[2014] DHYpharmproject: Duloxetine

by JulieBreen
Last updated 6 years ago


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[2014] DHYpharmproject: Duloxetine

DRUG CLASS: Antidepressant


Mechanism of ActionDuloxetine affects the neurotransmitters in the brain serotonin and norepinephrine. It is believed that there is an imbalance in the levels of serotonin and norepinephrine in patients with depression and other psychiatric disorder. To make the two neurotransmitters balanced in the brain, Duloxetine works by preventing the reuptake of serotonin and norepinephrine by nerves, which increases the effect of serotonin in the brain.

Main Purpose of UseTreatment of major depression disorder (MDD); diabetic peripheral neuropathic pain

Treatment ModificationsStress Reduction Protocol may be indicated depending on the severity of the adverse effects of the duloxetine. Xerostomia is common in patients who take this drug, so CAMBRA should be in full affect during the dental exam and patient education on the side effects of the drug on the link between xerostomia and caries. Light headed and dizziness has been reported in patients who take duloxetine. Hence it is important to remember not to let the patient jump out of the dental chair immediately (wait 2 min. before allowing patient out of the chair at the end of a visit.)Increased blood pressure has been reported in patients taking duloxetine. (Monitor patient's blood pressure. )

Dental Considerations+General:- Monitor vital signs at any appointment because of cardiovascular side effects.- Assess salivary flow as a factor in caries, periodontal disease, candidiasis, denture sore mouth.- Assess salivary flow as a factor to reduced retention and/or increased irritation of removable prosthesis.+Consultations:- Medical consultation may be required. Inform physician of potential adverse effects of dry mouth.

DosagePOAdult: 40 mg/day (20 mg twice daily) to 60 mg/day (once or twice/day)

Other Adverse EffectsDrowsinessLathargic feelingConstipationExcessive sweating

Other SSRI'svenlafaxine (Effexor)desvenlafaxine (Pristiq)milnacipran (Savella)levomilnacipran (Fetzima)

SPECIAL CONSIDERATION! Increased serotonin levels cause drowsiness. Try taking drug for a couple weeks and analyze the effect it may have on you before deciding to operate a vehicle, or heavy machinery while taking duloxetine.

Local AnesthesiaConsiderationDuloxetine and epinephrine can increase your blood pressure and heart rate.Someone with any form of cardiovascular disease, HBP or hyperthyroidism should be limited to 0.04 mg of epi. Epinephrine would also be the limiting factor for a patient with any of the listed conditions mentioned before.

References Haveles, Elena B. Applied Pharmacology for the Dental Hygienist. St. Louis: Mosby Inc., Sixth edition, 2011Jeske, Arthur H. Mosby’s Dental Drug Reference. St. Louis: Mosby Inc., 11th Edition, 2013


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