Duloxetine: An update

Authors

DOI:

https://doi.org/10.33448/rsd-v13i3.45331

Keywords:

Duloxetine hydrochloride; Pharmacology; Mental disorders; Usos Terapêuticos; Drug interactions.

Abstract

Duloxetine, a serotonin-norepinephrine reuptake inhibitor (SNRI), has established itself as a versatile therapeutic agent across a spectrum of psychiatric and neurological disorders. The objective of this article is to update the pharmacological properties of duloxetine. To this end, a review was carried out on the pharmacology, clinical efficacy, safety and tolerability of duloxetine, focusing on its application in the treatment of major depressive disorder (MDD), generalized anxiety disorder (GAD), diabetic peripheral neuropathic pain, fibromyalgia and musculoskeletal pain. chronic. Comparative analyzes highlight the relative effectiveness of duloxetine versus other antidepressants and its unique advantage in managing conditions with overlapping mood and pain symptoms. Safety profiles and pharmacological interactions, particularly with NSAIDs and tamoxifen, highlight the importance of personalized treatment plans and vigilant monitoring. The review concludes with an assessment of the clinical utility of duloxetine, emphasizing individual patient assessment to maximize therapeutic outcomes while minimizing risks. Future research directions are suggested to further delineate the role of duloxetine in treatment algorithms and explore potential new indications.

References

Baldaçara, L., Grudtner, R. R., Leite, V. S., Porto, D. M., Robis, K. P., Fidalgo, T. M., Rocha, G. A., Díaz, A. P., Meleiro, A., Correa, H., Tung, T. C., Malloy-Diniz, L. F., & da Silva, A. G. (2021). Brazilian guidelines for the management of suicide behavior. Part 2. Screening, intervention, and prevention. Braz J Psychiatry, 43(5), 538-549. 10.1590/1516-4446-2020-1108.

Baldaçara, L., Paschoal, A. B., Pinto, A. F., Loureiro, F. F., Gaiotto, L. A. V., Veiga, D. L., Almeida, T. M., Dos Santos, D. C., Malloy-Diniz, L. F., de Mello, M. F., de Mello, A. F., Sanches, M., Gandarela, L. M., Bernik, M. A., Nardi, A. E., da Silva, A. G., & Uchida, R. R. (2023). Brazilian Psychiatric Association guidelines for the treatment of generalized anxiety disorder (GAD). Pharmacological and Psychotherapy approach. Perspectives. Braz J Psychiatry. https://doi.org/10.47626/1516-4446-2023-3235. In press.

Baldaçara, L., Rocha, G. A., Leite, V. D. S., Porto, D. M., Grudtner, R. R., Diaz, A. P., Meleiro, A., Correa, H., Tung, T. C., Quevedo, J., & da Silva, A. G. (2021). Brazilian Psychiatric Association guidelines for the management of suicidal behavior. Part 1. Risk factors, protective factors, and assessment. Braz J Psychiatry, 43(5), 525-537. 10.1590/1516-4446-2020-0994.

Birkinshaw, H., Friedrich, C. M., Cole, P., Eccleston, C., Serfaty, M., Stewart, G., White, S., Moore, R. A., Phillippo, D., & Pincus, T. (2023). Antidepressants for pain management in adults with chronic pain: a network meta-analysis. Cochrane Database Syst Rev, 5(5), CD014682. 10.1002/14651858.CD014682.pub2.

Brown, J. P., & Boulay, L. J. (2013). Clinical experience with duloxetine in the management of chronic musculoskeletal pain. A focus on osteoarthritis of the knee. Ther Adv Musculoskelet Dis, 5(6), 291-304. 10.1177/1759720X13508508.

Cipriani, A., Furukawa, T. A., Salanti, G., Chaimani, A., Atkinson, L. Z., Ogawa, Y., Leucht, S., Ruhe, H. G., Turner, E. H., Higgins, J. P. T., Egger, M., Takeshima, N., Hayasaka, Y., Imai, H., Shinohara, K., Tajika, A., Ioannidis, J. P. A., & Geddes, J. R. (2018). Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis. Lancet, 391(10128), 1357-1366. 10.1016/S0140-6736(17)32802-7.

Dhaliwal, J., Spurling, B. C., & Molla M. (2023). Duloxetine. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK549806/

Dugan, S. E., & Fuller, M. A. (2004). Duloxetine: a dual reuptake inhibitor. Ann Pharmacother, Dec;38(12), 2078-85. 10.1345/aph.1E084.

Eli Lilly and Company. (2004). CYMBALTA safely and effectively. In E. L. a. Company (Ed.). Lilly USA, LLC, Indianapolis.

Fasipe, O. (2018). Neuropharmacological classification of antidepressant agents based on their mechanisms of action. Archives of Medicine and Health Sciences, 6(1), 81-94. 10.4103/amhs.amhs_7_18.

Fava, G. A., Benasi, G., Lucente, M., Offidani, E., Cosci, F., & Guidi, J. (2018). Withdrawal Symptoms after Serotonin-Noradrenaline Reuptake Inhibitor Discontinuation: Systematic Review. Psychother Psychosom, 87(4), 87(4):195-203. 10.1159/000491524.

Gautam, S., Jain, A., Gautam, M., Vahia, V. N., & Grover, S. (2017). Clinical Practice Guidelines for the management of Depression. Indian J Psychiatry, 59(1), S34-S50. 10.4103/0019-5545.196973.

Goldstein, D. J. (2007). Duloxetine in the treatment of major depressive disorder. Neuropsychiatr Dis Treat, 3(2), 193-209. 10.2147/nedt.2007.3.2.193.

He, H., Xiang, Y., Gao, F., Bai, L., Gao, F., Fan, Y., Lyu, J., & Ma, X. (2019). Comparative efficacy and acceptability of first-line drugs for the acute treatment of generalized anxiety disorder in adults: A network meta-analysis. J Psychiatr Res, 118, 21-30. 10.1016/j.jpsychires.2019.08.009.

Hunziker, M. E., Suehs, B. T., Bettinger, T. L., & Crismon, M. L. (2005). Duloxetine hydrochloride: a new dual-acting medication for the treatment of major depressive disorder. Clin Ther, 27(8), 1126-43. 10.1016/j.clinthera.2005.08.010.

Ishtiak-Ahmed, K., Musliner, K. L., Christensen, K. S., Mortensen, E. L., Nierenberg, A. A., & Gasse, C. (2024). Real-World Evidence on Clinical Outcomes of Commonly Used Antidepressants in Older Adults Initiating Antidepressants for Depression: A Nationwide Cohort Study in Denmark. Am J Psychiatry, 181(1), 47-56. doi: 10.1176/appi.ajp.20230356.

Kraus, C., Kadriu, B., Lanzenberger, R., Zarate, C. A., Jr., & Kasper, S. (2019). Prognosis and improved outcomes in major depression: a review. Transl Psychiatry, 9(1), 127. 10.1038/s41398-019-0460-3.

Li, M. J., Liu, L. Y., Chen, L., Cai, J., Wan, Y., & Xing, G. G. (2017). Chronic stress exacerbates neuropathic pain via the integration of stress-affect-related information with nociceptive information in the central nucleus of the amygdala. Pain, 158(4):717-739. 10.1097/j.pain.0000000000000827.

Lobo, E. D., Bergstrom, R. F., Reddy, S., Quinlan, T., Chappell, J., Hong, Q., Ring, B., & Knadler, M. P. (2008). In vitro and in vivo evaluations of cytochrome P450 1A2 interactions with duloxetine. Clin Pharmacokinet, 47(3), 191-202. 10.2165/00003088-200847030-00005.

Müller, N., Schennach, R., Riedel, M., & Moller, H. J. (2008). Duloxetine in the treatment of major psychiatric and neuropathic disorders. Expert Rev Neurother, 8(4), 527-36. 10.1586/14737175.8.4.527.

Park, K., Kim, S., Ko, Y. J., & Park, B. J. (2020). Duloxetine and cardiovascular adverse events: A systematic review and meta-analysis. J Psychiatr Res, 124, 109-114. 10.1016/j.jpsychires.2020.02.022.

Rizea-Savu, S., Duna, S. N., Ghita, A., Iordachescu, A., & Chirila, M. (2020). The Effect of Food on the Single-Dose Bioavailability and Tolerability of the Highest Marketed Strength of Duloxetine. Clin Pharmacol Drug Dev, 9(7), 797-804. 10.1002/cpdd.759.

Rodrigues-Amorim, D., Olivares, J. M., Spuch, C., & Rivera-Baltanas, T. (2020). A Systematic Review of Efficacy, Safety, and Tolerability of Duloxetine. Front Psychiatry, 11, 554899. 10.3389/fpsyt.2020.554899.

Sansone, R. A., & Sansone, L. A. (2014). Serotonin norepinephrine reuptake inhibitors: a pharmacological comparison. Innov Clin Neurosci, 11(3-4), 37-42.

Shelton, R. C. (2019). Serotonin and Norepinephrine Reuptake Inhibitors. Handb Exp Pharmacol, 250:145-180. 10.1007/164_2018_164.

Smith, H. S., Smith, E. J., & Smith, B. R. (2012). Duloxetine in the management of chronic musculoskeletal pain. Ther Clin Risk Manag, 8, 267-77. 10.2147/TCRM.S17428.

Snyder, H. (2019). Literature review as a research methodology: An overview and guidelines. Journal of Business Research, 104, 333-339. https://doi.org/10.1016/j.jbusres.2019.07.039.

Trivedi, M. H., Desaiah, D., Ossanna, M. J., Pritchett, Y. L., Brannan, S. K., & Detke, M. J. (2008). Clinical evidence for serotonin and norepinephrine reuptake inhibition of duloxetine. Int Clin Psychopharmacol, 23(3), 161-9. 10.1097/YIC.0b013e3282f41d7e.

Wernicke, J. F., Gahimer, J., Yalcin, I., Wulster-Radcliffe, M., & Viktrup, L. (2005). Safety and adverse event profile of duloxetine. Expert Opin Drug Saf, 4(6), 987-93. 10.1517/14740338.4.6.987.

Westanmo, A. D., Gayken, J., & Haight, R. (2005). Duloxetine: a balanced and selective norepinephrine- and serotonin-reuptake inhibitor. Am J Health Syst Pharm, 62(23), 2481-90. 10.2146/ajhp050006.

Wittchen, H. U., Kessler, R. C., Beesdo, K., Krause, P., Hofler, M., & Hoyer, J. (2002). Generalized anxiety and depression in primary care: prevalence, recognition, and management. J Clin Psychiatry, 63(8), 24-34.

Wright, A., & Vandenberg, C. (2009). Duloxetine in the treatment of generalized anxiety disorder. Int J Gen Med, 2, 153-62.

Downloads

Published

19/03/2024

How to Cite

BALDAÇARA, L. Duloxetine: An update. Research, Society and Development, [S. l.], v. 13, n. 3, p. e7313345331, 2024. DOI: 10.33448/rsd-v13i3.45331. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/45331. Acesso em: 8 may. 2024.

Issue

Section

Health Sciences