the pharmacokinetics of 5-hydroxy metabolite. Therefore, caution should be exercised when using duloxetine with drugs that are metabolized mainly the system and have a narrow therapeutic index.
Since is involved in the metabolism of duloxetine, duloxetine with simultaneous application of potential inhibitors may lead to increased concentrations of duloxetine. Paroxetine (20 mg 1 time per day) reduced the average clearance of duloxetine by about 37%. When using duloxetine with inhibitors omnadren cycle should be careful.
Agents acting on the central nervous system.
Caution should be exercised when using duloxetine with other drugs and drugs affecting the central nervous system, particularly those that have a similar mechanism of action, including alcohol.
Drugs highly bound to blood proteins.
Duloxetine is largely bound to plasma protein (> 90%). Therefore, the appointment of duloxetine patients who are taking other medication, is highly bound to plasma proteins, can lead to an increase in the concentration of free fractions of both drugs.
monoamine oxidase inhibitors . In patients receiving serotonin reuptake inhibitor in combination with an MAOI, there have been cases of serious reactions, sometimes fatal, including met hyperthermia, rigidity, myoclonus, peripheral disorders with possible sharp fluctuations of vital signs, and mental status changes that include expressed excitement with the transition to delirium and coma.These reactions have also been observed in patients who shortly before the appointment was canceled inhibitor of serotonin reuptake. In some cases, patients experienced symptoms characteristic of neuroleptic malignant syndrome. Effects of combined use of duloxetine and have not been evaluated either in humans or in animals. Therefore, considering the fact that the inhibitor is duloxetine, and serotonin, and norepinephrine, it is not recommended in combination with duloxetine for at least 14 days after cessation of treatment.
Based on the duration of the half-life of duloxetine, you should take a break of at least 5 days after receiving duloxetine before taking .
The worsening of mania / hypomania: As with similar drugs that affect the central nervous system, duloxetine should be used with caution in patients with manic episodes in history. Seizures: As with similar drugs that affect the central nervous system, duloxetine should be used with caution in patients with a history of seizures.
Mydriasis: there have been cases of mydriasis for duloxetine, therefore, caution should be exercised in the appointment of duloxetine in patients with increased intraocular pressure, or in patients at risk of developing acute angle-closure glaucoma.
Impaired Hepatic or renal function: in patients with severe renal impairment (creatinine clearance <30 mL / min) or severe hepatic insufficiency, there is an increase in plasma concentrations of duloxetine. If such patients receiving duloxetine clinically justified, should be used lower initial dose.
Suicide attempts: in depression there is a possibility omnadren cycle of suicide attempts, which may persist until the onset of stable remission. Careful monitoring of patients at risk.
Driving and perform activities that require attention
during duloxetine studies found no violations of psychomotor reactions, cognitive function and memory. However, the drug may be accompanied by sleepiness. In this regard, patients receiving duloxetine, caution should be exercised in controlling harmful mechanical means, including a car.