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Incontinence - urinary, in women - Management
What monitoring is required for duloxetine?

  • In people with hypertension or other cardiac disease and those whose condition could be affected by an increase in blood pressure (BP), monitor BP before starting treatment and regularly throughout treatment, especially during the first month.
    • If a sustained increase in BP occurs, consider either a dose reduction or a gradual discontinuation of duloxetine.
  • In people taking warfarin, monitor the international normalized ratio (INR) when duloxetine is started or stopped, or after an increase in dose.
Basis for recommendation
  • Duloxetine has been associated with an increase in blood pressure and clinically significant hypertension in some people. This may be due to the noradrenergic effect of duloxetine. Cases of hypertensive crisis have been reported with duloxetine, especially in people with pre-existing hypertension [Micromedex, 2009].
    • For people who experience a sustained increase in blood pressure while receiving duloxetine, the manufacturer recommends that either a dose reduction or a gradual discontinuation should be considered [ABPI Medicines Compendium, 2008a].
  • Increases in the international normalized ratio (INR) have been reported when duloxetine was co-administered with warfarin [ABPI Medicines Compendium, 2008a]. It would therefore seem prudent to monitor the INR in anyone taking warfarin concomitantly with duloxetine.

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