Duzela Capsule (Delayed Release)

Introduction

Duloxetine hydrochloride is a serotonin-norepinephrine reuptake inhibitor (SNRI) used to treat major depression, anxiety, and neuropathic pain. It may also be used for fibromyalgia, chronic musculoskeletal pain, chronic fatigue syndrome, and urinary incontinence.

Uses for

Duloxetine hydrochloride is used to treat a variety of mental health conditions, such as, depression, anxiety, neuropathic pain, fibromyalgia, chronic musculoskeletal pain, chronic fatigue syndrome, and urinary incontinence.

Brand Name	Duzela
Type	Capsule (Delayed Release)
Weight	20 mg
Generic	Duloxetine Hydrochloride
Manufacturer	Sun Pharmaceutical Ltd.
Available in	English বাংলা

Mechanism of Action

Duzela Capsule (Delayed Release) 20 mg works by blocking the reuptake of serotonin and norepinephrine in the brain, resulting in an increased availability of these neurotransmitters and increased overall activity in the brain. This increases mood and reduces pain.

How Long Does it Take to Work?

The effects of Duzela Capsule (Delayed Release) 20 mg can usually be felt within 1 to 2 weeks of starting treatment. However, the full therapeutic effect may not be seen for up to several weeks of treatment, depending on the severity of the condition being treated.

Absorption

Duloxetine hydrochloride is well absorbed in the gastrointestinal tract, with peak concentrations reached in 1-2 hours. It is extensively metabolized in the liver and has a bioavailability of about 50%.

Route of Elimination

Duloxetine hydrochloride is metabolized in the liver and excreted in the feces and urine. Approximately 40% of the dose is excreted unchanged in the urine.

Dosage

Major Depressive Disorder (MDD)-

Starting Dose: 40 mg/day to 60 mg/day
Target Dose: Acute: 40 mg/day (20 mg twice daily) to 60 mg/day (once daily or as 30 mg twice daily); Maintenance: 60 mg/day
Maximum Dose: 120 mg/day

Generalized Anxiety Disorder (GAD)-

Starting Dose: 60 mg/day
Target Dose: 60 mg/day (once daily)
Maximum Dose: 120 mg/day

Diabetic Peripheral Neuropathic Pain (DPNP)-

Starting Dose: 60 mg/day
Target Dose: 60 mg/day (once daily)
Maximum Dose: 60 mg/day

Fibromyalgia-

Starting Dose: 30 mg/day
Target Dose: 60 mg/day (once daily)
Maximum Dose: 60 mg/day

Chronic Musculoskeletal Pain-

Starting Dose: 30 mg/day
Target Dose: 60 mg/day (once daily)
Maximum Dose: 60 mg/day

Some patients may benefit from starting at 30 mg once daily. There is no evidence that doses greater than 60 mg/day confers an additional benefit, while some adverse reactions were observed to be dose-dependent. A gradual dose reduction is recommended to avoid discontinuation symptoms.

Duloxetine hydrochloride is available in 10 mg, 20 mg, 30 mg, and 60 mg capsules. The recommended starting dose is 30 to 60 mg per day, taken orally in divided doses once or twice daily. The dosage may be increased gradually, as needed, up to 120 mg per day.

Administration

Duloxetine hydrochloride should be taken orally in divided doses once or twice daily, with or without food. It may be taken with or without food, but it is important to take it consistently, either always with food or always without food.

Side Effects

Common side effects of duloxetine hydrochloride include nausea, constipation, dry mouth, loss of appetite, tremor, drowsiness, increased sweating, anxiety, and headaches.

Toxicity

Duloxetine hydrochloride is generally well tolerated, but overdosage may result in serotonin syndrome. Symptoms of serotonin syndrome include agitation, coma, muscle twitching, hallucinations, confusion, rapid heart rate, and high blood pressure.

Precaution

Duloxetine hydrochloride should be used cautiously in patients with conditions that may be worsened by increases in serotonin levels, such as bipolar disorder, seizure disorders, or those taking monoamine oxidase inhibitors (MAOIs). It should also be used cautiously in elderly patients and in patients with renal or hepatic impairment. Patients should inform their healthcare provider if they are pregnant, planning to become pregnant, or breastfeeding.

Interaction

Duloxetine hydrochloride may interact with a variety of medications, including antidepressants, certain pain medications, and antipsychotics. It can also interact with drugs that affect serotonin levels in the body, such as MAOIs and selective serotonin reuptake inhibitors (SSRIs). Patients should inform their healthcare provider of all medications they are taking prior to starting duloxetine hydrochloride.

Disease Interaction

Duloxetine hydrochloride should be used cautiously in patients with conditions that may be worsened by increases in serotonin levels, such as bipolar disorder and seizure disorders. It should also be used with caution in elderly patients, in patients with renal or hepatic impairment, and in those taking MAOIs.

Drug Interaction

Duloxetine hydrochloride can interact with a variety of medications, including antidepressants, certain pain medications, and antipsychotics. It can also interact with drugs that affect serotonin levels in the body, such as MAOIs and SSRIs.

Food Interactions

Duloxetine hydrochloride should be taken consistently, either with or without food. It should not be taken with grapefruit juice, as this can increase the levels of the drug in the body.

Pregnancy Use

Duloxetine hydrochloride is not recommended for use in pregnant women. If you are pregnant or planning to become pregnant, you should inform your healthcare provider prior to starting treatment with duloxetine hydrochloride.

Lactation Use

Duloxetine hydrochloride is excreted in breast milk in very small amounts and is not recommended for use in breastfeeding women.

Acute Overdose

An acute overdose of duloxetine hydrochloride is likely to lead to symptoms of serotonin syndrome, such as agitation, confusion, rapid heart rate, and high blood pressure. Treatment of an acute overdose of duloxetine hydrochloride may include supportive measures, such as monitoring of vital signs and fluid balance, as well as gastric decontamination.

Contraindication

Duloxetine hydrochloride is contraindicated in patients with a known hypersensitivity to the drug and in those taking MAOIs.

Use Direction

Duloxetine hydrochloride should be taken orally in divided doses once or twice daily, with or without food. The recommended starting dose is 30 to 60 mg per day, taken orally in divided doses once or twice daily. The dosage may be increased gradually, as needed, up to 120 mg per day.