Diliner DR
- Brand:Square Pharmaceuticals Ltd.
- Product Code: Diliner DR 60 mg
- Availability: In Stock
-
17.00Tk.
Indications
Duloxetine is a
serotonin and norepinephrine reuptake inhibitor (SNRI) indicated for-
- Major Depressive Disorder (MDD)
- Generalized Anxiety Disorder
(GAD)
- Diabetic Peripheral Neuropathic
Pain (DPNP)
- Fibromyalgia and
- Chronic Musculoskeletal Pain.
Pharmacology
Duloxetine
Hydrochloride is a selective serotonin and norepinephrine reuptake inhibitor
(SSNRI) for oral administration. Duloxetine is a less potent inhibitor of
dopamine reuptake. Duloxetine has no significant affinity for dopaminergic,
adrenergic, cholinergic, histaminergic, opioid, glutamate, and GABA receptors
in vitro. Duloxetine does not inhibit monoamine oxidase (MAO). Orally
administered Duloxetine hydrochloride is well absorbed. Elimination of
Duloxetine is mainly through hepatic metabolism.
Dosage & Administration
Major Depressive
Disorder (MDD)-
- Starting Dose: 40 mg/day to 60 mg/day
- Target Dose: Acute: 40 mg/day (20 mg twice daily) to 60 mg/day
(once daily or as 30 mg twice daily); Maintenance: 60 mg/day
- Maximum Dose: 120 mg/day
Generalized Anxiety
Disorder (GAD)-
- Starting Dose: 60 mg/day
- Target Dose: 60 mg/day (once daily)
- Maximum Dose: 120 mg/day
Diabetic Peripheral
Neuropathic Pain (DPNP)-
- Starting Dose: 60 mg/day
- Target Dose: 60 mg/day (once daily)
- Maximum Dose: 60 mg/day
Fibromyalgia-
- Starting Dose: 30 mg/day
- Target Dose: 60 mg/day (once daily)
- Maximum Dose: 60 mg/day
Chronic Musculoskeletal
Pain-
- Starting Dose: 30 mg/day
- Target Dose: 60 mg/day (once daily)
- Maximum Dose: 60 mg/day
Some patients may
benefit from starting at 30 mg once daily. There is no evidence that doses
greater than 60 mg/day confers an additional benefit, while some adverse
reactions were observed to be dose-dependent. A gradual dose reduction is
recommended to avoid discontinuation symptoms.
* চিকিৎসকের পরামর্শ মোতাবেক ঔষধ সেবন করুন'
Interaction
Both CYP1A2 and CYP2D6
isozymes are responsible for Duloxetine metabolism. When Duloxetine was
co-administered with fluvoxamine, a potent CYP1A2 inhibitor, the AUC, Cmax and
t of Duloxetine was increased. Other drugs that inhibit CYP1A2 metabolism
include cimetidine and quinolone antimicrobials such as ciprofloxacin and
enoxacin would be expected to have similar effects and these combinations
should be avoided. Because CYP2D6 is involved in Duloxetine metabolism,
concomitant use of Duloxetine with potent inhibitors of CYP2D6 may result in
higher concentrations of Duloxetine.
Contraindications
Duloxetine is
contraindicated in patients with a known hypersensitivity to this drug or any
of the inactive ingredients. Duloxetine is not approved for use in treating bipolar
depression. Duloxetine should not be prescribed to patients with substantial
alcohol use or evidence of chronic liver disease. In clinical trials,
Duloxetine was associated with an increased risk of mydriasis; therefore, it
should be used cautiously in patients with controlled narrow-angle glaucoma.
Side Effects
The most commonly
observed adverse events in Duloxetine hydrochloride treated patients were
nausea, dizziness, dry mouth, constipation, decreased appetite, fatigue,
somnolence, increased sweating, hyperhidrosis and asthenia. It may slightly
increase blood pressure. No clinically significant differences were observed
for QT, PR, and QRS intervals between Duloxetine-treated and placebo-treated
patients.
Pregnancy & Lactation
Pregnancy: Pregnancy Category C. There are no adequate
and well-controlled studies in pregnant women; therefore, Duloxetine should be
used during pregnancy only if the potential benefit justifies the potential
risk to the fetus.
Labor and Delivery: The effect of Duloxetine on labor and
delivery in humans is unknown. Duloxetine should be used during labor and
delivery only if the potential benefit justifies the potential risk to the
fetus.
Lactation: It is unknown whether or not Duloxetine
and/or it's metabolites are excreted into human milk, but nursing while on
Duloxetine is not recommended
Precautions & Warnings
All patients being
treated with antidepressants for any indication should be monitored
appropriately and observed closely for clinical worsening, suicidality and unusual
changes in behavior, especially during the initial few months of a course of
drug therapy, or at times of dose changes. Blood pressure should be measured
prior to initiating treatment and periodically measured throughout treatment.
Patients should be cautioned about the risk of bleeding associated with the
concomitant use of Duloxetine and NSAIDs, aspirin, or other drugs that affect
coagulation. Duloxetine should be used cautiously in patients with a history of
mania. Duloxetine should be prescribed with care in patients with a history of
a seizure disorder.
Use in Special Populations
Use in the pediatric
population: Safety and efficacy
in pediatric patients have not been established
Overdose Effects
There is limited
clinical experience with Duloxetine overdose in humans. There is no specific
antidote to Duloxetine. In case of acute overdose, treatment should consist of
those general measures employed in the management of overdose with any drug. An
adequate airway, oxygenation, and ventilation should be assured, and cardiac
rhythm and vital signs should be monitored. Induction of emesis is not
recommended. Gastric lavage with a large-bore orogastric tube with appropriate
airway protection, if needed, may be indicated if performed soon after
ingestion or in symptomatic patients. Activated charcoal may be useful in
limiting the absorption of Duloxetine from the gastrointestinal tract.
Therapeutic Class
Serotonin-norepinephrine
reuptake inhibitor (SNRI)
Storage Conditions
Do not store above
30°C. Keep away from light and out of the reach of children.
Tags: Diliner DR