Cymbalta ( Duloxetine )
Antidepressant, a reuptake inhibitor of serotonin and norepinephrine (norepinephrine). Slightly inhibits the seizure of dopamine, does not have a significant affinity for histamine, dopamine, cholinergic and adrenergic receptors. The mechanism of action of duloxetine is to inhibit the reuptake of serotonin and norepinephrine (norepinephrine). Duloxetine has a central mechanism for suppressing the pain syndrome, which is primarily manifested by an increase in the threshold of pain sensitivity in the pain syndrome of neuropathic etiology.
Depression, a painful form of diabetic neuropathy.
The recommended initial dose is 60 mg 1 time / day.
If necessary, you can increase the daily dose from 60 mg to a maximum dose of 120 mg / day in 2 divided doses.
In patients with severe renal dysfunction (CK <30 ml / min), the initial dose should be 30 mg 1 time / day. In patients with impaired liver function, the initial dose of the drug should be reduced or the frequency of administration reduced.
From the side of the central nervous system: often – dizziness (except vertigo), sleep disturbances (drowsiness or insomnia), headache (headache was less common than with placebo); sometimes – tremor, weakness, blurred vision, lethargy, anxiety, yawning; very rarely – glaucoma, mydriasis, visual impairment, agitation, disorientation.
On the part of the digestive system: often – dry mouth, nausea, constipation; sometimes – diarrhea, vomiting, decreased appetite, change in taste, impaired liver function; very rarely – hepatitis, jaundice, increased activity of alkaline phosphatase, ALT, AST and bilirubin levels; belching, gastroenteritis, stomatitis.
From the musculoskeletal system: sometimes – muscle tension and / or twitching; very rarely – bruxism.
From the cardiovascular system: sometimes – palpitation; very rarely – orthostatic hypotension, syncope (especially at the beginning of therapy), tachycardia, increased blood pressure, cold extremities.
On the part of the reproductive system: sometimes – anorgasmia, decreased libido, delay and violation of ejaculation, erectile dysfunction.
From the urinary system: sometimes – difficulty urinating; very rarely – nocturia.
Other: sometimes – weight loss, increased sweating, hot flashes, night sweats; very rarely anaphylactic reactions, thirst, hyponatremia, chills, angioedema, rash, Stevens-Johnson syndrome, urticaria, poor health, feeling hot and / or cold, weight gain, dehydration, photosensitivity. With cancellation, dizziness, nausea, and headache were often noted. In patients with a painful form of diabetic neuropathy, there may be a slight increase in fasting blood glucose.
Uncompensated closed-angle glaucoma, concomitant use with MAO inhibitors, increased sensitivity to duloxetine.
The use of the drug during pregnancy is possible only in cases where the intended use for the mother exceeds the potential risk to the fetus, because clinical experience with duloxetine in pregnancy is not enough.
If you need to use the drug during lactation, you should decide whether to stop breastfeeding (due to lack of experience).
Patients should be warned that in the event of the onset or planning of pregnancy during the period of duloxetine, they must inform their doctor.