Duloxetine nausea

The use of duloxetine in stress urinary incontinence is complicated by (1) the potential for multiple clinically relevant drug-drug interactions with cytochrome P-450 2D6 and 1A2 inhibitors, (2) withdrawal reactions if abruptly discontinued, (3) high rates of nausea and other side effects, (4) the hepa-totoxicity that contraindicates its use in patients with any degree of hepatic impairment, and (5) its mild hypertensive effect. 

When starting a SSRI, the abrupt increase in serotonin may cause side effects. In the brain, the short-term effects include headache, sleep disturbance, nervousness, anxiety, and tremulousness. The digestive system effects include nausea, loose stools, decreased appetite, and indigestion. Most of these effects are mild and shortlived or can be managed with over-the-counter remedies. Nausea, for example, can be minimized by taking a SSRI after meals. These effects are also commonly seen with venlafaxine and duloxetine, atypical antidepressants that block serotonin reuptake like the SSRIs. 

Discontinuation of treatment Symptoms associated with discontinuation of duloxetine and other SSRIs and SNRIs have been reported. Monitor patients for symptoms including dizziness, nausea, headache, paresthesia, vomiting, irritability, and nightmares when discontinuing treatment. 

Regarding side-effect profiles, all three SSNRIs are generally well tolerated, most adverse events occurring early in treatment, with a mild to moderate severity and a tendency to decrease or disappear with continued treatment. Venlafaxine (1) seems to be the least weU-toIerated SNRI, combining a higher level of serotonergic adverse events (nausea, sexual dysfunction, withdrawal problems) with dose-dependent hypertension. In contrast, milnacipran (2) and duloxetine (3) appear better tolerated and essentially devoid of cardiovascular toxicity. 

Duloxetine has recently been marketed as an antidepressant in Europe. It inhibits the re-uptake of serotonin and noradrenaline, with minimal effects on other neurotransmitter mechanisms. It is therefore classified as a serotonin and noradrenaline re-uptake inhibitor (SNRI) and is grouped with venlafaxine. The adverse effect profile of duloxetine appears to be similar to that of the SSRIs and venlafaxine. In placebo-controlled trials the most common adverse effects were nausea (37%), dry mouth (32%), dizziness (22%), somnolence (20%), insomnia (20%), and diarrhea (14%). Sexual dysfunction has also been reported. Current data suggest that, unlike venlafaxine, duloxetine does not increase the blood pressure, but further post-marketing surveillance studies will be needed to confirm this (1). 

D. Selective norepinephrine and serotonin reuptake inhibitors. Both Venlafaxine and Duloxetine have shown significant higher effect than placebo in the treatment of pain in diabetic patients and both compounds are being used with increasing frequency in these patients. Duloxetine is a more potent inhibitor than Venlafaxine and seems from clinical studies to be more efficacious. Doses tested in trials are 60 and 120 mg/day and side effects include nausea, somnolence, dizziness, dry mouth and decreased appetite. 

These drugs target both serotonin and norepinephrine neurotransmitter systems in the brain. The group includes duloxetine (Cym-balta), venlafaxine (Effexor), and mirtazapine (Remeron). Side effects may include dry mouth, headache, sedation, nausea, and tremors. 

The most commonly observed adverse reactions associated with duloxetine were nausea, constipation, decreased appetite, dry mouth, somnolence, and hyperhidrosis. Patients in DPNP trials also reported dizziness and asthenia. 

Placebo-controlled studies In a placebo-controlled study of 1491 patients nausea was more frequent in those who took duloxetine (30% versus 7.1%) and weight loss was significantly greater all of those who withdrew because of an adverse event were taking duloxetine (22%) [42 ]. 

Systematic reviews In a systematic review of 36 experimental and observational studies duloxetine caused nausea, vomiting, and dry mouth more often than comparator drugs, but these differences did not lead to higher withdrawal rates than in patients taking SSRIs [43 ]. 

A 36 year-old man who had had a right parietal lobe stroke took duloxetine 30 mg/day for 1 week and developed mild nausea and sedation were mentioned. The dose was increased to 60 mg/day and he started to have increased sexual desires and masturbated 3-4 times a day, even in front of his children or wife. There were no other hypomanic, manic, or obsessive-compulsive symptoms. 

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