Select a medication above to begin.
Cymbalta
duloxetine
Black Box Warnings .
Suicidality
incr. suicidality risk in children, adolescents, and young adults w/ major depressive or other psychiatric disorders; weigh risk vs. benefit; in short-term studies of antidepressants vs. placebo, suicidality risk not incr. in pts >24 yo, and risk decr. in pts 65 yo and older; depression and certain other psychiatric disorders themselves assoc. w/ incr. suicide risk; observe all pts for clinical worsening, suicidality, or unusual behavior changes; advise families and caregivers of need for close observation and communication w/ prescriber
Adult Dosing .
Dosage forms: DR CAP: 20 mg, 30 mg, 60 mg
major depressive disorder
- [acute tx]
- Dose: 20-30 mg PO bid or 60 mg PO qd; Max: 120 mg/day; Info: may start 30 mg PO qd x1wk if tolerability concern; doses >60 mg/day rarely more effective, may incr. ADR risk; do not open cap; taper dose gradually to D/C
- [maintenance tx]
- Dose: 60 mg PO qd; Max: 120 mg/day; Info: doses >60 mg/day rarely more effective, may incr. ADR risk; do not open cap; periodically reassess need for tx; taper dose gradually to D/C
generalized anxiety disorder
- [60 mg PO qd]
- Max: 120 mg/day; Info: start 30 mg PO qd x2wk in elderly pts; may start 30 mg PO qd x1wk if tolerability concern; may incr. dose in 30 mg increments; doses >60 mg/day rarely more effective, may incr. ADR risk; do not open cap; taper dose gradually to D/C
neuropathic pain, diabetic
- [60 mg PO qd]
- Max: 120 mg/day; Info: may start 30 mg PO qd x1wk if tolerability concern; doses >60 mg/day rarely more effective, may incr. ADR risk; do not open cap; taper dose gradually to D/C
fibromyalgia
- [60 mg PO qd]
- Start: 30 mg PO qd x1wk; Max: 60 mg/day; Info: some pts may respond to 30 mg/day; do not open cap; taper dose gradually to D/C
musculoskeletal pain, chronic
- [60 mg PO qd]
- Start: 30 mg PO qd x1wk; Max: 60 mg/day; Info: do not open cap; taper dose gradually to D/C
stress urinary incontinence (off-label)
- [40 mg PO bid]
- Start: 20 mg PO bid x1wk; Info: do not open cap; taper dose gradually to D/C
peripheral neuropathy, chemo-induced (off-label)
- [60 mg PO qd]
- Start: 30 mg PO qd x1wk; Info: do not open cap; taper dose gradually to D/C
renal dosing
- [neuropathic pain, diabetic]
- CrCl 30-89: consider decr. start dose, titrate slowly; CrCl <30: avoid use
- HD/PD: not defined
- [all other indications]
- CrCl <30: avoid use
- HD/PD: not defined
hepatic dosing
- [see below]
- chronic hepatic dz or cirrhosis: avoid use
Peds Dosing .
- Dosage forms: DR CAP: 20 mg, 30 mg, 60 mg
generalized anxiety disorder
- [7-17 yo]
- Dose: 30-60 mg PO qd; Start: 30 mg PO qd, may incr. by 30 mg/day after 2wk; Max: 120 mg/day; Info: do not open cap; taper dose gradually to D/C
fibromyalgia
- [13-17 yo]
- Dose: 30-60 mg PO qd; Start: 30 mg PO qd x1wk; Max: 60 mg/day; Info: do not open cap; taper dose gradually to D/C
renal dosing
- [see below]
- CrCl <30: avoid use
- HD/PD: not defined
hepatic dosing
- [see below]
- chronic hepatic dz or cirrhosis: avoid use