Safety and adverse event profile of duloxetine.
Duloxetine is the first relatively balanced serotonin and noradrenaline re-uptake inhibitor to be widely available for three indications including: major depressive disorder, peripheral diabetic neuropathic pain and female stress urinary incontinence, although it is not currently approved for all indications in all countries. Generally, duloxetine is safe and well-tolerated across indications, with few reported serious side effects. Common adverse events are consistent with the pharmacology of the molecule and are mainly referable to the gastrointestinal and the nervous systems. The studied dose range is up to 400 mg/day (administered 200 mg b.i.d) but the maximum dose approved for marketing is 120 mg/day (administered 60 mg b.i.d). Duloxetine is eliminated (half-life = 12.1 hours) primarily in the urine after extensive hepatic metabolism by multiple oxidative pathways, methylation and conjugation. Duloxetine would not be expected to cause clinically significant inhibition of the metabolic clearance of drugs metabolised by P450 (CYP)3A, (CYP)1A2, (CYP)2C9, or (CYP)2C19, but would be expected to cause some inhibition of CYP 2D6. Duloxetine should not be used in combination CYP 1A2 inhibitors or nonselective, irreversible monoamine oxidase inhibitors. The purpose of this review is to provide an overview of some of the most important information related to safety and tolerability of duloxetine.
Wernicke
Joachim F
JF
Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana 46285, USA. jfwernicke@lilly.com
Gahimer
James
J
Yalcin
Ilker
I
Wulster-Radcliffe
Meghan
M
Viktrup
Lars
L
D003577:Cytochrome P-450 Enzyme System / Q000378:metabolism; D003865:Major Depressive Disorder / Q000188:drug therapy; D003929:Diabetic Neuropathies / Q000150:complications / Q000188:drug therapy; D004305:Dose-Response Relationship, Drug; D004347:Drug Interactions; D000068736:Duloxetine Hydrochloride; D006207:Half-Life; D006801:Humans; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects* / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use; D013876:Thiophenes / Q000009:adverse effects* / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use; D014550:Urinary Incontinence, Stress / Q000188:drug therapy
D003577:Cytochrome P-450 Enzyme System; D000068736:Duloxetine Hydrochloride; D017367:Selective Serotonin Reuptake Inhibitors; D013876:Thiophenes