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Incontinence - urinary, in women - Management
What are the key drug interactions with duloxetine?

  • Concurrent use of duloxetine with a monoamine oxidase inhibitor or a reversible inhibitor of monoamine oxidase type A is contraindicated.
  • Combination with a CYP1A2 inhibitor (such as fluvoxamine or ciprofloxacin) is also contraindicated.
  • Concurrent use of duloxetine with other serotonergic drugs is not recommended.
Clarification / Additional information
  • Duloxetine should not be started for 2 weeks after a monoamine oxidase inhibitor (MAOI) has been stopped, or for 24 hours after a reversible inhibitor of monoamine oxidase type A (RIMA [i.e. moclobemide]) has been stopped.
  • An MAOI or RIMA should not be started for at least 1 week after duloxetine has been stopped.

[Taylor et al, 2007]

Basis for recommendation
  • Concurrent use of duloxetine with monoamine oxidase inhibitors and reversible inhibitors of monoamine oxidase type A can cause very toxic and sometimes fatal reactions similar to serotonin syndrome [Baxter, 2008].
  • Concurrent use of duloxetine with selective serotonin reuptake inhibitors, tricyclic antidepressants, St John's wort, venlafaxine, triptans, tramadol, pethidine, and tryptophan can rarely cause serotonin syndrome [Baxter, 2008].
  • Combination with a CYP1A2 inhibitor (such as fluvoxamine or ciprofloxacin) is not recommended by the manufacturer of duloxetine because this results in elevated plasma concentration of duloxetine [ABPI Medicines Compendium, 2008a].

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