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General overview

Duloxetine is a prescription medication which belongs to the group of oral antidepressants called the serotonin and noradrenaline reuptake inhibitors or SNRI's.

This medication is used to treat mental health issues such as major depression and generalized anxiety disorders as well as pain syndromes such as diabetic peripheral neuropathy, fibromyalgia and chronic musculoskeletal pain. 

Common side-effects

As with all medications, side-effects do seem to occur in some patients when using this medication. It doesn't mean that one will definitely experience side-effects, but rather that patients should be aware that certain experienced signs and symptoms could be side-effects of a medication.

These following most commonly experienced side-effects tend to resolve on their own in most cases and include the following:

  • Coughing.
  • Dry mouth.
  • Body and muscle aches.
  • Constipation.
  • Headaches.
  • Loss of appetite.
  • Nausea.
  • Drowsiness.
  • Increased sweating.
  • Insomnia.

The following side-effects are less common, but one should immediately either let their doctor know or present to an emergency centre if they are experienced. They include the following:

  • Jaundice (yellow discolouration of the skin and/or eyes).
  • Clay or pale coloured stool.
  • Dark urine.
  • Pain in the right upper abdomen.
  • Blurred or decreased vision.
  • Change in consciousness or coma.
  • Convulsions.
  • Fast or irregular heartbeat.
  • Skin rash or welts and hives on the body.
  • Chest tightness.
  • Vomiting of blood.
The highlighted signs and symptoms occur due to liver damage and it is then very important that these patients seek immediate medical attention.

Precautions

There are certain situations that patients who use duloxetine should be aware of:

  • Duloxetine can improve one's mood and therefore the patient's drive will also increase. This can cause suicidal thoughts to turn into suicidal behaviours and this needs to be discussed with the patient's doctor immediately.
  • Care should be taken when using other medications, which also increase serotonin levels in the brain, together with duloxetine. This can lead to a condition called 'serotonin syndrome'. Therefore, the patient's doctor should be notified of all medications being used by the patient.
  • Duloxetine can also increase the risk of bleeding, therefore the patient's doctor should also be made aware if the patient is using medications such as anti-inflammatories.
  • One shouldn't suddenly stop taking duloxetine as this can cause the patient to experience withdrawal symptoms such as nausea, vomiting, irritability, nightmares and generalized pins-and needles sensations.

Duloxetine and alcohol

Duloxetine can cause serious liver problems, although this is rare. It is therefore advised that patients on this medication should abstain from alcohol intake. The combined effect of both substances can increase one's risk of liver damage or worsen existing liver issues. The signs and symptoms of this issue have been mentioned above.

There is no clinical evidence to show that duloxetine causes a patient to consume more alcohol. The possible explanation behind this could be that the patient's depression is worsening and this then results in them consuming more alcohol.

The cause of the worsening depression could be that the medication is no longer effective, the dosage is not optimal or the medication itself could be worsening the patient's mood.

This situation then needs to be discussed with the prescribing doctor as soon as possible so that the patient can be re-evaluated.

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