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Warnings & Precautions
Do not use duloxetine together with:
- thioridazine (Mellaril®)
- isocarboxazid (Marplan®)
- tranylcypromine (Parnate®)
- phenelzine (Nardil®)
- rasagiline (Azilect®)
- selegiline (Eldepryl®, Emsam®)
Serious and sometimes fatal reactions can occur when these medicines are taken
with duloxetine. You must wait at least 14 days after stopping an MAO inhibitor before
you can take duloxetine. After you stop taking duloxetine, you must wait at least 14 days
before you start taking an MAOI. You must wait 5 days after stopping duloxetine before you
can take an MAOI.
Do not use this medication if you are allergic to duloxetine, or if you have untreated
or uncontrolled glaucoma.
Before taking duloxetine, tell your doctor if you are allergic to any drugs, or if you
have:
- Liver or Kidney Disease
- Seizures or Epilepsy
- Bipolar Disorder (manic depression)
- History of Drug Abuse or Suicidal Thoughts
If you have any of these conditions, you may not be able to use duloxetine, or you may
need a dosage adjustment or special tests during treatment.
Depression - Suicide
You may have an increased risk of suicidal thoughts or behavior at the start of
treatment with an antidepressant medication, especially if you are under 18 years
old. Talk with your doctor about this risk. While you are taking duloxetine you
will need to be monitored for worsening symptoms of depression and/or suicidal thoughts
during the first weeks of treatment, or whenever your dose is changed.
In addition to you watching for changes in your own symptoms, your family or other
caregivers should be alert to changes in your mood or symptoms. Your doctor will need to
check you at regular visits for at least the first 12 weeks of treatment.
Pregnancy
duloxetine may be harmful to an unborn baby, and may cause problems in a newborn baby
if the mother takes the medication late in pregnancy (during the third trimester). Tell
your doctor if you are pregnant or plan to become pregnant during treatment. Duloxetine
can pass into breast milk and may harm a nursing baby. Do not use this medication without
telling your doctor if you are breast-feeding a baby.
Elderly
Older adults may be more sensitive to the side effects of this medication.
Do not give this medication to anyone under 18 years old without the advice of a doctor.
Severe Skin Reactions
Severe skin reactions, including erythema multiforme and Stevens-Johnson Syndrome (SJS),
can occur with duloxetine. The reporting rate of SJS associated with duloxetine use
exceeds the general population background incidence rate for this serious skin reaction (1
to 2 cases per million person years). The reporting rate is generally accepted to be an
underestimate due to underreporting.
Duloxetine should be discontinued at the first appearance of blisters, peeling rash,
mucosal erosions, or any other sign of hypersensitivity if no other etiology can be
identified.
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