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DULoxetine

DULoxetine
Brand names: Cymbalta
Form Strength
DELAYED RELEASE CAPSULE, ORAL 20 mg; 30 mg; 60 mg
Display Selective Serotonin- and Norepinephrine-reuptake Inhibitors Class: 28160416
Medication comments:
Enteral Drug Administration notes.
Generic
(Brand)		 Comments and Considerations Recommendations for Administration with Enteral Nutrition
DULoxetine
(Cymbalta)		 Capsule contains delayed release granules Do NOT administer through feeding tube. Use therapeutic alternative.
2023 American Geriatrics Society Beers Criteria® for potentially inappropriate medication use in older adults.
Medication: DULoxetine (Cymbalta)
Criteria 2: Potentially inappropriate medication use in older adults due to drug–disease or drug–syndrome interactions that may exacerbate the disease or syndrome. (Table 3)
Drug(s) ⇆ disease or syndrome antidepressants (selected classes: SNRIs) ⇄ History of falls or fractures
Rationale May cause ataxia, impaired psychomotor function, syncope, or additional falls. Antidepressants (selected classes): evidence for risk of falls and fractures is mixed; newer evidence suggests that SNRIs may increase falls risk. If one of the drugs must be used, consider reducing the use of other CNS-active medications that increase the risk of falls and fractures. (i.e., anticholinergics, selected antidepressants, antiepileptics, antipsychotics, sedative/hypnotics including benzodiazepines and, Nonbenzodiazepine benzodiazepine receptor agonist hypnotics, opioids) and implement other strategies to reduce fall risk.
Recommendation Avoid unless safer alternatives are not available.
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 
Criteria 3: Potentially inappropriate medications: drugs to be used with caution in older adults. (Table 4)
Drug(s) antidepressants (selected: SNRIs)
Rationale May exacerbate or cause SIADH or hyponatremia; monitor sodium levels closely when starting or changing dosages in older adults.
Recommendation Use with caution
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 
Criteria 4: Potentially clinically important drug-drug interactions that should be avoided in older adults. (Table 5)
Interacting drug(s) or class(es) antidepressants (TCAs, SSRIs, and SNRIs) ⇄ CNS-active agents
Risk Rationale Increased risk of falls and of fracture with the concurrent use of ≥3 CNS-active agents (antiepileptics including gabapentinoids, antidepressants, antipsychotics, benzodiazepines, Nonbenzodiazepine benzodiazepine receptor agonist hypnotics, opioids, and skeletal muscle relaxants).
Recommendation Avoid concurrent use of ≥3 CNS-active drugs Click for list; minimize the number of CNS-active drugs.
 Quality of evidence: High, Strength of Recommendation: Strong
 
Criteria 5: medications that should be avoided or have their dosage reduced with varying levels of kidney function in older adults. (Table 6)
CrCl (mL/min) at which action is required <30
Rationale Increased GI adverse effects (nausea, diarrhea)
Recommendation Avoid
 Quality of evidence: Moderate, Strength of Recommendation: Weak
Last updated: Sep. 18, 2025
  • Black Box Warnings Suicidal Ideation
  • Look-Alike/Sound-Alike DULoxetine confused with Dexilant, FLUoxetine, PARoxetine
UpToDate Lexidrug

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