Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (146 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(du-lox′uh-teen)
Cymbalta
Func. class.:
Antidepressant
Chem. class.:
Serotonin-norepinephrine reuptake inhibitor (SNRI)
May potentiate serotonergic, noradrenergic activity in the CNS; in studies, DULoxetine is a potent inhibitor of neuronal serotonin and norepinephrine reuptake
Major depressive disorder (MDD), neuropathic pain associated with diabetic neuropathy, generalized anxiety disorder, fibromyalgia, chronic low back pain, osteoarthritis pain
Unlabeled uses:
Stress, urinary incontinence
Alcohol intoxication, alcoholism, closed-angle glaucoma, hepatic disease, hepatitis, jaundice, hypersensitivity
Precautions:
Pregnancy (C), breastfeeding, geriatric patients, mania, hypertension, renal/cardiac disease, seizures, increased intraocular pressure, anorexia nervosa, bleeding, dehydration, diabetes, hyponatremia, hypotension, hypovolemia, orthostatic hypotension, abrupt product withdrawal
Black Box Warning:
Children, suicidal ideation
Calculator
•
Adult: PO
40-60 mg/day as single dose or 2 divided doses
•
Adult: PO
60 mg/day
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Adult: PO
60 mg/day, may start with 30 mg/day × 1 wk then increase to 60 mg/day; maintenance 60-120 mg/day
•
Adult: PO
30 mg/day × 1 wk then 60 mg/day
•
Adult: PO
60 mg/day or 30 mg/day × 1 wk then 60 mg/day
•
Adult: PO
Start with 20 mg, gradually increase; avoid use in severe renal disease
Available forms:
Caps 20, 30, 60 mg
•
Swallow cap whole; do not break, crush, or chew; do not sprinkle on food or mix with liquid
•
Without regard to food
CNS:
Insomnia, anxiety, dizziness, tremor, somnolence, fatigue, decreased appetite, decreased weight, agitation, diaphoresis, hallucinations,
neuroleptic malignant–like syndrome reaction,
aggression,
seizures,
headache
CV:
Thrombophlebitis,
peripheral edema, hypertension, palpitations,
supraventricular dysrhythmia
EENT:
Abnormal vision
ENDO:
Hypo/hyperglycemia
GI:
Constipation, diarrhea, dysphagia,
nausea
, vomiting, anorexia, dry mouth, colitis, gastritis, abdominal pain,
hepatic failure
GU:
Abnormal ejaculation, urinary hesitation/retention/frequency, ejaculation delayed, erectile dysfunction, gynecologic bleeding
INTEG:
Photosensitivity, bruising, sweating,
Stevens-Johnson syndrome
MS:
Gait disturbance, muscle spasm, restless leg syndrome
SYST:
Anaphylaxis, angioedema, serotonin syndrome, Stevens-Johnson syndrome
Well absorbed; extensively metabolized (CYP2D6, CYP1A2) in the liver to an ac
tive metabolite; 70% of product recovered in urine, 20% in feces; 90% protein binding; elimination half-life 9.2-19.1 hr
•
Do not use with linezolid or methylene blue IV
•
Narrow therapeutic index: CYP2D6 extensively metabolized products (flecainide, phenothiazines, propafenone, tricyclics, thioridazine)
Hyperthermia, rigidity, rapid fluctuations of vital signs, mental status changes, neuroleptic malignant syndrome—MAOIs, coadministration contraindicated within 14 days of MAOI use
Increase:
CNS depression—opioids, antihistamines, sedative/hypnotics
Increase:
serotonin syndrome, neuroleptic malignant syndrome—SSRIs, serotonin-receptor agonists
Increase:
bleeding risk—anticoagulants, antiplatelets, salicylates, NSAIDs
Increase:
action of DULoxetine—CYP1A2 inhibitors (fluvoxamine, quinolone antiinfectives); CYP2D6 inhibitors (FLUoxetine, quiNIDine, PARoxetine)
Increase:
ALT, bilirubin—alcohol
•
Serotonin syndrome: St. John’s wort
Increase:
CNS depression—kava, valerian
Increase:
blood glucose
Black Box Warning:
Depression:
mood, sensorium, affect,
suicidal tendencies,
increase in psychiatric symptoms; depression, panic, monitor children q wk face to face during first 4 wk, or dosage change, then every other week for next 4 wk, then at 12 wk
•
B/P lying, standing; pulse q4hr; if systolic B/P drops 20 mm Hg, hold product, notify prescriber; take VS q4hr in patients with CV disease
•
Hepatic studies: AST, ALT, bilirubin
•
Weight weekly; weight loss or gain; appetite may increase; peripheral edema may occur
•
Sugarless gum, hard candy, frequent sips of water for dry mouth
•
Withdrawal symptoms:
headache, nausea, vomiting, muscle pain, weakness; not common unless product is discontinued abruptly
Malignant neuroleptic-like syndrome reaction
Serotonin syndrome:
nausea/vomiting, dizziness, facial flush, shivering, sweating
•
Sexual dysfunction:
ejaculation dysfunction, erectile dysfunction, decreased libido, orgasm dysfunction
•
Storage in tight container at room temp; do not freeze
•
Assistance with ambulation during beginning therapy; drowsiness, dizziness occur
•
Confirmation that PO medication swallowed
•
Therapeutic response: decreased depression
•
To report urinary retention; about signs and symptoms of bleeding (GI bleeding, nosebleed, ecchymoses, bruising)
•
To use with caution when driving, performing other activities requiring alertness because of drowsiness, dizziness, blurred vision
•
To avoid alcohol ingestion, MAOIs, other CNS depressants
•
Not to discontinue medication quickly after long-term use; may cause nausea, headache, malaise; taper
Black Box Warning:
That clinical worsening and suicide risk may occur
•
To wear sunscreen or large hat; photosensitivity may occur
•
To notify prescriber if pregnancy planned or suspected, or if breastfeeding
•
Improvement may occur in 4-8 wk or in up to 12 wk (geriatric patients)
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert