Sunday, January 12, 2014

Duloxetine (Cymbalta) part 3

Interstitial cystitis
There is a U.S. Patent 6150396 for the use of duloxetine for treatment of interstitial cystitis although one study found positive outcomes in only a small proportion of cases.[28] Interstitial cystitisis a bladder and urinary tract disorder which presents as chronic pelvic and perineal pain. It is speculated that duloxetine suppresses neural impulses related to pain below a threshold level sufficient to alleviate some or all neurological pain symptoms.

Musculoskeletal pain
On November 4, 2010, the U.S. Food and Drug Administration approved Cymbalta to treat chronic musculoskeletal pain, including discomfort from osteoarthritis and chronic lower back pain.[29]
Contraindications
The following contraindications are listed by the manufacturer:[30]
·         Hypersensitivity - duloxetine is contraindicated in patients with a known hypersensitivity to duloxetine or any of the inactive ingredients.
·         MAOIs - concomitant use in patients taking MAOIs is contraindicated.
·         Uncontrolled narrow-angle glaucoma - in clinical trials, Cymbalta use was associated with an increased risk of mydriasis (dilation of the pupil); therefore, its use should be avoided in patients with uncontrolled narrow-angle glaucoma, in which mydriasis can cause sudden worsening.
·         CNS acting drugs - given the primary central nervous system (CNS) effects of duloxetine, it should be used with caution when it is taken in combination with or substituted for other centrally acting drugs, including those with a similar mechanism of action.
·         Cymbalta and thioridazine should not be co-administered.

In addition, the FDA has reported on life threatening drug interactions that may be possible when co-administered with any CNS stimulant, such as phenterminediethylpropionamphetamine,sibutraminemethylphenidatemethamphetamine, and cocaine leading to increased risk for serotonin syndrome.[31]

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