Cymbalta, 30 mg capsules 14 pcs

Antidepressant, serotonin and norepinephrine reuptake inhibitor and weakly inhibits dopamine reuptake, has no significant affinity for histamine, dopamine, choline and adrenoreceptors.

Indications

depression; painful form of diabetic neuropathy; generalized anxiety disorder; chronic musculoskeletal pain syndrome (including that caused by fibromyalgia, chronic pain syndrome in the lower back and osteoarthritis of the knee).

Active ingredient

Duloxetine

Composition

1 capsule contains duloxetine (as hydrochloride) 30 mg.

How to take, the dosage

Symbalta is prescribed orally, regardless of meals.

The capsules should be swallowed whole without chewing or crushing. Cymbalta should not be added to food or mixed with liquids as this may damage the capsule’s gut-soluble coating.

The recommended starting dose of Cymbalta is 60 mg once daily. If necessary, it is possible to increase the dose to the maximum dose of 120 mg per day in 2 doses. There has been no systematic evaluation of Cymbalta doses above 120 mg.

In end-stage chronic renal failure (CKR less than 30 ml/min), the initial dose of Cymbalta is 30 mg once daily.

Interaction

Monoamine oxidase inhibitors (MAOIs). Because of the risk of serotonin syndrome, duloxetine should not be used in combination with an IMAO, and for at least 14 days after stopping IMAO treatment.

Special Instructions

Monoamine oxidase inhibitors (MAOIs). In patients receiving a serotonin reuptake inhibitor in combination with an IMAO, there have been cases of serious reactions, sometimes fatal, including hyperthermia, rigidity, myoclonus, peripheral disorders with possible dramatic fluctuations of vital functions and mental status changes, including severe agitation with a transition to delirium and coma.

These reactions have also been observed in patients who had had a serotonin reuptake inhibitor withdrawn shortly before IMAO administration. In some cases, patients experienced symptoms characteristic of neuroleptic malignant syndrome. The effects of the combined use of duloxetine and IMAO have not been evaluated in either humans or animals.

Hence, given that duloxetine is an inhibitor of both serotonin and norepinephrine, it is not recommended that duloxetine be taken in combination with IMAO or for at least 14 days after stopping IMAO treatment. Based on the half-life of duloxetine, you should take a break for at least 5 days after stopping duloxetine before taking an IMAO.

An exacerbation of manic/hypomanic states: as with similar drugs that affect the CNS, duloxetine should be used with caution in patients with a history of manic episodes.

Epileptic seizures: As with analogous drugs that affect the CNS, duloxetine should be used with caution in patients with a history of epileptic seizures.

Mydriasis: cases of mydriasis have been observed with duloxetine, so caution should be exercised when prescribing duloxetine in patients with elevated intraocular pressure or in those at risk of acute closed-angle glaucoma.

Hepatic or renal impairment: In patients with severe renal impairment (creatinine clearance < 30 ml/min) or severe hepatic impairment, increased plasma concentrations of duloxetine are observed. If duloxetine administration is clinically reasonable in such patients, lower initial doses of the drug should be used.

Suicide attempts: in depression, there is a possibility of suicide attempts, which may persist until sustained remission. Close monitoring of patients at risk is necessary.

Contraindications

• High sensitivity to the drug.
• Simultaneous use with monoamine oxidase inhibitors (MAOIs).
• Uncompensated closed-angle glaucoma

With caution

If manic/hypomanic exacerbation, epileptic seizures, mydriasis, impaired liver or kidney function, likelihood of suicide attempts.

Side effects

Most common (10%): dizziness (except vertigo), dry mouth, nausea, constipation, sleep disturbances (drowsiness or insomnia), headache (less often than on placebo).

Less common (1-10%): diarrhea, vomiting, tremor, decreased appetite, weight loss, weakness, increased sweating, hot flashes, blurred vision, anorgasmia, decreased libido, delayed and impaired ejaculation and erectile dysfunction.

Significant increase in fasting blood glucose concentration in patients with a painful form of diabetic neuropathy.

Dizziness, nausea, and headache have been reported as frequent adverse effects when duloxetine is withdrawn.

Overdose

A few cases of overdose have been reported when up to 1400 mg of the drug was administered at one time, with no fatal consequences. Overdose may be accompanied by the following symptoms: tremor, clonic convulsions, ataxia, vomiting and decreased appetite.

Treatment in overdose. No specific antidote is known. Cardiac monitoring and monitoring of basic vital signs are recommended, along with symptomatic and supportive treatment.

Pregnancy use

Because of the lack of experience with the use of Cymbalta during pregnancy, the drug should only be prescribed during pregnancy if the potential benefit to the patient significantly exceeds the potential risk to the fetus.

Patients should be advised that if they become pregnant or plan to become pregnant while on duloxetine treatment, they should inform their physician.

In view of the lack of experience with duloxetine in women during breastfeeding, breastfeeding during duloxetine therapy is not recommended.

Similarities

Duloxetine Canon, Duloxenta