SNRI (Serotonin-Norepinephrine Reuptake Inhibitor)
Enhances serotonergic and noradrenergic activity in the prefrontal cortex and descending pain pathways by inhibiting serotonin and norepinephrine reuptake.
Major depressive disorder (MDD), generalized anxiety disorder (GAD), fibromyalgia, diabetic peripheral neuropathic pain, chronic musculoskeletal pain.
Stress urinary incontinence, mood and cognitive dysfunction in Lewy body dementia (LBD), neuropathic pain in multiple sclerosis (MS), post-stroke depression (PSD), depression in Parkinson’s disease (PD)
Oral delayed-release capsules (20 mg, 30 mg, 60 mg)
20–30 mg p.o. daily, titrating to 60 mg/day as clinically indicated.
30–60 mg/day
Half-life ~12 hours; metabolized via CYP1A2 and CYP2D6; steady state in ~3 days.
Nausea, headache, dry mouth, dizziness, somnolence or insomnia, constipation, decreased appetite, weight loss, and increased blood pressure.
Hepatotoxicity, serotonin syndrome, Stevens-Johnson syndrome, SIADH, hyponatremia, orthostatic hypotension.
Monitor sodium in older adults, blood pressure, liver function tests in those with hepatic risk, and mental status for suicidality.
Increased risk of suicidal thoughts and behaviors in children, adolescents, and young adults with MDD.
Duloxetine may cause SIADH and hyponatremia, particularly in older adults, warranting slow titration and monitoring. In individuals with MS, duloxetine may reduce neuropathic pain and improve affective symptoms, though fatigue or sedation may occur. It may support mood and cognition in patients with LBD but should be used cautiously due to orthostatic hypotension risk. Avoid use in severe hepatic or renal impairment due to toxicity concerns. Duloxetine may lower the seizure threshold and should be used cautiously in patients with epilepsy or a history of structural brain injury.