This is how duloxetine works for depression and incontinence

Duloxetine is an antidepressant and increases drive and mood by increasing levels of norepinephrine and serotonin. Duloxetine is therefore mainly used in the treatment of  depression  . Another major area of ​​application is stress incontinence in women, as the active ingredient strengthens the bladder and pelvic floor muscles. Learn more about the effects, side effects, and dosage of duloxetine.

Other uses of duloxetine

Duloxetine is also used in diabetic polyneuropathy. Due to its pain-relieving effect, it helps with   nerve pain (neuropathy) caused by diabetes .

In the US, duloxetine is also approved for the treatment of fibromyalgia, a muscle pain syndrome. In Germany, use in this indication was rejected by the European Medicines Agency (EMA) in 2008.

Dosing and stopping duloxetine

The doctor treating you must decide how many capsules of duloxetine you should take each day. As a rule, this will be a psychiatric specialist. The amount of the dose depends on age, gender, size, weight and smoking status. 

A typical starting dose is 60 mg once daily and then increased steadily to a maintenance dose of 120 mg. 

It is important not to discontinue the drug without further ado, but to gradually taper it off, otherwise there is a risk of serious side effects.

Duloxetine side effects

The most common side effects of duloxetine include:

  • nausea
  • Vomit
  • diarrhea and  constipation
  • headache
  • a dry mouth
  • Appetitverlust

Visual disturbances, tremor and sleep disturbances can also occur. The increased level of norepinephrine can also lead to sweating and  hot flashes , increased blood pressure, urinary retention and erectile dysfunction.

particularly critical side effect  arises from the drug’s initial increase in drive. Since this effect sets in before the mood-enhancing effect, there is a risk of suicide attempts in the first two weeks after the start of therapy, which is why you should be closely monitored by a specialist during this time.

Interactions with duloxetine

Duloxetine should not be combined with certain other antidepressants, which also lead to an increase in serotonin levels. Otherwise there is a risk of the life-threatening serotonin syndrome, which becomes noticeable through heart palpitations, fever and nausea.

Simultaneously taking CNS depressant substances such as benzodiazepines, opiates and alcohol should also be avoided.

Contraindications of the active substance

The following contraindications should be observed when taking duloxetine:

  • MAO inhibitors such as selegeline or tranylcypromine
  • Serotonergic drugs, for example venlafaxine,  fluoxetinecitalopram
  • Certain antibiotics such as ciprofloxacin or enoxacin
  • Johannis herbs
  • Hepatic and renal dysfunction
  • An  allergy  to the drug duloxetine
  • Children younger than 18 years
  • Uncontrolled  high blood pressure

There is no absolute contraindication during pregnancy and lactation, but there is also no recommendation for taking it, since there are no studies for duloxetine under these circumstances.

Instructions for taking duloxetine

Duloxetine capsules should be taken regardless of meals. With regard to the duration of intake, it should be noted that duloxetine should be taken for at least six months in order to be able to observe an effect.

Duloxetine is a so-called “serotonin-norepinephrine reuptake inhibitor” (SNRI). The SNRI drug group, which also includes venlafaxine, is effective in the central nervous system. A complex interaction of different hormones and messenger substances (neurotransmitters) takes place here. The neurotransmitters serotonin and noradrenaline play an important role.

Serotonin is found throughout the body and has a variety of functions. In the brain, it is responsible, among other things, for the feeling of happiness. Norepinephrine is a stress hormone that affects blood pressure and heart rate. It has a drive-enhancing and activating effect on the nerve cells.

Mechanism of action of duloxetine

In the nerve cells, serotonin and noradrenaline are released into the so-called “synaptic gap”, which is located between two communicating nerve cells. The neurotransmitters unfold their effect by docking to the receptors of the subsequent nerve cell. 

Duloxetine prevents the two messenger substances from being reabsorbed back into the cell of origin and thus ensures a sustained high concentration and an extended effect. By increasing the concentration of norepinephrine, pain-relieving nerve pathways in the spinal cord are stimulated, so that the body’s own pain relief is activated.

 

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