Serotonin norepinephrine reuptake inhibitors (SNRI)
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--Km39 13:54, 22 March 2007 (PDT)
Contents |
Description
Duloxetine is a Selective serotonin and norepinephrine reuptake inhibitor (SSNRI) that is supplied as an oral capsule. It was approved for depression on August 3, 2004 and on September 28, 2004 it was approved for pain caused from diabetic neuropathy. In February 2007, it was approved for generalized anxiety disorder in patients 18 years and older. [1] This drug carries a Black Box warning for risk of suicidality in children and adolescents with major depressive disorder. It is important to monitor any child put on this medication for worsening of depression or thoughts of suicide. [2] A meta-analysis of studies involving duloxetine (9 studies), fluoxetine (22 studies) and venlafaxine (8 studies) for Major Depressive Disorder examined Hedge’s g effect size and dropout rate as a secondary outcome. The results found that duloxetine and fluoxetine were comparable in tolerability and efficacy. Venlafaxine was found to be more effective, though had a higher drop out rate than duloxetine. This study is limited because it is not a head to head trial.[3] A second meta-analysis found that venlafaxine-XR was preferred in terms of rates of remission and response rates in Major Depressive Disorder.[4] A randomized controlled trial is needed to confirm these results.
Mechanism of action
Duloxetine has been shown to be a potent inhibitor of serotonin and norepinephrine reuptake in the central nervous system. It is more effective in inhibiting the reuptake of serotonin then norepinephrine. It appears to be a mild inhibitor of dopamine reuptake. It does not inhibit Monoamine oxidase. The exact mechanism of duloxetine is unknown.[2]
Agents in Class
- Duloxetine
- Venlafaxine
References
- ↑ FDA approves antidepressant Cymbalta (duloxetine HCl) for treatment of generalized anxiety disorder. News Medical.net 26 Feb. 2007 [cited 10 March 2007]; Available from: http://www.news-medical.net/?id=22194
- ↑ 2.0 2.1 Eli Lilly and Company. Duloxetine Package Insert. Indianapolis, IN 46285; 2007.
- ↑ Eckert L, Lancon C. Duloxetine compared with fluoxetine and venlafaxine: use of meta-regression analysis for indirect comparisons. BMC psychiatry. 2006;6:30.
- ↑ Vis PM, van Baardewijk M, Einarson TR. Duloxetine and venlafaxine-XR in the treatment of major depressive disorder: a meta-analysis of randomized clinical trials. The Annals of pharmacotherapy. 2005 Nov;39(11):1798-807.
