Switching Duloxetine (Cymbalta, Drizalma Sprinkle) for Depression & Anxiety скачать в хорошем качестве

Switching Duloxetine (Cymbalta, Drizalma Sprinkle) for Depression & Anxiety

Transcript: Duloxetine, marketed under the brand name Cymbalta, is classified as a selective serotonin and norepinephrine reuptake inhibitor (SNRI). It is approved in both Canada and the United States for the treatment of major depressive disorder, generalized anxiety disorder, diabetic neuropathic pain, fibromyalgia, chronic low back pain, and osteoarthritis of the knee. The recommended dose for depression is 60 mg daily, while the recommended dose for anxiety and most pain conditions is up to 120 mg daily. Some experienced clinicians may use higher off-label doses if each dose increase is well tolerated and results in further improvement. It’s important to note that the norepinephrine effect of duloxetine is not typically clinically significant until doses reach 90 mg or higher. Duloxetine may be started at 30 mg daily, though 60 mg is the usual starting dose. Starting lower and titrating slowly is appropriate for patients with significant anxiety, elderly patients, or those who may be sensitive to early side effects. When titrating, wait at least one week (or longer, depending on tolerability) before increasing from 30 mg to 60 mg. If necessary, doses may be further increased in 30 mg increments, no more often than every two weeks. If early side effects occur, do not increase the dose until those effects have resolved. If needed, lowering the dose by 30 mg may help alleviate side effects, and the dose can later be increased again once symptoms have resolved. It’s crucial to treat depression and anxiety symptoms fully, since residual symptoms like fatigue, low energy, or cognitive impairment strongly predict relapse. Full functional recovery should be the ultimate goal of treatment. Duloxetine can be taken in the morning or evening. Some patients prefer to start in the evening to sleep through common early side effects like nausea or headache. If duloxetine interferes with sleep, taking it at breakfast is recommended. It can be taken with or without food, although taking it with food may reduce nausea. Early nausea is fairly common but is usually mild and temporary, resolving within one to two weeks. Avoid increasing the dose until nausea has subsided. The most common adverse effects include dry mouth, headache, nausea, and excessive sweating (hyperhidrosis). Sweating can be particularly bothersome during warmer months and may require a medication switch or an additional treatment. Weight gain is uncommon with duloxetine, but sexual dysfunction may occur. Discontinuation symptoms are possible with all antidepressants, though less common with duloxetine. Patients should taper gradually over several weeks when stopping the medication. If switching to or from another antidepressant, refer to the SwitchRx Antidepressant Overview for guidance. Duloxetine has no known risk of QTc prolongation. As with all antidepressants, use caution in patients with or at risk for bipolar disorder to prevent hypomania or mania. Duloxetine is not recommended for patients with hepatic impairment, severe renal impairment, or end-stage renal disease. Monitor blood pressure and heart rate in patients with hypertension or cardiac conditions. No dose adjustment is generally required for elderly patients, though starting lower and titrating slowly is always prudent. For children and adolescents, use careful risk–benefit assessment and close monitoring for behavioral changes or suicidality, consistent with all antidepressant prescribing guidelines.