An SNRI antidepressant
Duloxetine
An SNRI used for depression and anxiety, and also widely used for nerve pain such as diabetic neuropathy.
What is Duloxetine?
Duloxetine is a serotonin and noradrenaline reuptake inhibitor (SNRI). It is used for depression and generalised anxiety, and is also one of the main medicines for nerve pain, including diabetic nerve pain.
Education and reference only. This is a plain-language guide to Duloxetine — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.
What it is
Duloxetine is a serotonin and noradrenaline reuptake inhibitor (SNRI). It is used for depression and for generalised anxiety, and it is also one of the main medicines for nerve (neuropathic) pain — for example painful diabetic neuropathy — and is used for some types of long-term pain. The same active ingredient is sold under different brand names depending on use (Cymbalta is commonly used for mood and pain, while Yentreve is used for a specific type of stress urinary incontinence). It is a long-term tablet that builds its effect over weeks.
How it works
Duloxetine increases the activity of two natural chemical messengers in the brain and nerves — serotonin and noradrenaline — by slowing their reabsorption, so more remains available to pass signals between nerve cells. Boosting these messengers can lift mood and ease anxiety over a few weeks. The same effect on the nerve pathways that carry pain signals is thought to be how it dampens nerve pain, which is why it is used for both mood and pain conditions.
Company & origin
Originated / developed by: Eli Lilly.
Duloxetine, an SNRI, was developed by Eli Lilly and Company (USA) in the 1990s and first approved by the US FDA in 2004, marketed as Cymbalta.
What it treats
Conditions Duloxetine is used for
Practical use
How to take Duloxetine
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- Usually taken once a day, with or without food, at a regular time.
- Swallow the capsule whole; do not open, chew or crush it.
- It often takes a few weeks to feel the full benefit, so keep taking it even if you notice little change at first.
- Do not stop suddenly, as this can cause withdrawal effects; your doctor will taper it gradually when stopping.
- Tell your doctor if your mood worsens or you have distressing thoughts, especially in the early weeks.
- Mention any new medicines, as duloxetine can interact with several others.
Weighing it up
Advantages & disadvantages of Duloxetine
Advantages
- Treats both low mood or anxiety and certain types of nerve pain, which can be useful when both occur together.
- Taken once daily for many people.
- Well-established option with good evidence in depression, anxiety and neuropathic pain.
Disadvantages
- Can cause nausea, dry mouth, sleep changes and dizziness, especially when starting.
- Stopping abruptly can cause unpleasant withdrawal symptoms, so it must be tapered.
- May not be suitable for people with certain liver problems or uncontrolled high blood pressure.
- Full benefit takes weeks, which requires patience.
Practical use
Good to know
It usually takes a couple of weeks or more to start helping, and several weeks for the full effect — so it is worth persevering. It should not be stopped suddenly: doing so can cause unpleasant discontinuation ("withdrawal") symptoms such as dizziness, electric-shock sensations and irritability, so it is reduced gradually when the time comes. It can raise blood pressure, so this is sometimes checked. In adults under twenty-five, mood and any thoughts of self-harm are watched a little more closely early on, as with other antidepressants. Care is needed with alcohol and in liver problems.
Who should not take it / use with caution
- People with significant liver disease, or who drink heavily — duloxetine can affect the liver.
- People with poorly controlled high blood pressure, as it can raise blood pressure further.
- Used with care alongside other medicines that boost serotonin, and never combined with or taken close to certain older antidepressants (MAOIs).
Monitoring
- Mood and, in younger adults, any thoughts of self-harm early on
- Blood pressure
- Tolerability and, in some, liver function
Side effects
- Feeling sick, dry mouth, constipation, reduced appetite, headache or dizziness, especially early on.
- Difficulty sleeping, sweating, tiredness or sexual difficulties.
- A rise in blood pressure; rarely, liver problems or serotonin syndrome (agitation, shivering, sweating, a racing heart) — seek urgent advice if these occur.
Key interactions
- It must not be taken with, or close to, certain older antidepressants (MAOIs), and care is needed with other serotonin-boosting medicines, including some painkillers and the herbal remedy St John's wort.
- Combining it with medicines or supplements that increase bleeding risk (such as aspirin, antiplatelets, anticoagulants and some NSAIDs) can raise that risk.
- Some medicines raise duloxetine levels, and care is needed with other medicines that affect blood pressure.
Available as: Capsules, usually swallowed whole.
Answers
Duloxetine: frequently asked questions
How long does duloxetine take to work?
For mood and anxiety it usually takes around two weeks to begin helping and several weeks for the full benefit, so it is worth sticking with it even if you do not feel a change at first. For nerve pain it can also take a couple of weeks. If you notice no benefit after a reasonable trial, your prescriber can review it.
Why can't I stop duloxetine suddenly?
Stopping duloxetine abruptly can cause discontinuation symptoms such as dizziness, "electric-shock" sensations, nausea, irritability and sleep problems. To avoid this, it is reduced gradually under guidance when you and your prescriber decide to stop. Never stop it on your own without a plan to taper.
Is duloxetine for depression or for pain?
Both. Duloxetine is an SNRI used for depression and anxiety, and it is also a mainstay treatment for nerve pain such as painful diabetic neuropathy. It works on the same nerve chemicals in each case, which is why one medicine treats several conditions — your prescriber can tell you which use applies to you.
Can I drink alcohol while taking duloxetine?
It is best to be cautious. Duloxetine can affect the liver, and heavy drinking adds to that risk and can worsen side effects, so it is not recommended for people who drink heavily. If you drink, keep it modest and discuss it with your prescriber or pharmacist.
What is the difference between duloxetine and brands like Cymbalta or Yentreve?
They are the same active ingredient — duloxetine is the generic name. Cymbalta is commonly used for mood and pain, while Yentreve is the brand used for a specific bladder condition; the medicine inside is duloxetine in each case.
The wider class
About SNRIs
Duloxetine belongs to the snris class. For how the class as a whole works, its shared safety principles and monitoring, see the full guide.
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Authoritative sources
- BNF: Duloxetine.
- electronic Medicines Compendium (SmPC): Cymbalta.
- NICE CKS: Duloxetine.
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