Experiences with
Duloxetine

Duloxetine is a type of antidepressant medicine known as a serotonin-noradrenaline reuptake inhibitor (SNRI). SNRIs are thought to work by increasing the amount of mood-enhancing chemicals, serotonin and noradrenaline, in your brain.

It's used to treat depression and anxiety.

It's also used to treat nerve pain, such as fibromyalgia, and can be used to treat stress urinary incontinence in women.

Duloxetine comes as capsules. It is only available on prescription.

Who can take duloxetine

Most adults aged 18 years and over can take duloxetine.

For stress urinary incontenince, duloxetine can only be taken by women.

Who may not be able to take duloxetine

Duloxetine is not suitable for some people. To make sure it's safe for you, tell your doctor if you:

have ever had an allergic reaction to duloxetine or any other medicine
have kidney or liver problems
have a heart problem
are taking or have taken other medicines for depression within the last 14 days
have glaucoma – duloxetine can increase the pressure in your eye
have ever had a seizure or fit, manic episodes or bipolar disorder
bruise easily
are trying to get pregnant, are already pregnant, or you're breastfeeding

Dosage and strength

For depression, anxiety and nerve pain, duloxetine comes in 30mg and 60mg capsules.

For stress urinary incontinence, duloxetine comes in 20mg and 40mg capsules.

How much you take will depend on what you're taking it for:

depression – the starting dose is 60mg, taken once a day and this can be increased to 120mg, taken once a day
anxiety – the starting dose is 30mg, taken once a day and this can be increased to 60mg, taken once a day
nerve pain – the starting dose is 60mg taken once a day, and this can be increased to 60mg taken twice a day
stress urinary incontinence – the starting dose is 20mg, taken twice a day and this can be increased to 40mg, taken twice a day, after 2 weeks

How to take it

Swallow the capsules whole with a drink of water or juice. Do not chew them.

You can take duloxetine with or without food, but it's best to take it at the same time each day.

How long to take it for

How long you take duloxetine for depends on why you're taking it.

For depression or anxiety, once you're feeling better, it's likely that you'll continue to take it for several more months. Most doctors recommend that you take antidepressants for 6 months to a year after you no longer feel depressed or anxious. Stopping your medicine too soon can make depression and anxiety come back.

When you stop taking it, your doctor will probably recommend reducing your dose gradually over several weeks, to help prevent withdrawal side effects.

For nerve pain or urinary incontinence, if duloxetine is helping your symptoms, you can continue taking it long term. Your doctor may check that you're still having relief from the pain or urinary incontinence every few months.

If you forget to take it

If you usually take duloxetine once a day, take the missed dose as soon as you remember, unless it's less than 12 hours until your next dose, in which case skip the missed dose and take the next one at the usual time.

If you usually take it twice a day, take the missed dose as soon as you remember, unless it's less than 4 hours until your next dose, in which case skip the missed dose and take the next one at the usual time.

Never take 2 doses at the same time to make up for a forgotten dose.

If you often forget doses, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.

If you take too much

Taking too much duloxetine can cause symptoms such as:

feeling sleepy
being sick (vomiting)
tremors
feeling dizzy
a fast heart rate
sweating
feeling restless

The amount of duloxetine that can lead to an overdose varies from person to person.

you take more than your prescribed dose of duloxetine

Go to 111.nhs.uk or call 111

you take more than your prescribed dose of duloxetine and you have a seizure or fit

Find your nearest A&E

If you need to go to A&E, do not drive. Ask someone to drive you or call 999 and ask for an ambulance.

Bring the duloxetine packet or leaflet inside it, any remaining medicine, and any other medicines you take.

If you have been feeling better for 6 months or more, your doctor may suggest coming off duloxetine.

Your doctor may reduce your dose gradually over several weeks, or longer if you've been taking duloxetine for a long time.

This is to help prevent any extra side effects you might get as a reaction to coming off the medicine.

Do not stop taking duloxetine suddenly or without talking to your doctor first.

Common side effects

These common side effects of duloxetine can happen in up to 1 in 10 people. There are things you can do to help cope with them:

Try taking duloxetine first thing in the morning.

Make sure you rest and drink plenty of fluids. Try not to drink too much alcohol. Ask your pharmacist to recommend a painkiller. Talk to your doctor if the headaches last longer than a week or are severe.

If duloxetine makes you feel dizzy when you stand up, try getting up very slowly or stay sitting down until you feel better. If you begin to feel dizzy, lie down so you do not faint, then sit until you feel better. Do not drive, cycle or use tools or machinery if you feel dizzy.

Avoid driving, cycling or using tools or machinery while this is happening. If it lasts for more than a day or two, your doctor may need to change your treatment.

Try to get more fibre into your diet, such as fresh fruit and vegetables and cereals, and drink plenty of water. Try to exercise more regularly, for example by going for a daily walk or run.

Drink lots of fluids, such as water or squash, to avoid dehydration. Signs of dehydration include peeing less than usual or having dark, strong-smelling pee.

Do not take any other medicines to treat diarrhoea without speaking to a pharmacist or doctor.

If you take the combined contraceptive pill or the progestogen-only pill and you have severe diarrhoea for more than 24 hours, your contraception may not protect you from pregnancy. Check the pill packet for advice.

Stick to simple meals and do not eat rich or spicy food. Make sure you take duloxetine in the morning with some food. Try small, frequent sips of water if you're being sick to avoid dehydration. Signs of dehydration include peeing less than usual or having dark, strong-smelling pee.

If you take the combined contraceptive pill or the progestogen-only pill and you're being sick, your contraception may not protect you from pregnancy. Check the pill packet for advice.

Chew sugar-free gum or suck sugar-free sweets.

Try wearing loose clothing, use a strong anti-perspirant, and keep cool using a fan if possible. If this does not help, you may need to try a different type of antidepressant.

Do not drive, cycle or use tools or machinery if you're feeling this way. Try taking duloxetine 1 hour before bedtime. Cut down the amount of alcohol you drink as alcohol will make you feel more tired.

If the tiredness does not go away after 2 weeks, ask your doctor for advice.

This side effect should get better as your body gets used to the medicine. It may also help to eat smaller meals more often and eat foods you really enjoy. If your appetite does not improve or you lose a lot of weight, ask your doctor for advice.

Speak to your doctor if you get this side effect and it does not go away.

Speak to a doctor or pharmacist if the advice on how to cope does not help and a side effect is still bothering you or does not go away.

Serious side effects

Serious side effects are rare and happen in less than 1 in 100 people.

Book an appointment with your doctor if you get changes in your periods, such as heavy bleeding, spotting or bleeding between periods.

Call a doctor or call 111 straight away if you have:

hallucinations (seeing or hearing things that are not real), or you become aggressive and angry
feelings of euphoria, excessive enthusiasm or excitement, or feeling restless so that you cannot sit or stand still
constant headaches, long-lasting confusion or weakness, or frequent muscle cramps – these can be signs of low sodium levels in your blood
yellowing of the whites of your eyes, or your skin although this may be less obvious on brown or black skin – these can be signs of a liver problem
eye pain or blurred vision
black or red poo or blood in your vomit – these can be signs of bleeding from your gut
coughed up blood or have blood in your pee
bleeding from your gums, or bruises that appear without a reason or get bigger

tightness in your chest or shortness of breath
any heavy bleeding that you cannot stop, such as cuts or nosebleeds that do not stop within 10 to 15 minutes
painful erections that last longer than 2 hours – this may happen even when you're not having sex
thoughts about harming yourself or ending your life

Find your nearest A&E

Meds - serious side effects A&E safety messaging

In rare cases, it's possible to have a serious allergic reaction (anaphylaxis) to duloxetine.

Meds New IA (H4) - serious allergic reaction

These are not all the side effects of duloxetine. For a full list, see the leaflet inside your medicines packet.

Duloxetine and pregnancy

Duloxetine is not generally recommended in pregnancy because there is not much information on whether it may affect the developing baby. But if duloxetine was working well for you before you got pregnant, then it may be reasonable to keep taking it during pregnancy. Discuss this with your doctor or midwife.

If you take duloxetine in the weeks before birth it can sometimes cause short-term withdrawal symptoms and, very rarely, breathing problems in the baby. Your baby will be checked after birth and given additional care if needed.

Taking duloxetine in the last month of pregnancy may slightly increase your risk of bleeding after delivery. However, because this side effect is rare, it is not a reason to stop taking duloxetine while pregnant.

It is important that mental health problems are well treated since these can affect both your and your baby's wellbeing. Depression and anxiety can sometimes get worse during pregnancy and after your baby has been born.

Speak to your doctor if you get pregnant. They will help you weigh up the risks and benefits so you can decide on the best treatment for you and your baby.

Duloxetine and breastfeeding

If your doctor or health visitor says your baby is healthy, you can take duloxetine while breastfeeding.

Duloxetine gets into breast milk in very small amounts, and has not been known to cause side effects in breastfed babies.

If you're breastfeeding, or planning to breastfeed, talk to your doctor or pharmacist as other medicines might be better while breastfeeding. It is important that you take the medicine that works for you.

It's important to continue taking duloxetine to keep you well. Breastfeeding will also benefit both you and your baby.

If you notice that your baby is not feeding as well as usual or seems unusually sleepy, irritable or restless, or you have any other concerns about your baby, talk to your health visitor, midwife, pharmacist or doctor as soon as possible.

Duloxetine and fertility

There's no clear evidence to suggest that taking duloxetine reduces fertility in either men or women.

But speak to your doctor before taking it if you're trying to get pregnant.

Meds New IA (H2) - Pregnancy non-urgent care card

Cautions with other medicines

Some medicines and duloxetine can affect each other and increase the chances of you having side effects.

Tell your doctor or pharmacist if you're taking:

any other medicines for depression – some rarely used antidepressants can affect duloxetine and cause very high blood pressure even after you have stopped taking them
medicine used to help prevent blood clots, such as warfarin
diazepam, chlorphenamine or other medicines that can make you feel more sleepy
tramadol – this can increase the chances of you having certain side effects

Mixing duloxetine with herbal remedies and supplements

Do not take the herbal remedy St John's wort while you're being treated with duloxetine, as this will increase your risk of side effects.

There's not enough information to say that other herbal remedies and supplements are always safe to take with duloxetine. They're not tested in the same way as pharmacy and prescription medicines.

Meds New IA (H2) - Cautions with other medicines alert