Based on repeated plasma duloxetine serum concentration determinations, a plasma half-life of duloxetine was calculated to be 18 hours reference range Discussion: The Naranjo probability scale suggested that duloxetine was the probable cause for the symptoms described.
Conclusion: Overdose with duloxetine can induce coma several hours after intake, with a fast reversal in our case. Shortly after her return from radiology testing, she sustained a cardio-pulmonary arrest and was unable to be successfully resuscitated.
No microorganisms were isolated from post-mortem blood cultures. There was mild systemic atherosclerosis and hypertension with an enlarged and dilated heart g. The gastric contents consisted of 40 cc of thick, brown-yellow liquid with no foreign objects or detectable pills. No injuries were present with the exception of cardiopulmonary resuscitation-related anterior rib fractures. No pneumonia was seen grossly or microscopically. No central blood was collected.
All samples were refrigerated until analyzed. Positive results were confirmed and quantified by subsequent and specific techniques. Louis, MO. Second source diphenhydramine control obtained from Lipomed Cambridge, MA , prepared in methanol. Internal standard : diphenhydramine-d 3 obtained from Cerilliant Round Rock, TX , prepared in methanol.
Second source control obtained from Lipomed Cambridge, MA , prepared in methanol. Using mepivacaine as the internal standard and a modified liquid—liquid extraction similar to that published by Foerster and Mason 8 , the case sample and the corresponding controls were analyzed using GC—MS in full scan mode.
Diphenhydramine, cyclobenzaprine and duloxetine were identified based on the relative retention time and full scan mass spectra. Presumptive identification of analytes by MS full scan mode includes a retention time RRT match compared with a reference standard and a library match containing at least the three most abundant ions in appropriate proportions.
Diphenhydramine and cyclobenzaprine were quantified in-house. The femoral blood, vitreous, liver, urine and gastric were sent to NMS Laboratories to quantitate duloxetine. Diphenhydramine was measured using a deuterated internal standard and a modified Foerster 8 extraction procedure.
The analytical column was a HP-1 MS 15 m, 0. The ions monitored for diphenhydramine were Cyclobenzaprine was measured using a deuterated internal standard and a modified Foerster 8 extraction procedure.
The flow rate is 0. The mobile phase gradient was 0. The ions monitored for cyclobenzaprine were Duloxetine was measured using a deuterated internal standard with protein precipitation by means of a zinc sulfate solution. Calibrators and control solutions were prepared in methanol from 1. Indianapolis, IN. The ions monitored for duloxetine-d 4 were A six-point calibration was prepared from the stock standard solution ranging from 3. The determination of duloxetine in urine, liver tissue homogenate, gastric contents fluid and vitreous humor was performed using two levels of standard addition for each specimen.
The alkaline drug screen revealed the presence of diphenhydramine, cyclobenzaprine and duloxetine. Table II lists the quantitative results. The cause of death in this case was determined to be a mixed drug toxicity of duloxetine, cyclobenzaprine and diphenhydramine. The most significant component of the toxicity was from duloxetine. Duloxetine is a relatively new drug, and limited reports of related overdose and fatalities exist in the literature.
If you have questions about how Cymbalta may affect you, talk with your doctor or pharmacist. This was one of the more common side effects of the drug in clinical studies. In the studies:. If you have questions about side effects from Cymbalta, talk with your doctor or pharmacist. You may wonder how Cymbalta compares with other medications that are prescribed for similar uses.
Here we look at how Cymbalta and Lexapro are alike and different. Lexapro contains the active drug escitalopram. Lexapro belongs to a class of medications called selective serotonin reuptake inhibitors SSRIs. Both types of drugs are commonly used as antidepressants. Cymbalta comes as capsule that you take by mouth. Cymbalta and Lexapro have some similar side effects and others that vary. Below are examples of these side effects. This list contains 10 of the most common mild side effects that can occur with both Cymbalta and Lexapro when taken individually :.
These lists contain examples of serious side effects that can occur with Cymbalta, with Lexapro, or with both drugs when taken individually. The use of Cymbalta and Lexapro in treating depression in adults has been compared in a meta-analysis. A meta-analysis is a type of study that looks at the results of numerous clinical studies to see if there are any consistent results across the studies. In this meta-analysis , researchers looked at 16 different clinical studies that compared Cymbalta to other antidepressants, including three studies that compared Cymbalta with Lexapro.
The researchers found the two drugs to be similarly effective for treating depression. Cymbalta and Lexapro have also been compared in a meta-analysis for treating anxiety in adults.
The researchers looked at 41 clinical studies involving a total of 11 antidepressants, including Cymbalta and Lexapro. They found Cymbalta and Lexapro to be similarly effective for treating anxiety. According to estimates on GoodRx. Lexapro is available as a generic drug called escitalopram. Cymbalta and Effexor XR are prescribed for similar uses. Here we look at how these drugs are alike and different. Effexor XR contains the active drug venlafaxine ER.
Duloxetine and venlafaxine ER both belong to a class of medications known as serotonin-norepinephrine reuptake inhibitors SNRIs. This medication class is commonly used as antidepressants. Cymbalta and Effexor have some similar side effects and others that differ. This list contains 10 of the most common mild side effects that can occur with both Cymbalta and Effexor XR when taken individually :. These lists contain examples of serious side effects that can occur with Cymbalta, with Effexor XR, or with both drugs when taken individually.
The use of Cymbalta and Effexor XR in treating depression in adults has been compared in a meta-analysis. In this meta-analysis , researchers looked at 16 clinical studies comparing Cymbalta with other antidepressants , including three studies that compared Cymbalta with Effexor XR. A clinical study directly compared Cymbalta and Effexor XR for treating anxiety in adults.
In this study, the researchers randomly assigned people to take either Cymbalta, Effexor XR, or a placebo a treatment with no active drug once a day for 10 weeks. At the end of the study, the researchers found that people who took Cymbalta or Effexor XR had improved HAM-A scores compared with those who took a placebo.
They found Cymbalta and Effexor XR to be similarly effective for treating anxiety. Effexor XR is available as a generic drug called venlafaxine ER. Other drugs are available that can treat your condition. Some may be a better fit for you than others. They can tell you about other medications that may work well for you. Note: Some of the drugs listed here are used off-label to treat these specific conditions. Examples of other drugs that may be used to treat depression include:.
Examples of other drugs that may be used to treat anxiety include:. Examples of other drugs that may be used to treat diabetic neuropathy diabetic nerve pain include:. Examples of other drugs that may be used to treat fibromyalgia include:. Examples of other drugs that may be used to treat chronic musculoskeletal pain pain in the bones, muscles, ligaments, nerves, and tendons include:.
On its own, Cymbalta has caused liver damage and liver failure. In rare cases, this liver damage was fatal. Therefore, drinking heavily during your Cymbalta treatment could raise your risk for liver damage even more.
If you drink alcohol, talk with your doctor before you start taking Cymbalta. Depending on the amount of alcohol you consume, they may decide to have you try a different medication for your condition. Cymbalta belongs to a drug class called serotonin-norepinephrine reuptake inhibitors SNRIs. Cymbalta begins working as soon as you take your dose. It takes about 3 days for levels of the drug to become stable in your body.
For example, in clinical trials , some adults with pain caused by diabetic neuropathy nerve damage , as well as some adults with fibromyalgia, noticed improvement within 1 week of starting the drug. However, the National Alliance on Mental Illness notes that full improvement of depression symptoms may take up to 8 weeks. If you have questions about how Cymbalta works, or how long it takes to work, talk with your doctor or pharmacist. Cymbalta can interact with several other medications.
It can also interact with certain supplements. Different interactions can cause different effects. For instance, some interactions can interfere with how well a drug works. Other interactions can increase side effects or make them more severe.
Below are lists of medications that can interact with Cymbalta. Before taking Cymbalta, talk with your doctor and pharmacist. Tell them about all prescription, over-the-counter, and other drugs you take.
Also tell them about any vitamins, herbs, and supplements you use. Sharing this information can help you avoid potential interactions. If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.
Cymbalta can increase serotonin levels in your body. Using Cymbalta with other drugs that also increase serotonin may raise your risk for serotonin syndrome. Serotonin syndrome is a rare but potentially life threatening condition. Taking multiple medications that increase serotonin levels could cause serotonin to build up to dangerous levels in your blood.
Before taking Cymbalta, be sure to tell your doctor if you take any of the medications listed above. They may want to monitor you for any signs of serotonin syndrome. Or they may have you take a different drug to treat your condition. Taking Cymbalta with these drugs may increase Cymbalta levels in your body.
Slowing down this process could raise your risk for side effects from Cymbalta. Certain drugs have stronger effects on these enzymes. Examples of strong CYP1A2 inhibitors include:.
Examples of CYP2D6 inhibitors include:. Before you take Cymbalta, be sure to tell your doctor if you take any of these medications. They can determine which drug is the best fit for you. This means it can affect the levels of other drugs that are also broken down by this enzyme. However, some medications can cause side effects if their levels in your body are changed slightly. Examples of these drugs include:. Before taking Cymbalta, talk with your doctor about all the medications you take.
They can determine whether Cymbalta can be taken with your other medications. Drugs that affect serotonin levels, such as Cymbalta, may increase your risk for bleeding.
Before taking Cymbalta, tell your doctor if you take any of the medications listed above. This monitoring may include ordering blood tests.
Or they may decide to use a different medication to treat your condition. Such models can predict plasma concentration curves, and then it can quickly be determined whether treatment with gastric lavage and activated charcoal is feasible.
In this way, it may be possible to deal with individual cases by reflecting the differences in pharmacokinetics. In hospitals, a simplified PBPK model simulator could replace the need to routinely measure the blood levels of drugs. It is hoped that the results of this study based on drug monitoring data and pharmacokinetic predictions could serve as a guide when setting the treatment period in cases of overdoses of antipsychotic drugs, e.
All data generated or analyzed during this study are included in this published article and are also available from the corresponding author on reasonable request. Ereshefsky L. Pharmacokinetics and drug interactions: update for new antipsychotics.
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