duloxetine
hydrochloride
Cymbalta
Nursing Considerations
• Avoid giving duloxetine to patients with
severe renal impairment or end-stage renal
disease that requires hemodialysis because
blood drug levels increase significantly in
these patients. Also avoid duloxetine in
patients with hepatic insufficiency because
drug is metabolized by the liver.
• Use duloxetine cautiously in patients with
delayed gastric emptying because drug’s
enteric coating resists dissolution until it
reaches an area where pH exceeds 5.5.
• Give duloxetine cautiously to patients with
a history of mania, which it may activate.
Also give cautiously to patients with a
seizure disorder because drug effects aren’t
known in these patients.
•Obtain patient’s baseline blood pressure
before duloxetine therapy starts, and assess
it periodically thereafter for changes. If
orthostatic hypotension occurs during
therapy, notify prescriber and anticipate
that drug may need to be discontinued.
•Monitor patient’s serum sodium level,
especially if patient is elderly, is taking a
diuretic, or has volume depletion, because
drug may lower serum sodium level.
•Monitor patient’s hepatic function, as
ordered, because drug may increase the
risk of hepatotoxicity.
• If patient takes duloxetine for depression
(especially if he’s a child or an adolescent),
watch closely for evidence of suicidal
thinking or behavior, especially when therapy
starts or dosage changes.
• Avoid stopping duloxetine therapy abruptly,
if possible, because withdrawal symptoms
such as dizziness, nausea, headacle,
fatigue, paresthesia, vomiting, irritability,
nightmares, insomnia, diarrhea, anxiety,
hyperhidrosis, and vertigo may occur.
Taper dosage gradually, as ordered.
WARNING Monitor patient for serotonin
syndrome, characterized by agitation,
chills, confusion, diaphoresis, diarrhea,
fever, hyperactive reflexes, poor coordination,
restlessness, shaking, talking or acting
with uncontrolled excitement, tremor, and
twitching. In its most severe form, serotonin
syndrome can resemble neuroleptic
malignant syndrome, which includes a
high fever, muscle rigidity, autonomic
instability with possible fluctuations in
vital signs, and mental status changes.
PATIENT TEACHING
• Tell patient to take capsule whole and not
to chew it, crush it, or sprinkle contents
on food or liquids because doing so alters
enteric coating and may affect drug
absorption.
• Inform patient that full effect of duloxetine
may take weeks to occur; stress the
importance of continuing to take the drug
as directed.
• Caution patient against excessive alcohol
consumption while taking duloxetine
because it may increase risk of hepatic
dysfunction.
• Advise patient not to stop duloxetine
abruptly because adverse reactions may
occur. Explain that drug will be stopped
gradually.
• Instruct patient to notify prescriber if any
serious or troublesome adverse effects
develop.
• Advise patient to avoid hazardous activities
until drug’s CNS effects are known.
• Instruct patient to rise from a lying or sitting
position slowly to minimize drug’s
effect on lowering blood pressure.
• If patient takes duloxetine for depression,
urge caregivers to watch closely for evidence
of suicidal tendencies, especially if
patient is a child or an adolescent and
especially when therapy starts or dosage
changes.
• Instruct female patients of childbearing
potential to notify prescriber if they are,
could be, or wish to become pregnant;
duloxetine therapy may cause adverse
reactions in neonates exposed to it during
the third trimester.
