Duloxetine is an antidepressant of the serotonin-norepinephrine reuptake inhibitor class. It is effective in treating symptoms of depression, including physical pain associated with depression; other uses include therapy of neuropathic pain, fibromyalgia, and urinary stress incontinence. Duloxetine also inhibits serotonin uptake in human platelets, and may be associated with potentiation of bleeding.
Duloxetine undergoes extensive hepatic biotransformation to numerous inactive metabolites. The drug is metabolized by CYP1A2 and CYP2D6, with moderate potential for drug interactions (duloxetine is both a substrate and a moderate inhibitor of CYP2D6). The mean elimination half-life is 12.5 hours with steady-state concentrations occurring in about 3 days. Specimens for therapeutic monitoring should be drawn immediately before the next scheduled dose (ie, trough).
Duloxetine is not recommended for patients with hepatic impairment, substantial alcohol use, or chronic liver disease. Use in patients with renal disease significantly increases exposure to duloxetine due to decreased elimination. Patients with mild-to-moderate renal dysfunction should be monitored closely; use of duloxetine is not recommended in end-stage renal disease.
Monitoring serum concentration during therapy
Evaluating potential toxicity
The test may also be useful to evaluate patient compliance
Therapeutic ranges are not well-established, but literature suggests that patients receiving duloxetine monotherapy for depression responded well when trough concentrations were 60 to 120 ng/mL. Higher levels may be tolerated by individual patients. The therapeutic relevance of this concentration range to other uses of duloxetine therapy is currently unknown.
This test cannot be performed on whole blood. Serum must be separated from cells within 2 hours of draw. Specimens that are obtained from gel tubes are not acceptable.
Clinical References Provides recommendations for further in-depth reading of a clinical nature
1. Westanmo AD, Gayken J, Haight R: Duloxetine: a balanced and selective norepinephrine- and serotonin-reuptake inhibitor. Am J Health-Syst Pharm 2005;62:2481-2490
2. Waldschmitt C, Vogel F, Pfuhlmann B, Hiemke C: Duloxetine serum concentrations and clinical effects. Data from a therapeutic drug monitoring (TDM) survey. Pharmacopsychiatry 2009;42:189-193