Cymbalta

NURS 2516 Clinical Medications Worksheets (You will need to make additional copies of these forms) Generic Name Trade Name Duloxetine Cymbalta Peak 6 hr

Onset unknown

Classification Dose Route Time/frequency Antidepressants 20mg PO 0900 daily (SSNRIs) Duration For IV meds, compatibility with IV drips and /or solutions 12 hr N/A

Mechanism of action and indications (Why med ordered) Inhibits serotonin and norepinephrine reuptake in the CNS. Both antidepressant and pain inhibition are centrally mediated. Depression, pain.

Nursing Implications (what to focus on) Contraindications/warnings/interactions Hypersensitivity. Use cautiously in: History of suicide attempt or ideation; History of mania (may activate mania/hypermania); Concurrent use of other centrally-acting drugs (increased risk of adverse reactions); History of seizure disorder. Pedi: May increase risk of suicide attempt/ideation especially during dose early treatment or dose adjustment; risk may be greater in children and adolescents (safe use in children and adolescents not established). Increased risk of hepatotoxicity with alcohol use. Common side effects SEIZURES, fatigue, drowsiness, insomnia, decreased appetite, constipation, dry mouth, nausea, dysuria, increased sweating

Interactions with other patient drugs, OTC or herbal medicines (ask patient specifically) none

Nursing Process- Assessment (Pre-administration assessment) Monitor blood pressure before and periodically during therapy. Monitor appetite and nutritional intake. Assess mental status and mood. Assess suicidal tendencies. Assesspain intensity, quality, and location.

Lab value alterations caused by medicine May increase ALT, AST, bilirubin, CPK, and alkaline phosphatase. Be sure to teach the patient the following about this medication Instruct pt. to take as directed at the same time each day. Take missed doses as soon as possible unless time for next dose. Do not stop abruptly; must be decreased gradually. Encourage pt. and family to be alert for emergence of anxiety, agitation, panic attacks, insomnia, irritability, hostility, impulsivity, akathisia, hypomania, mania, worsening of depression and suicidal idealation, especially during early antidepressant therapy. If these symptoms, notify health care professional. May cause drowsiness. Caution pt. to avoid driving or other activities requiring alertness until response to medication is known. Advise pt to consult health care professional prior to taking any Rx, OTC, or herbal products. Instruct p. to notify healthcare professional if signs of liver damage (pruritus, dark uring, jaundice, right upper quadrant tenderness, unexplained “flulike symptoms) occur. Advise pt. to avoid taking alcohol during duloxetine therapy. Instruct pt. to notify health care professional if pregnancy is suspected.

Assessment Why would you hold or not give this med? Sustained hypertention, occurrence of severe side effects.

Evaluation Check after giving Increased sense of well-being, renewed interest in surroundings. Need for therapy should be periodically reassessed. Pts. May notice improvement within -4 wks, but should be advised to continue therapy as directed. Therapy is usually continued for several months.

Dose Range: no pediatric range available because safe use in children/adolescents is not established. Adult dose range for antidepressant use is 20-30 mg twice daily and for neuropathic pain is 60 mg once daily.