DuloxetineDuloxetine Hydrochloride

About Duloxetine

Duloxetine raises both serotonin and norepinephrine signalling. That dual action is why it is approved for pain conditions as well as mood disorders: norepinephrine is involved in the body’s own pain-dampening pathways. It is one of the few antidepressants with FDA approval for diabetic peripheral neuropathy, fibromyalgia and chronic low back and osteoarthritis pain.

It comes only as delayed-release capsules, which must be swallowed whole; the capsules protect the drug from stomach acid. Nausea, dry mouth, sleepiness, constipation and sweating are common when starting. Because it also affects norepinephrine it can raise blood pressure slightly, and it should be used cautiously with liver disease or heavy alcohol use. Stopping suddenly causes discontinuation symptoms, so it is tapered.

The class boxed warning about suicidal thinking in young people applies. Duloxetine interacts with a range of medicines through liver enzymes and through its serotonin effect, so a full medicine list is worth reviewing with the pharmacist.

Taking Duloxetine

How to take it

Once or twice a day, with or without food. Swallow the capsules whole; do not open, crush or chew them, or sprinkle them on food. Do not stop suddenly; your prescriber will reduce it gradually.

If you miss a dose

Take it as soon as you remember, unless it is nearly time for your next dose; in that case skip the missed dose and carry on as usual. Never take two doses at once to make up.

Storage

At room temperature in the original container, away from heat and moisture (so not in a bathroom cabinet), and out of reach of children.

Interactions to know about

It must not be taken with an MAOI, or within 5 days after stopping duloxetine or 14 days after stopping an MAOI, or with thioridazine. Fluvoxamine and ciprofloxacin raise its levels sharply. Other serotonin-affecting medicines raise the risk of serotonin syndrome; blood thinners and anti-inflammatories raise bleeding risk; and heavy drinking raises the risk of liver injury.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Duloxetine differs from pharmacy to pharmacy

Duloxetine capsules cost pharmacies more than plain generic tablets because of the delayed-release pellet manufacturing, and the price spread between manufacturers is wider. That means the pharmacy’s supplier choice affects your cash price as much as its mark-up does.

Two 30 mg capsules and one 60 mg capsule are the same dose but can be priced very differently, in either direction, depending on the pharmacy’s purchasing. The prescriber decides the capsule strength, but the pharmacy can tell you which combination is cheaper there.

Ways to pay less for Duloxetine without insurance

• Ask the pharmacy to quote your daily dose as one capsule and as two smaller capsules, and ask the prescriber to write whichever is cheaper if clinically equivalent.
• Ask for a ninety-day prescription once your dose is stable.
• Ask which manufacturer’s generic the pharmacy stocks and whether an alternative is available.
• Compare independent and mail-order pharmacies.
• Upload your prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Duloxetine

1. 1.Can I open the capsule if I have trouble swallowing?
2. 2.Should I take it with food to reduce nausea?
3. 3.Which of my other medicines interact with duloxetine?
4. 4.How is it tapered if I need to stop?
5. 5.Should I watch my blood pressure?

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