Medication is just part of the management of these illnesses. Other therapies are also helpful; you may wish to discuss these with your prescriber.

Know Your Medicines Duloxetine The purpose of this leaflet is to give you some general information on duloxetine, and is intended as a guide only. This should be read in conjunction with the official patient information leaflet, supplied with the medication. You may find out more information from other sources. Remember some sources of information are more accurate than others. Your healthcare professional maybe able to point you in the right direction or give you further information Why have I been prescribed duloxetine? Duloxetine is licensed to treat moderate to severe major depressive disorder and generalised anxiety disorder. You may wish to discuss this with your prescriber who will be able to give you more information Medication is just part of the management of these illnesses. Other therapies are also helpful; you may wish to discuss these with your prescriber. What exactly is duloxetine? Duloxetine is an antidepressant. It is not a tranquilliser or sleeping tablet. It comes as 30mg and 60mg capsules. Is duloxetine safe to take? It is usually safe to take as prescribed by your health professional, but like many medicines will not suit everyone. Let your prescriber know beforehand if any of the following apply to you: If you are taking other medication; this includes prescribed medication or any medicines you have bought over the counter from a pharmacy including any herbal remedies. Have severe kidney disease Uncontrolled blood pressure History of fits, liver s or eye s such as glaucoma. History of bleeding disorders (tendency to bruise easily) If you are pregnant, breast feeding, or wishing to become pregnant. Under 18 years of age Used with caution in patients with history of mania What is the usual dose of duloxetine? The normal dose of duloxetine is 60mg, taken once daily, up to a maximum of 120mg once daily. 1

How should I take my duloxetine? Follow the directions on the label. If you have any questions ask your pharmacist, nurse or prescriber. You should also read the information leaflet supplied with the medication. What should I do if I miss a dose? If you miss a dose and it is within a few hours of the normal time, continue to take it as normal. If it is longer, miss the dose and continue as normal when the next dose is due. Never double up on the dose. When I feel better, can I stop taking duloxetine? No, if you stop your duloxetine too early, your symptoms may return. To reduce the chances of this happening, it is advised you should continue to take it for at least 6 months after you become well and sometimes longer. You should discuss this with your prescriber. You should not stop taking duloxetine suddenly as it may cause some unpleasant withdrawal effects see next section. Is duloxetine addictive? Duloxetine is not addictive but it can cause withdrawal or discontinuation effects if stopped suddenly, or rarely if a few dose are missed. These effects can include anxiety, dizziness, feeling sick and s sleeping. Other people describe feeling confused or out of sorts. Generally these symptoms are self-limiting and resolve within 2 weeks, though in some individuals they maybe prolonged (2-3 months or more). To help reduce the chance of this happening, the duloxetine should be slowly stopped over a period of weeks. You may wish to speak to your prescriber, pharmacist or nurse about this. What will happen to me when I start taking duloxetine? All antidepressants work slowly. Although some people notice a change in the first week, normally it will take several weeks for the duloxetine to have its full effect. It is important to continue to take the medication, as long as you are able to tolerate it, for long enough so that its full effects can be seen, generally 2-4 weeks for depression. As with all antidepressants, careful observations need to be made in the first few weeks of treatment to look for any increase in suicidal thoughts which may occur As with all medication, duloxetine does have side effects. You may well experience these before you start feeling the benefits. Most side effects are short lived and will pass with time. The following table contains some of the more common and more important side effects of duloxetine and what to do about them. It is not a complete list and not everyone will get all of those listed. Ask your pharmacist, nurse or prescriber if you are worried about anything else you notice that you think might be a side effect. Side Effect What is it? What should I do if it happens to me? Very Common (greater than 1 in 10 people) Feeling sick Nausea No saliva, dry mouth Dry mouth Pounding head Headache Feeling drowsy Somnolence 2

Common (between 1 in 10 and 1 in 100 people) Feeling nervous or on edge Anxiety/Agitation Feeling bunged up inside. You can t pass a motion or stool, excess wind Constipation, flatulence Eat more fibre in your diet, such as fruit. Exercise will help. Make sure you drink plenty of fluid. If it becomes a speak to your prescriber Loose stools, the runs Diarrhoea This should pass with time; if it is severe or. Problems sleeping Insomnia This should pass with time; if it is severe or. Reduced sex drive, s achieving orgasm Reduced libido, impotence Feeling light headed Dizziness This should wear off with time. If it is bad, contact your prescriber. Yawning Lacking energy Lethargy Avoid using machinery or driving, discuss this with your prescriber, it will normally be temporary Feeling less hungry than normal, not wanting to eat, losing weight Reduced appetite Being sick Vomiting Stomach upset Dyspepsia, abdominal pain Strange dreams or nightmares Fluttering heart beat Palpitations Discuss this with your prescriber Sweating more than normal, especially at night Sweating If it is bad, speak to your prescriber Pins and needles Paraesthesia Blurred vision Blurred Vision Speak to your prescriber, it does not mean you will need to wear glasses. Make sure you tell your optician if you normally do wear glasses. General muscle aches or tightness Sudden feeling of being hot or flushed Hot flush Uncommon (between 1 in 100 and 1 in 1,000 people) Altered taste Dysgeusia Feeling disorientated or s concentrating 3

Raised blood pressure Hypertension Normally only seen on higher doses (above 200mg). Your prescriber will check your blood pressure and pulse throughout treatment A low blood pressure, particularly on standing Hypotension Try not to stand or get up suddenly. If you feel dizzy do not drive, speak to your prescriber about this Blotches on your skin and or itching Rash or Urticaria Stop taking your duloxetine straight way, and contact your prescriber now. Feeling shaky Tremor / vertigo Contact your prescriber now Lost voice, sore throat Laryngitis Grinding teeth Bruxism Jerky or movement disorders Myoclonus, dyskinesia Stomach discomfort, wind Stomatitis, Gastroenteritis Feeling disorientated, s concentrating Problems sleeping Insomnia Lacking energy or drive Apathy and malaise Feeling hot or cold Temperature deregulation Feeling thirsty Discuss this with your prescriber Problems focusing Mydriasis Discuss this with your prescriber Feeling dizzy on Orthostatic hypotension Discuss this with your prescriber standing or fainting Changes in blood pressure Can go up or down Your prescriber will check your blood pressure periodically Problems passing water Contact your prescriber straightaway (easier or harder) Changes in liver function Hepatitis Your prescriber will occasionally carry out blood tests Racing heart beat Tachycardia Contact your prescriber straightaway Skin reaction in sunlight Photosensitivity reactions If affected avoid strong sunlight and use a suitable sunblock Rare (between 1 in 1,000 and 1 in 10,000 people) Changes in thyroid function feeling cold or lacking energy Hypothyroidism Your prescriber will occasionally carry out blood tests Dehydration Discuss this with your prescriber Sudden changes in Mania Contact your prescriber straightaway mood, becoming elated Bad Breath Halitosis Discuss this with your prescriber Pain in eyes Glaucoma Contact your prescriber straightaway 4

Duloxetine can also occasionally cause changes in sodium levels. These will be checked periodically by your prescriber and will be discussed with you if there are any s. Duloxetine is occasionally associated with allergic or anaphylactic reactions, severe restlessness, fits, heart arrhythmias, and severe blood pressure changes, liver failure (rare), swelling around the face, accompanied by itching, blisters on the skin (rare). It is unclear exactly how common these s are, although they are infrequent. What about alcohol? Ideally do not drink alcohol when taking this medication. This is because taking them together can make you more drowsy, sometimes severely. There is no safe drink and drive limit when taking this medication. Once people have been taking this medication for some time, they may be able to take small amounts of alcohol. Try a small amount in a safe environment and see how you feel. Ideally get someone else to tell you. Duloxetine stays in the body a long time, so there is no point missing a tablet to have a drink. Pharmacy Team RDASH October 2011 If you want further information please ring: Pharmacy Services: 01302 798307 Name: No.. Version: 2 / Review date: October 2014 5