Duzela (Duloxetine Hydrochloride)
Also sold as: Duzela, Cymbalta, Dulane, Dulan, Duxet
Pregnancy
Cat C
Lactation
Caution
Schedule
H
Forms
Capsule (enteric-coated pellets) 20mg, 30mg, 40mg, 60mg
Indications
- Major depressive disorder (MDD)
- Generalised anxiety disorder (GAD)
- Diabetic peripheral neuropathic pain
- Fibromyalgia
- Chronic musculoskeletal pain (osteoarthritis, chronic low back pain)
- Stress urinary incontinence (off-label in India)
Adult Dosing
MDD / GAD
Start 30 mg PO once daily × 1 week; increase to 60 mg once daily
Target dose 60 mg/day. Max 120 mg/day (no additional benefit usually above 60 mg)
Diabetic neuropathy
60 mg PO once daily
Can start 30 mg × 1 week. Max 60 mg/day for neuropathic pain
Fibromyalgia
30 mg once daily × 1 week, then 60 mg once daily
Chronic musculoskeletal pain
60 mg once daily
Pediatric Dosing
Not approved for paediatric depression. GAD: specialist use only.
Renal Dose Adjustment
| CrCl / eGFR | Dose Adjustment |
|---|---|
| CrCl > 30 mL/min | No adjustment |
| CrCl < 30 mL/min / ESRD | AVOID — active metabolite accumulates; increased adverse effects |
Hepatic Adjustment
AVOID in significant hepatic impairment (hepatotoxicity risk; Child-Pugh B/C)
Pregnancy & Lactation
Pregnancy: Category C
Neonatal adaptation syndrome (jitteriness, poor feeding) with 3rd trimester use. Persistent pulmonary hypertension of newborn (PPHN) risk. Taper before delivery if possible.
Lactation: Caution
Low levels in breast milk; generally considered acceptable with monitoring.
Top Drug Interactions
| Interacting Drug | Effect | Severity |
|---|---|---|
| MAO inhibitors | CONTRAINDICATED — serotonin syndrome; 14-day washout required | Major |
| CYP1A2 inhibitors (fluvoxamine, ciprofloxacin) | Increase duloxetine levels up to 6-fold | Major |
| CYP2D6 inhibitors (fluoxetine, paroxetine) | Increase duloxetine levels; increased toxicity | Major |
| NSAIDs / Anticoagulants / Antiplatelet agents | Increased bleeding risk (platelet serotonin depletion) | Moderate |
| Tramadol / Triptans / Linezolid | Serotonin syndrome risk | Major |
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Side Effects
Common
- Nausea (very common — especially early)
- Headache
- Dry mouth
- Insomnia or somnolence
- Dizziness
- Constipation
- Hyperhidrosis
- Sexual dysfunction
Serious / Discontinue If
- Hepatotoxicity (avoid in liver disease)
- Hyponatraemia (SIADH)
- Suicidal ideation (under 25)
- Serotonin syndrome
- Severe discontinuation syndrome (taper slowly)
- Hypertension (NE effect)
- Angle-closure glaucoma
Contraindications
- Concurrent MAO inhibitors
- Uncontrolled narrow-angle glaucoma
- Hepatic impairment (Child-Pugh B/C)
- CrCl < 30 mL/min
- Concurrent thioridazine
Available Indian Brands
| Brand | Manufacturer | Price (approx) |
|---|---|---|
| Duzela 30mg | Sun Pharma | 10 cap ₹85 |
| Dulane 30mg | Sun Pharma | 10 cap ₹78 |
| Duxet 30mg | Lupin | 10 cap ₹72 |
| Cymbalta 60mg | Eli Lilly | 14 cap ₹485 |
Monitoring Required
- LFTs at baseline; avoid if pre-existing liver disease
- Blood pressure (NE-mediated hypertension)
- Serum sodium (SIADH in elderly)
- Mood and suicidality (first 4 weeks)
- Glucose in diabetics
Patient Counseling Points
- Swallow capsule whole — do not crush, chew, or open
- Nausea common early — take with food to reduce
- Takes 2-4 weeks for antidepressant effect; neuropathic pain: 2-8 weeks
- Do NOT stop suddenly — severe discontinuation (dizziness, electric-shock sensations, nausea)
- Avoid alcohol — worsens liver risk and sedation
- Report: yellowing of skin/eyes (hepatitis), difficulty passing urine, severe agitation
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Clinically reviewed by: Dr. Ananya Krishnan, MD (Psychiatry), Senior Consultant
Last reviewed: 2026-04-01
References
- BNF — Duloxetine
- NICE Depression Guidelines 2022
- ADA Diabetic Neuropathy Guidelines
- CANMAT Depression 2023