Dulox 20 mg Tablet

Serotonin–noradrenaline reuptake inhibitor (SNRI) for:

• Major depression
• Generalised anxiety disorder
• Diabetic peripheral neuropathic pain
• Fibromyalgia and chronic musculoskeletal pain (some countries)
• Stress urinary incontinence in women (some products)

Depression: 60 mg once daily (start 30 mg for 1–2 weeks to reduce nausea); maximum 120 mg/day.

Generalised anxiety: start 30 mg once daily, increase to 60 mg (up to 120 mg).

Diabetic neuropathic pain: 60 mg once daily (some need 120 mg in 2 doses); review after 2 months.

• Swallow capsules whole, with or without food.
• Do not stop suddenly — taper over at least 2 weeks.
• Not for children under 18 (except specialist use for anxiety 7+).

• Use with MAO inhibitors (or within 14 days; 5 days after stopping duloxetine), linezolid, methylene blue
• Use with fluvoxamine, ciprofloxacin, enoxacin (strong CYP1A2 inhibitors)
• Liver disease; severe kidney impairment (CrCl < 30)
• Uncontrolled high blood pressure
• Uncontrolled narrow-angle glaucoma

Very common: nausea, dry mouth, headache, drowsiness.

Common: dizziness, constipation, diarrhoea, loss of appetite, insomnia, fatigue, sweating, sexual dysfunction, tremor, blurred vision, raised blood pressure, weight loss.

Serious: suicidal thoughts (young adults), serotonin syndrome, liver injury, low sodium, bleeding, mania, seizures, severe skin reactions, urinary retention, discontinuation syndrome.

• Monitor blood pressure, mood and suicidal thoughts.
• Avoid heavy alcohol (liver injury).
• Bleeding risk with NSAIDs/anticoagulants.
• Elderly: watch for low sodium (confusion).

Use in pregnancy only if benefit outweighs risk (risk of postpartum haemorrhage and newborn adaptation problems if used late). Passes into milk in small amounts — specialist decision.

• MAO inhibitors, linezolid (contraindicated); tramadol, triptans, SSRIs, TCAs, lithium, St John's wort (serotonin syndrome)
• Fluvoxamine, ciprofloxacin (contraindicated — raise levels)
• Paroxetine, fluoxetine, quinidine (raise levels)
• Warfarin, NSAIDs, aspirin (bleeding)
• Metoprolol, flecainide, TCAs (duloxetine raises their levels)
• Smoking (lowers levels)

Drowsiness, serotonin syndrome, seizures, vomiting, fast heartbeat. Emergency care.

Store below 30°C.