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Continue 910 0 obj>>stream warning, see fetal/neonatal mortality and mortality. ACE inhibitors also prevent the breakdown of surkinin and other vasodilator prostaglandins. BT-Davis' drug guide monitors your blood pressure if a combination is needed. 000002156 000000 n 000000170000 000000n% EOF 000000101000 000001000 000001000 0000000000 Find information about 01000 00000000000000000000000000000000000000000000000000000000 00000000 n (Geodon) including dosage, side effects, Interaction, Nursing means, mechanisms of action, Half, more administration, more. The handbook covers dosages, side effects, interactions, and use. UR - agency 0000007621 00000n ZESTRIL (Lysinovil) ZESTRIL (Risinofil) when used for pregnancy during the second and third trimesters of pregnancy, ACE inhibitors can cause injury and even death to the developed fetus. This site uses cookies to provide, maintain and improve the experience. Name /bks_53161_deglins_md_disk/duloxetine 02/25/2014 09:41AM plate #0-composite pg #1 #1 PDF page #1 Canadian drug name. 000009193 000000 n ER - Notice your doctor immediately of these signs. Periodically assess blood pressure and compare it to normal values (assessment of signs and symptoms of CHF (shortness of breath, rales/stiffness, peripheral edema, jugular hypertrophy, exercise intolerance) helps to document whether medication is effective in reducing these symptoms. Sanowski CA, Valeland AH. See the latest official manual style if you have questions about type accuracy. Pharmacology: Angiotensin conversion enzyme (ACE) inhibitors alone or with other agents in the management of hypertension. Half-life, management, and more. In severe cases, please notify your doctor, as it can lead to life-threatening arrhythmias and paralysis. Implement aerobic exercise and cardio conditioning programs to enhance medication and maintain or improve cardiovascular pump function. Heart attack patients or MI. 000001725 00000 n 0000002425 00000225 00000n Dry, be careful during aerobic exercise and endurance conditioning to recover from a irritating cough. Watch for signs of angioedema, including 00000006469 00000 n rash, red or white skin (Weltz), burning/itching skin, swelling on the face and shortness of breath. Sibalda (or general equivalent, Capsule:... Risinovil: (usually) orthogonal and fainting have been reported during duloxetin administration. 00000016850 00000 n Sacubitril and Valsartan (ENTRESTO) Drug Papers 2015 Updated version may be found in www.pbm.va.gov or PBM INTRAnet 2 box warning to stop sacubitil/valsartan as soon as pregnancy is detected, due to risk of fetal injury and death. DB - Emergency Central Duroxetin [Internet]. Enter the tag name separated by the space and enter the hitEmergency Central is a collection of test information, including disease, drug and five-minute emergency medical consultation, diagnostic ® of Davis's drug, McGraw Hill Medical, pocket guide for diagnostic testing, and MEDLINE journal created for emergency professionals. Includes apps for iPhone, iPad, and Android smartphones + tablets. Haloperdolin is the subject of Davis's drug guide. Sign in or purchase a subscription to view the full topic. 0000013443 00000 n Davis drug guide for rehabilitation specialists .com/content.aspx?bookid=1873§ionid=139016332 . 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Davis's Drug Guide, 16 Th Ed, F.A. Davis Company, 2020. Davis's Drug Guide - Long-Use 2.0, www.drugguide.com/ddo/view/Davis-Drug-Guide/51844/all/DULoxetine. Curing C, Sanoski CA, Ballayland AH. Duroxetin. Davis's drug guide. F.A. Davis Company; 2020. . October 25, 2020.Quigging, C., Sanowski, C. A., and Valeland, A. H. (2020). Duroxetin. In Davis's Drug Guide (16th Edition). F.A. Davis Company. Numbered in C at Sanowski CA, Valais AH, October 25, 2020. Durokcetin [Internet]. In: Davis's Drug Guide. F.A. Davis Company; 2020. [Citation 2020 October 25]. Available in: AMA quoted article title must be in sentenceMLAAMAAPAVANCOUVERTY - ELEC T1 - Duroxetin ID - 51844 A1 - Quiring, Courtney, AU - Sanowski, Cynthia A, AU - Valeland, April Hazard, BT - Davis' Drug Guide UR - PB - F.A. Davis Company ET - 16 DB - Davis's Drug Guide - OLD - USE 2.0 DP - Medically reviewed by .com. Updated August 9, 2020. Pronunciation (doo LOX e teen) index terms (+) --(S) -N-methyl-γ-(1-naphtiloxi) -2-thiophenenepropylamine hydrochloride hydrochloride 248686 administration form when provided for titration information (especially limited) for specific product labeling. Capsule delay-release particles, oral: Simbalta: 20 mg, 30 mg, 60 mg [fd&c blue #2 included (indigo tin)] General: 20 mg, 30 mg, 40 mg, 60 mg capsule delay release sprinkle, oral: Drizalma sprinkle: 20 mg [including gorgeous blue fcf (fd&c blue #1), fd&c #40 red fd&c yellow #10 (qui Nolin yellow)]] Dridalma Sprinkle: 30 mg [gorgeous blue fcf (including fd&c blue #1), fd&c red #40]Drizalma Sprinkle: sprinkled with 40 mgDrizalma: 60 mgDrizriz Sprinkle alma: 60 mgDrizalma Sprinkle: 60 mg [gorgeous blue fcF (including fd&c blue #1), fd&c red #40, fd&c yellow #10 (quinoline)] Name: U.S. Symbaldrdalroot Pharmacological Category Antidepressant, /Norepinepine Reuptake Inhibitor Pharmacology Duloxethin is a weak inhibitor of serotonin and jaupup and reupt. Duloxetine does not have significant activity on muscarine, H1-, or alpha 2-adraner-type receptors. Duloxetine does not possess MAO inhibitory activity. Absorption is well absorbed. Food does not affect Cmax, but it reduces AUC by 10%. Distribution Vd: children ≥7 years and adolescents: 1,200 L (Robo 2014) adults: ~ 1,640 L metabolic liver, through CYP1A2 and CYP2D6; Multiple metabolites (inactive) urine (~70%; >lt;1% of= total= dose= as= unchanged= drug;= feces= (~20%) = onset= of action= onset= of action=anxiety= disorders= (generalized= anxiety= disorder=initial= effects=may= be= observed= within= 2= Weeks= of= treatment,= with= continued= improvements= through= 4= to= 6= weeks= (wfsbp= [bandelow= 2012];= some= experts= suggest= up= to = 12= of weeks= treatment= may= be= necessary= necessary= for response= (bap= [baldwin= 2014]; man= 2014;= wfsbp= [bandelow= 2012].depression:= initial= effects= may= be= observed= within= 1= to= 2= weeks= of treatment, = with continued= improvements= through= 4= to= 6 weeks = (papakostas= 2006;= posternak= 2006 05;= szegedi= 2009).=time= peak = peak = 5= to= 6= hours;= food = delays= by= by= 1.7= to= 4= hours.= half-life= elimination = children = ≥7= years= and= adolescents= 10.4= hours = (lobo= 2014).adults := ~12 = hours = (range:= 8= to 22= hours;= 4= hours= longer= in= elderly= women.= protein = binding = >90%, mainly the protein specific population per pillamine and alpha 1 acid: renal dysfunction Cmax and AUC were ~100% greater in ESRD patients receiving intermittent hemodialysis. Special population: Six patients with cirrhosis and interceantis disorder had five times higher exposure (AUC) and three times longer half-life (Suri 2005) compared to patients with normal liver function. Special population: Elderly AUC was ~25% higher in elderly women. Special Population Note Tobacco Smoking: Duloxetine is reduced by ~33% in smokers. Use: Marked marked marked (delayed release particle capsules only): adults and pediatric patients≥13 years old. generalized anxiety disorders: treatment of generalized anxiety disorders in adults and pediatric patients ≥7 years old. Musculoskeletal pain, chronic: management of chronic musculoskeletal pain, including osteoarthritis of the knee and lower back pain in adults. Neuropathy pain associated with diabetes: pain management associated with diabetic peripheral neuropathy in adults. Off-label use chemotherapy-induced peripheral neuropathy data in randomized, double-blind, supported the use of placebo-controlled studies </1%>Treatment of pain, numbness and tingling associated with peripheral neuropathy caused by chemotherapy. Subgroup analysis suggests that the efficacy for oxaliplatin-induced neuropathy as opposed to pack-clicitaxel-induced neuropathy may be greater [Smith 2013]. Duloxetine for the prevention and management of peripheral neuropathy caused by chemotherapy in adult cancer survivors according to U.S. Clinical Oncology Clinical Practice Guidelines is proposed in the management of peripheral neuropathy due to chemotherapy. Data from a single blind randomized study of stress urinary incontinence (men) and data from 2 small open-label studies support the use of lessoxetine in the treatment of post-stress incontinence in patients who do not respond to non-pharmacological interventions [Filocamo 2007], [Fink 2008], [Schlenker 2008]. In men with stress urinary incontinence in accordance with European urologist guidelines for the evaluation and non-surgical management of incontinence, it is recommended to hasten the recovery of incontinence after the prostate, combined with a solely or conservative treatment. Stress pee incontinicate (female) low quality, data from controlled tests of systematic review and meta-analysis conflict. [Lee 2013], [Schagen van Leeuwen 2008], [Shamliyan 2012] American College of Physicians (ACP) guidelines for non-surgical management of incontinence recommended for pharmacoplastic therapy treatment in stress urinary incontinence women and less quality, a placebo- controlled study of duloxetine has proven beneficial effects, but it is not confirmed that these data from these quality quality is high. According to evidence-based guidelines for managing incontinence and pelvic organ prolapse in women at the National Institute of Health and Medical Excellence (NICE), duloxein should not be considered a primary treatment for women with stress urinary incontinence and should not be routinely used as a second treatment for women with stressful urinary incontinence. However, duloxetine can be considered a second-line treatment for women who refuse surgical treatment or are not suitable for surgical treatment. Contraindications are the use of monoamine oxidizers (MAO) inhibitors for the treatment of mental disorders (at the same time or within 14 days to stop MAO inhibitors); Initiation of MAO inhibitors to treat mental illness within 5 days of discontinuing DULoxetine; Initiation of duloxetine in patients receiving reinsolide or intravenous methylene blue. Canadian labeling: additional contraindications (not U.S. labeling): irritability for all components of duloxetin or formulation; Liver disorders; Severe renal failure (e.g., CrCl & lt;30 mL /min) or end-stage kidney disease (ESRD); Uncontrolled narrow angle glaucoma; Concomitant use Or a powerful CYP1A2 inhibitor. Dosing: Adult chemotherapy-induced peripheral neuropathy (off-label use): Oral: 30 mg daily 1 week, then 60 mg once daily (Smith 2013). Advocate (delayed release particle capsules only): Oral: Early: 30 mg daily for one week, then increase disallowed 60 mg daily. Alternatively, slow titration has been rated:20 mg once daily, then increased by 20 mg every week by 60 mg daily as tolerated (Murakami 2017). Maximum dosage: 60 mg/day; Dosages up to 120 mg/day were studied in clinical trials but did not grant any additional benefits. Generalized anxiety disorder: oral: early: 60 mg once daily; For some patients, it may be desirable to start at 30 mg daily for one week before increasing to about 60 mg daily. Maintenance: 60 mg once daily. Although dosages >60 mg/day did not give additional benefits to clinical trials, some experts rated 60 mg/day considering it reasonable to escalate the dosage to individuals who do not respond satisfactorily to (Bystritsky 2018; Simon 2010). When the dosage is escalated, an increase of 30 mg at intervals of ≥1 weeks is allowed as needed (Bystritsky 2018). Max: 120 mg/day. major depressive disorder (unipolar): Oral: early: 40 days to 60 split twice daily or given with a single daily dose. For some patients, it may be desirable to start at 30 mg daily for one week before increasing to about 60 mg daily. Maintenance: 60 mg once daily. Dosages >60 mg/day did not confer additional benefits in clinical trials, according to limited data, individual patients may benefit from dosage escalation (Nelson 2018; Shelton 2007). When the dosage is escalated, increase 30 mg increments of ≥1 weeks as needed (Nelson 2018). Max: 120 mg/day. musculoskeletal pain, chronic: back and non-radiicular neck pain, chronic (alternative agent): Note: Subs for patients with improper responseto non-pharmacology and NSAID treatment (ACP [Qaseem 2017]; Chul 2018; Isaac 2019). Oral: initial: 30 mg once daily to receive 2 weeks, then increase to 60 mg daily as allowed; Maximum dosage: 60 mg/day (Isaac 2019; manufacturer's label). Osteoarthritis of the knee (alternative agent): Note: Contraindications in patients with moderate to severe symptoms and elixir interventions and inappropriate reactions to oral NSAIDs or oral NSAIDs (Deveza 2018; OARSI [McAlindon 2014]. Oral: Initial: 30 mg once daily for 1 week, then 60 mg once daily. Maximum dosage (manufacturer's label): 60 mg/day. maximum dose 120 mg/day can provide some additional benefits (Chappell 2009); However, side effects may be increased (Micca 2013). Neuropathy pain associated with diabetes: oral: early: 60 mg once daily; Lower initial doses may be considered in patients when tolerance is an issue; Maximum dosage: 60 mg/day; Maximum dose 120 mg/day Studied in clinical trials but did not grant additional benefits (Ormseth 2011). Stress urinary incontinence (women and men) (off-label use): Note: Patients with non-kinetic interventionoric interventionoric depression or comorbid depression (ACP [Qaseem 2014]; EAU [Buckhart 2018]; NICE 2013). Oral: 40 mg twice daily (Filocamo 2007; Lee 2013). Low initial doses have been used in women to reduce adverse effects: 20 mg daily for two weeks and then 40 mg twice daily (Castro-Diaz 2007; Schagen van Liuwen 2008). Discontinued treatment: > When discontinuing antidepressant therapy that lasts for 3 weeks, gradually taper the dose (e.g., 2-4 weeks or more) to minimize withdrawal symptoms and detect recurrence symptoms (APA 2010; WFSBP [Bauer 2015]. The reason for slow taper (e.g., more than 4 weeks) includes the use of the drug with a half-life;lt;24 hours= (eg,= paroxetine,= venlafaxine),= prior= history= of antidepressant= withdrawal= symptoms,= high= doses= antidepressant= antidepressant= (apa= 2010;= withdrawal= withdrawal= withdrawalr= previously= prescribed= and/or= dose= dose= at= a= more= gradual= rate= (shelton= 2001).= select= patients= (eg,= those= with= with= history= of discontinuation= syndrome)= on= long-term= treatment= (=gt;6 months >) you can benefit from taper over 3 months (WFBPS20). Evidence supporting the ideal taper charge is limited (Shelton 2001; WFSBP [Bauer 2015]. Antidepressant Transition: Evidence of the ideal antidepressant switching strategy is limited. The strategy is cross-titration (gradually increasing new and at the same time discontinuing the first antidepressant at the same time) and direct switch (suddenly stop the first antidepressant and start new antidepressants at equal or low doses and gradually increase). Cross titration (for example, depending on the sensitivity to discontinued symptoms and side effects over 1-4 weeks) is standard for most switches, but contraindications when switching from MAOI. The direct switch is <1 week, or when the discontinuation is for adverse effects. When choosing the switch strategy, consider the risk of discontinuation symptoms, potential for drug interactions, other antidepressant properties (eg, half-life, effects adverse, and ), and the degree of symptom control desired (Hirsch 2018; Ogle 2013; WFSBP [Bauer 2013]. Switching to or from an MAOI:Allow 14 days to elapse between discontinuing an MAOI and initiation of duloxetine. Allow ≥5 days to elapse between discontinuing duloxetine and initiation of an MAOI according to manufacturer labeling; However, some experts recommend a 14-day washout period (APA 2010). Adjustment week, = or = when= the = discontinuation = for= adverse= adverse= effects.= when= choosing= switch= strategy,= consider= the= risk= of discontinuation= symptoms, = potential= for= drug= interactions, other= antidepressant= properties= (eg,= = Half-life,= adverse= effects,= and = = and = pharmacodynamics),= and= degree= of symptom= control= desired= (hirsch= 2018;= ogle= 2013;= wfsbp= [bauer= 2013]).switching= to= or= from = an= maoi:allow= 14= days= to elapse= between = discontinuing= an= maoi= and= initiation= of = duloxetine.allow= ≥5= days= to= elapse= between = discontinuing = duloxetine = and= initiation = of of = an= an= Maoi= according= to= manufacturer= labeling;= however, = some= experts= recommend= a= 14-day= washout= period= (apa= 2010).dosage= adjustment=>-lt;/1 week, or when the discontinuation is for adverse effects. When choosing the switch strategy, consider the risk of discontinuation potential for drug interactions, other antidepressant properties (eg, half-life, adverse effects, and pharmacodynamics), and the degree of symptom control desired (Hirsch 2018; Ogle 2013; WFSBP [Bauer 2013]. Switching to or from an MAOI:Allow 14 days to elapse between discontinuing an MAOI and initiation of duloxetine. Allow ≥5 days to elapse between discontinuing duloxetine and initiation of an MAOI according to manufacturer labeling; However, some experts recommend a 14-day washout period (APA 2010). Adjustment > When discontinued antidepressants are used, it may be an appropriate approach when switching from the same or similar class (for example, when switching between two SSRIs) to another agent.>24> Concomitant treatment: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. For more information, see the Drug Interactions database. Dosing: Elderly Generalized Anxiety Disorder: Oral: Early: 30 mg once daily; After 2 weeks, it can increase to 60 mg once daily; Titrate dosage >60 mg once daily in cremants of 30 mg once daily; Maximum dosage: 120 mg/day. major depressive disorder (unipolar): According to pharmacokinetic studies, manufacturers suggest that label dosage adjustments are not required; However, low initial starting doses (e.g., 20 mg/day) and low maintenance doses (e.g., 30 to 60 mg/day) have been recommended by some specialists for elderly patients with comorbid conditions (Kennedy 2005). See Adult Dozing. Other signs: See Adult Toring. Discontinued treatment: See adult dose. Antidepressant conversion: See Adult Dose. Dosing: Pediatric notes: Duloxetine is available in two capsule formulations: a delayed release particle capsule (e.g., Drizalma Sprinkle) for swallowing the entire and delayed release sprinkle capsules (e.g., dridalma sprinkle) will be opened. Both have similar dosings. Approved indications for formulations in pediatric patients may vary (see use). Advocate, adolescents: adolescents ≥13 years: oral: delayed release particle capsules (e.g., Cymbalta): initial: 30 mg daily; After one week, you can increase to 60 mg once daily depending on your content and response. In a multi-center double-blind placebo-controlled trial (n= 91 duloxetine, n=93 placebo, 13-week duration) and then open-label expansion phase (n=106, 26 weeks period), the end point of the change in the 24-hour average pain severity score (brief pain stock [BPI]) to the end of the blind phase of the test (13 weeks) compared to statistically significantly different duloxetine patients. However, much more douloccet treated patients experienced ≥30% and ≥50% reduction in pain severity (measured by BPI) (Upadhyaya 2019). Generalized anxiety disorder (GAD): children ≥7 years adolescent ≤17 years: oral: delayed release particles and root capsules (e.g., Symbalta, dridalma root): early: 30 mg once daily; After 2 weeks, the response and tolerance can increase depending on 60 mg once daily; Recommended daily dosage range: 30 days to 60 mg once daily; If additional dosage increases are necessary, an titration dosage in crescopy of 30 mg once daily; Maximum daily dose: 120 mg/day (straw 2015). Major Depressive Disorder (MDD): Limited Data Available, Unestablished Efficacy: Children ≥7 years In Adolescents ≤17 Years: Oral: Early: 30 Mg Daily; Responses and tolerance may increase by 30 mg/dose increases every two weeks; Maximum daily dose: 120 mg/day. 2 double-blind, placebo-controlled dosing according to study (n =800, age 7 to 17 years) duloxetine (n = 341) (n = 234) or placebo (n = 225) for the treatment of MDD; Treatment with duloxetine or fluoxetine in children depression rating scale revision (CDRS-R) did not show a better improvement than placebo in either trial; The test was carried out with a delayed emitted particle capsule formulation (Atkinson 2014;) at Emsley 2014. Discontinuation of treatment: Consider planning to discontinue antidepressants for low stress times, recognizing non-disease-related factors that may cause stress or anxiety and may be attributed incorrectly to antidepressant disruption (Hathaway 2018). When the antidepressant treatment is interrupted, gradually taper the dose to minimize the incidence of discontinued syndrome (withdrawal) and allow the detection of recurrent disease condition symptoms (e.g., recurrence). Evidence to support the ideal taper rate after disease exemption is limited. APA and NICE guidelines suggest taping therapy for at least a few weeks, taking into account the half-life of antidepressants. Shorter half-life and antidepressants may need to be tapered more conservatively. After long-term (years) antidepressant treatment, WFSBP guidelines recommend taping for more than four to six months, close monitoring for six months after discontinuation. If unbearable discontinuation symptoms occur due to decreased dose, consider resuming previously prescribed doses and/or reduce dosages at a more gradual rate (APA 2010; Bauer 2002; Penske 2009; Haddad 2001; NCCMH 2010; Schatzberg 2006; Shelton 2001; Warner 2006). Dosage adjustment for concomitant treatment: significant drug interactions exist, dosage/frequency adjustment or avoidance is required. For more information, see the Drug Interactions database. MAO inhibitor recommendations: or conversion into MAO inhibitors for the treatment of mental disorders: at least 14 days can elapse between the cessation of MAO inhibitors for the treatment of mental disorders and the onset of duloxetin. Allow at least 5 days to stop less oxetine and allow at least five days to elapse between the onset of MAO inhibitors for treating mental illness. Administrative Shoes: Care regardless of meals. Lots of capsules in its entirety; Do not crush or crush. Delayed release particle capsules: manufacturers do not recommend to open the capsule to facilitate administration, duloxetine is not to crush the pellets, so as not to damage the intestinal coating (Wells 2008) apple sauce or apple juice (not chocolate pudding) after spraying the capsule sprinkling it was found to be stable for up to 2 hours. Resistance studies of this administrative technology have not been conducted. Side effects have been reported to the FDA when patients open capsules, however, reports do not detail if pellets have been crushed (FDA 2007). Delayed release sprinkle capsules: capsules can be opened and contents are sprinkled. A small amount of apple sauce; Instruct the patient to swallow the drug/food mixture immediately after mixing. The contents of the capsule can also be added to the plastic catheter tip syringe with 50 mL of water and shaken for 10 seconds before administration through 12 French or larger nasal tubes. Storage storage of 20°C to 25°C (68°F to 77°F); Travel is allowed between 15°C and 30°C (59°F and 86°F). Drug interactions Abametapir: CYP1A2 may increase serum concentration seromyongos (inhibitors and high risk). Because to avoid the combination of labrutinip: it is can improve the antiplatelet effect of the formulation with antiplatelet properties. When monitoring the therapy agent with antiplatelet characteristics (e.g., P2Y12 inhibitors, NSAIDs, SSRIs, etc.) it is can improve the antiplatelet effect of other formulations with antiplatelet properties. Monitor Therapy Ajmaline: Can increase serum concentrations on CYP2D6 substrates (high risk with inhibitors). Monitor Therapy Ajmaline: CYP2D6 inhibitors (usually) may increase serum concentrations of Ajmaline. Monitor Therapeutic (Ethyl): May improve the adverse/toxic effects of serotonin/norepinephrine reuptake inhibitors. In particular, the risk of mental movement disorders may be improved. Alcohol (ethyl) may improve the liver toxic effects of serotonin/norepinephrine reuptake inhibitors. In particular, duloxetin and milnasifran. Care: Patients receiving serotonin/norepinephrine reuptake inhibitors (SNRIs) should be advised to avoid alcohol. Monitor the increasein psychomotor disorders and liver toxicity in patients who consume alcohol during treatment with SNRIs. Consider therapeutic modificationalmotriptan: may improve the vertical toner effect of the vertical toner (high risk). This may result in serotonin syndrome. Management: Monitoring for signs and symptoms of Serotonin syndrome/Serotonin toxicity (e.g., hyperreflexia, clononus, hyperthepsy, diaphoresis, tremor, autonomic instability, mental state changes) when combining these agents. Monitor therapyAlosetron: Can improve the vertical toner effect of vertical tonergies (high risk). This may result in serotonin syndrome. Management: Monitoring for signs and symptoms of Serotonin syndrome/Serotonin toxicity (e.g., hyperreflexia, clononus, hyperthepsy, diaphoresis, tremor, autonomic instability, mental state changes) when combining these agents. Monitor Therapy Alpha-/Beta-: Serotonin/Norepinephrine Reuptake Inhibitors Alpha/Beta-Agonist Tachycardia Can Improve Tachycardia Effects. Serotonin/Norepinephrine reuptake inhibitors may improve the vascular effects of alpha/beta-agonist. Management: If possible, avoid co-management of direct action alpha/beta and serotonin/norepinephrine reuptake inhibitors. When administered co-administered, monitor for increased sympathetic effects (e.g., increased blood pressure, chest pain, headaches). Treatment modification consideration Alpha2-agonist: Reuptake inhibitors may reduce the antihypertensive effects of Alpha2-Agonists. Exception: Afraclonidin. Monitor therapy : CYP2D6 inhibitors (usually) may increase the serum concentration of amphetamines. Management: Monitor for toxicity (including Serotonin Syndrome) when used with moderate CYP2D6 inhibitors. Start amphetamine treatment at lower doses, monitor frequently, and adjust the dosage as needed. If you develop hematonin syndrome, you can stop amphetamines [Amphetamines] and improve the vertical tonic effect (high risk) of seroroot preparations. This may result in serotonin syndrome. Management: Monitoring for signs and symptoms of Serotonin syndrome/serotonin toxicity (e.g., hyperreflexia, clononus, hyperfever, diarrhea, tremor, autonomic instability). Start amphetamines at lower doses, monitor frequently, and adjust the dosage as needed. Monitor therapeutic anticoagulants: agents with antiplatelet properties can improve the anticoagulant effect of anticoagulants. Exception: Bemiparin; Enoxaparin; Dumping. Monitor Therapeutic Antibodies (5HT3 Antagonists): Can improve the vertical toner effect of vertical toner preparations (high risk). This may result in serotonin syndrome. Management: Monitoring for signs and symptoms of Serotonin syndrome/Serotonin toxicity (e.g., hyperreflexia, clononus, hyperthepsy, diaphoresis, tremor, autonomic instability, mental state changes) when combining these agents. Exception: Ayloselon; On-stage setting theory; Ramos Tron. Monitor therapeutic : vertical toner (high risk) can improve the side effects / toxic effects of antipsychotics. In particular, certonate agents may also enhance parmine containment, possibly increasing the risk for neuroleptic malignancies. agents can improve the vertical toner effect of the certoner system (high risk). This may result in serotonin syndrome. Monitor therapyApixaban: Agents with anti-platelet properties can improve the adverse/toxic effects of Apixaban. Specifically, the risk for bleeding may be increased. Management: Carefully consider and closely monitor the risks and benefits of this combination. Monitor Therapy : CYP2D6 inhibitors (usually) may increase serum concentrations of ARIPiprazole. Management: Monitor for increased aripiprazole pharmacuriatulising effects. Aripiprazole dosage adjustments may or may not be required depending on the number of treatments, indications, or dosage forms. See the full interaction paper for specific recommendations. Monitor therapy : CYP2D6 inhibitors (usually) can increase the serum concentration of active metabolites of ARIPiprazole Lauroxil. Monitor Therapy: Serotonin/Norepinephrine Reuptake Inhibitors May Improve The Antiplatelet Effects of Aspirin. Monitor therapy atomozetin: CYP2D6 inhibitors (usually) may increase the serum concentration of atomozetin. Monitor Agents with antiplatelet properties can improve the anticoagulant effect of Bemiparin. Administration: Avoid the concomitant use of antiplatelets and bemiparin. If the accompanying use is unavoidable, closely monitor the signs and symptoms of bleeding. Therapeutic modifications are consideredblood pressure lowering agents: duLoxetine's hypotension effects may be improved. Monitor Therapy Brexanolone: Serotonin/Norepinephrine Reuptake Inhibitors may improve Brexanolone's CNS depression effects. Monitor Therapy : CYP2D6 inhibitors (usually) may increase serum concentrations of Brexpiprazole. Management: If brexpiprazole is used in conjunction with both moderate CYP2D6 inhibitors and strong and suitable CYP3A4 inhibitors, brexpiprazole dosage should be reduced to 25% of the normal dose when treating signs other than major depressive disorders. Monitor therapy broccoli: it is possible to reduce the serum concentration of the CYP1A2 substrate (high risk as a derivative). Monitor Therapy : May improve the adverse/toxic effects of serotonin/norepinephrine reuptake inhibitors. Avoid combinationSPIRone: Can improve the vertical toner effect of the vertical toner (high risk). This may result in serotonin syndrome. Management: Monitoring for signs and symptoms of Serotonin syndrome/Serotonin toxicity (e.g., hyperreflexia, clononus, hyperthepsy, diaphoresis, tremor, autonomic instability, mental state changes) when combining these agents. Monitor TherapeuticCannabis: It is possible to reduce serum concentration seromyoncitis of CYP1A2 substrate (inductor and high risk). Monitor therapy saklilol: CYP2D6 inhibitors (usually) may increase the serum concentration of the engraving roll. Monitor Therapy Cephalothin: Agents with antiplatelet properties may improve the adverse/toxic effects of cephalotin. Specifically, the risk for bleeding may be increased. Monitor therapy : CYP2D6 inhibitors (usually) can increase the serum concentration of clozapine. Monitor Therapy Cobicistat: CYP2D6 may increase serum concentration seromyoncing of substrates (with inhibitors and high risk). Monitor Therapy Codeine: CYP2D6 inhibitors (usually) can reduce the therapeutic effect of codeine. These CYP2D6 inhibitors can prevent the metabolic conversion of codeine to convert to active metabolites morphine. Monitor Therapy Colagenase (telegraph): Agents with antiplatelet properties can improve the side effects/toxic effects of colagenase (telegraph). In particular, it is may increase the risk of bruises and / or bleeding at the injection site. Monitor Therapy : Can improve the vertical toner effect of the vertical tonergik agent (high risk). This may result in serotonin syndrome. Management: Monitoring for signs and symptoms of Serotonin syndrome/Serotonin toxicity (e.g., hyperreflexia, clononus, hyperthepsy, diaphoresis, tremor, autonomic instability, mental state changes) when combining these agents. Monitor Treatment CYP1A2 Inducing Agent It is can reduce the serum concentration of duroxetine. Monitor treatment CYP1A2 inhibitors (usually): it is possible to increase the serum concentration of duroxetine. Monitor treatment CYP2D6 inhibitor (strong): It is possible to increase the serum concentration of duroxetine. Exception: fluoxetine; PARoxetine. Monitor Therapy Dabigatran Etexilate: Agents with antiplatelet properties can improve the anticoagulant effect of Dabitran Etexilate. Formulations with antiplatelet properties can increase the serum concentration of dabitran etexilate. This mechanism is specifically applied to clopidogrel. Management: carefully consider the risks and benefits of this combination and closely monitor; Canadian labels are recommended to avoid prasugrel or ticagrelor. Monitor treatment hyperlipidemia: May improve the effect of the vertical toner on the vertical tonergic formulation (high risk). This may result in serotonin syndrome. Management: Do not use agents (high risk) or within 7 days of cessation of blood tonerine agents. Daforkcetin labeling lists this combination as a taboo. Avoid combinations: Can improve the anticoagulation effect of agents with antiplatelet properties. Administration: The drugs listed as exceptions in this paper are further described in a separate drug interaction paper. Monitor Treatment Deoxycholic Acid: Agents with antiplatelet properties can improve the adverse/toxic effects of jailbreak colic acid. Specifically, the risk for bleeding or bruising in the area of treatment may be increased. Monitor Therapy Deutetrabenazine: CYP2D6 inhibitors (usually) can increase the concentration of serum of active metabolites of Deutetrabenazine. Monitor Therapy Dex Methylphenidate-Methylphenidate: May improve the vertical toner effect of the vertical tonergic formulation (high risk). This may result in serotonin syndrome. Management: Monitoring for signs and symptoms of Serotonin syndrome/Serotonin toxicity (e.g., hyperreflexia, clononus, hyperthepsy, diaphoresis, tremor, autonomic instability, mental state changes) when combining these agents. Monitor Therapy Dextrometor: Can improve the vertical toner effect of the vertical tonergy formulation (high risk). This may result in serotonin syndrome. Management: Monitoring for signs and symptoms of Serotonin syndrome/Serotonin toxicity (e.g., hyperreflexia, clononus, hyperthepsy, diaphoresis, tremor, autonomic instability, mental state changes) when combining these agents. Monitor therapy DOXOrubicin (conventional): CYP2D6 inhibitors (usually) may increase serum concentrations of DOXOrubicin (normally). Avoid combination edoxabane: Agents with antiplatelet properties can improve the adverse/toxic effects of edoxaban. In particular, the risk of bleeding may be increased. Monitor TreatmentEletriptan: Can improve the vertical toner effect of the vertical toner (high risk). This causes Serotonin Syndrome. Management: Monitoring for signs and symptoms of Serotonin syndrome/Serotonin toxicity (e.g., hyperreflexia, clononus, hyperthepsy, diaphoresis, tremor, autonomic instability, mental state changes) when combining these agents. Monitor therapy Eliglustart: CYP2D6 inhibitors (usually) may increase the serum concentration of the eliglustart. Care: The eliglustad dose is 84mg daily as a CYP2D6 inhibitor. It is also contraindicated (COI) when combined with powerful CYP3A4 inhibitors. Also when combined with the right CYP3A4 inhibitor, the use is COI from CYP2D6 EM or EM and should be avoided in CYP2D6 PM. Care: Stop antiplatelet enhancement before initiating enoxaparin as much as possible. If accompanying care is unavoidable, closely monitor the signs and symptoms of bleeding. Consider therapeutic modificationsErgot derivatives: May improve the effect of the vertical toner system (high risk). This may result in serotonin syndrome. Management: Monitoring for signs and symptoms of Serotonin syndrome/Serotonin toxicity (e.g., hyperreflexia, clononus, hyperthepsy, diaphoresis, tremor, autonomic instability, mental state changes) when combining these agents. Exceptions: Lisuride; The Nisgolin. Monitor Therapy Fat Emulsion (based on fish oil): Can improve the side effects/toxic effects of agents with antiplatelet properties. Monitor Treatment : Can improve the vertical toner effect of the vertical toner (high risk). This may result in serotonin syndrome. Monitor Therapy FentaNYL: May improve the vertical tonatitic effect of serotonin/norepinephrine reuptake inhibitors. This may result in serotonin syndrome. Management: Monitoring for signs and symptoms of Serotonin syndrome/Serotonin toxicity (e.g., hyperreflexia, clononus, hyperfever, diaphoresis, tremor, autonomic instability, mental state changes) when these agents are combined. Monitor Therapy Flecainide: CYP2D6 inhibitors (usually) can increase serum concentrations of fleas. Monitor Therapy FluvoxaMINE: Can improve the antiplatelet effect of DULoxetine flubosamine. Duroxcetin can improve the vertical toner effect of flubosamine. This may result in serotonin syndrome. Fluvoxamine can increase the serum concentration of duroxetine. Avoid combinationglucosamine: It can improve the antiplatelet effect of agents with antiplatelet properties. Monitor Therapy : CYP2D6 inhibitors (usually) may increase serum concentrations of haloperistone. Monitor Therapy Heparin: Agents with antiplatelet properties can improve the anticoagulation effect of heparin. Management: If joint management is required, reduce the capacity of heparin or agents with anti-hematopoietic properties. Consider therapeutic modificationsHerb (anticoagulant / antiplatelet properties) (e.g., alfalfa, Bilberry: Can improve the adverse/toxic effects of agents with antiplatelet properties. Bleeding may occur. Management: Avoid combinations whenever possible. When used, it is more closely monitored for evidence of bleeding. Two weeks before surgery, dental or invasive treatment, discontinue herbal products with anticoagulants or antiplatelet action. Consider therapeutic modificationIbritumomab Tiuxetan: Agents with anti-platelet properties can improve the adverse/toxic effects of Ibritusin Ab Tiuxetan. Both agents can contribute to an increased risk of damaged platelet function and bleeding. Monitor Therapy Ibrutinib: Can improve the adverse/toxic effects of agents with antiplatelet properties. Monitor Therapy : CYP2D6 inhibitors (usually) can reduce serum concentrations of peridone's active metabolites. Specifically, the concentration of metabolites P95 may be reduced. CYP2D6 inhibitors (usually) may increase the serum concentration of the active metabolites (s) of ilone peridone. Specifically, the concentration of metabolites P88 may be increased. CYP2D6 inhibitors (usually) may increase the serum concentration of the ilone peridone. Monitor therapy indoramon: CYP2D6 inhibitors (usually) may increase the serum concentration of indoracine. Monitor Therapy Innotogen: Can improve the antiplatelet effect of agents with antiplatelet properties. Monitor Therapy Iobenguane Radiopharmaceuticals: Serotonin/Norepinephrine Reuptake Inhibitors can reduce the therapeutic effects of Iobenguane radiation . Care: Stop all medications that may inhibit or interfere with the transport or intake of catecholamine for at least five biological half-life before administration of iovenguain. Do not administer these medications for at least 7 days after each iobenguane dosage. Combination pioflupan I 123: serotonin / norepinephrine reuptake inhibitors can reduce the diagnostic effect of Ioflupane I 123. Monitor therapyramidan: Can improve the vertical toner effect of the vertical tonergic formulation (high risk). This may result in serotonin syndrome. Management: Monitoring for signs and symptoms of Serotonin syndrome/Serotonin toxicity (e.g., hyperreflexia, clononus, hyperthepsy, diaphoresis, tremor, autonomic instability, mental state changes) when combining these agents. Monitor Therapy Levomethadone: Can improve the vertical toner effect of the vertical toner (high risk). This may result in serotonin syndrome. Management: Monitoring for signs and symptoms of Serotonin syndrome/Serotonin toxicity (e.g., hyperreflexia, clononus, hyperthepsy, diaphoresis, tremor, autonomic instability, mental state changes) when combining these agents. Monitor Therapy Limaprost: May improve the antiplatelet effect of agents with antiplatelet properties. Monitor Therapy Line Zolid: May improve the vertical tonic effect of serotonin/norepinephrine reuptake inhibitors. This may result in serotonin. By avoiding combinations, (withdrawn from the U.S. market): can improve the vertical toner effect of the vertical toner (high risk). This may result in serotonin syndrome. Management: Monitoring for signs and symptoms of Serotonin syndrome/Serotonin toxicity (e.g., hyperreflexia, clononus, hyperthepsy, diaphoresis, tremor, autonomic instability, mental state changes) when combining these agents. Monitor TherapyLumefantrine: CyP2D6 may increase serum concentration seromyoncis (high risk with inhibitors). Monitor Therapy Meperidine: May improve the vertical toner effect of serotonin/norepinephrine reuptake inhibitors. This may result in serotonin syndrome. Management: Monitoring for signs and symptoms of Serotonin syndrome/Serotonin toxicity (e.g., hyperreflexia, clononus, hyperfever, diaphoresis, tremor, autonomic instability, mental state changes) when these agents are combined. Monitor therapy : CYP2D6 inhibitors (usually) can increase the serum concentration of mequizine. Anti-combination Metaxalone: Can improve the vertical toner effect of the cerertone yesterday (high risk). This may result in serotonin syndrome. Management: Monitoring for signs and symptoms of Serotonin syndrome/Serotonin toxicity (e.g., hyperreflexia, clononus, hyperthepsy, diaphoresis, tremor, autonomic instability, mental state changes) when combining these agents. Monitor Therapeutic Metadone: May improve the effect of the vertical toner on the vertical tonergy formulation (high risk). This may result in serotonin syndrome. Management: Monitoring for signs and symptoms of Serotonin syndrome/Serotonin toxicity (e.g., hyperreflexia, clononus, hyperthepsy, diaphoresis, tremor, autonomic instability, mental state changes) when combining these agents. Monitor Therapy Methylene Blue: May improve the vertical toner effect of serotonin/norepinephrine reuptake inhibitor methylene blue. This may result in serotonin syndrome. To avoid the combination of mettoclopramy: CYP2D6 inhibitors (usually) may increase the serum concentration of methotlopramimid. Monitor Therapy : CYP2D6 inhibitors (usually) may increase serum concentrations of metoprolol. Monitor Therapeutic Mirzapine: May improve the vertical tonic effect of serotonin/norepinephrine reuptake inhibitors. This may result in serotonin syndrome. Management: Monitoring for signs and symptoms of Serotonin syndrome/Serotonin toxicity (e.g., hyperreflexia, clononus, hyperthepsy, diaphoresis, tremor, autonomic instability, mental state changes) when combining these agents. Monitor Therapy Monoamine Oxidase Inhibitors (antidepressants): May improve the vertical tonate effect of serotonin/norepinephrine reuptake inhibitors. This may result in serotonin syndrome. Avoid combinations Multivitamin/Fluoride (ADE use): Can improve the antiplatelet effect of formulations with antiplatelet properties. Monitor Therapy Multivitamin/Mineral (With ADEK, Folic Acid, Iron): Antiplatelet effect of agents with antiplatelet properties. Monitor Therapy Multivitamin/Mineral (AE, No Iron): Can improve the antiplatelet effect of formulations with antiplatelet properties. Monitor therapy nevibolol: CYP2D6 inhibitors (usually) may increase the serum concentration of the nevibolol. Monitor therapy nepazozon: May improve the vertical tonic effect of serotonin/norepinephrine reuptake inhibitors. This may result in serotonin syndrome. Management: Monitoring for signs and symptoms of Serotonin syndrome/Serotonin toxicity (e.g., hyperreflexia, clononus, hyperthepsy, diaphoresis, tremor, autonomic instability, mental state changes) when combining these agents. Monitor therapy non-steroidal anti-inflammatory agents (non-selective): serotonin / norepinephrine reuptake inhibitors can improve the antiplatelet effect of non-steroidal anti-inflammatory agents (non-selective). Monitor treatment non-steroidal anti- inflammatory agents (topical): serotonin / norepinephrine reuptake inhibitors can improve the antiplatelet effect of non-steroidal anti-inflammatory drugs (topical). Monitor Therapy Obinutuzumab: Agents with antiplatelet properties can improve the adverse/toxic effects of Obinutuzumab. In particular, the risk of serious bleeding-related events may increase. Monitor therapy olisereddine: CYP2D6 inhibitors (usually) may increase the serum concentration of oliseredin. Monitor therapy Olmutinib: CYP2D6 inhibitors (usually) can increase the serum concentration of Olmutinib. Monitor Therapy Omega-3 fatty acids: Can improve the antiplatelet effect of agents with antiplatelet properties. Monitor TherapyOndansetron: Can improve the effect of the vertical toner in the vertical toner formulation (high risk). This may result in serotonin syndrome. Management: Monitoring for signs and symptoms of Serotonin syndrome/Serotonin toxicity (e.g., hyperreflexia, clononus, hyperthepsy, diaphoresis, tremor, autonomic instability, mental state changes) when combining these agents. Monitor Therapeutic Opioid Agonists: May improve the effect of the vertical toner in the vertical toner preparation (high risk). This may result in serotonin syndrome. Management: Monitoring for signs and symptoms of Serotonin syndrome/Serotonin toxicity (e.g., hyperreflexia, clononus, hyperthepsy, diaphoresis, tremor, autonomic instability, mental state changes) when combining these agents. Exceptions: alfentanil; Benz hydrocodone; Buprenorphine; Butasol; Codeine; Dihydrocodin; Pentaniel; Hydrocodon; Lebometone; Meperidin; Methadone; Oliseredin; Oxycodone; Sufentanil; . Monitor therapy opioid agonist (metabolized by CYP3A4 and CYP2D6): it is can improve the vertical toner effect of the vertical toner gipps (high risk). This may result in serotonin syndrome. Management: Monitoring signs and symptoms of Serotonin Syndrome/Serotonin Toxicity (e.g., hyperreflexia, clonus, hyperthermia, diarrhea, tremors, autonomic instability, mental Change) If these agents are combined, monitor therapy opioid agonists (metabolized by CYP3A4): can improve the vertical toner effect of vertical toner preparations (high risk). This may result in serotonin syndrome. Management: Monitoring for signs and symptoms of Serotonin syndrome/Serotonin toxicity (e.g., hyperreflexia, clononus, hyperthepsy, diaphoresis, tremor, autonomic instability, mental state changes) when combining these agents. Exception: Lebometone; Meta. Monitor Therapy Oxitriptan: Can improve the vertical toner toner effect of vertical toner agent (high risk) Oxitriptan. This may result in serotonin syndrome. Management: Monitoring for signs and symptoms of Serotonin syndrome/Serotonin toxicity (e.g., hyperreflexia, clononus, hyperthepsy, diaphoresis, tremor, autonomic instability, mental state changes) when combining these agents. Monitor Therapy Ozanimod: May improve the side effects/toxic effects of vertical tonergic formulations (high risk). Care: The accompanying use of serotonergik formulations and ozani mode is not recommended. If combined, closely monitor the patient for the development of hypertension, including hypertension crisis. Consider therapeutic modifications Peginterferon Alpha-2b: CYP2D6 may reduce serum concentrations of substrates (inhibitors and high risk). Pepeperon alpha-2b can increase the serum concentration of the CYP2D6 substrate (high risk as an inhibitor). Monitor Treatment Pentosan Polysulfate Sodium: Can improve the adverse/toxic effects of agents with anti-hemoplate properties. In particular, the risk of bleeding can be increased by the simultaneous use of these agents. Monitor Therapy Pentoxifylline: May improve the antiplatelet effect of agents with antiplatelet properties. Monitor Therapy Perhexiline: CYP2D6 inhibitors (usually) may increase serum concentration seroly of Perhexiline. Monitor therapy : CYP2D6 inhibitors (usually) may increase serum concentration seroly of Perphenazine. Monitor therapy phymojid: CYP2D6 inhibitors (usually) may increase the serum concentration of the blood jid. Monitor therapy phytolist: CYP2D6 inhibitors (usually) may increase the serum concentration of phytolis jets. Monitor therapy propafenne: CYP2D6 inhibitors (usually) can increase the serum concentration of propafenne. Monitor therapy : CYP2D6 inhibitors (usually) may increase the serum concentration of propranolol. Monitor Therapy Prosacycline Analogs: Can improve the antiplatelet effect of agents with antiplatelet properties. Monitor Therapy : May improve the vertical toner effect of certonergic formulations (high risk). This may result in serotonin syndrome. Management: Monitoring for signs and symptoms of Serotonin syndrome/Serotonin toxicity (e.g., hyperreflexia, clononus, hyperthepsy, diaphoresis, tremor, autonomic instability, mental state changes) when combining these agents. Monitor Terrassagillin: Can improve the effect of vertical toner Serotonin/Norepinephrine reuptake inhibitors. This may result in serotonin syndrome. Avoid combinations: CYP2D6 inhibitors (usually) may increase the serum concentration of . Monitor Therapy Rivaroxaban: Agents with antiplatelet properties can improve the anticoagulant effect of Rivaroxaban. Management: carefully consider the risks and benefits of this combination and closely monitor; Canadian labels are recommended to avoid prasugrel or ticagrelor. Monitor Therapy : May improve the vertical tomatic effect of serotonin/norepinephrine reuptake inhibitors. This may result in serotonin syndrome. Anti-combination salicylate: Agents with antiplatelet properties can improve the adverse/toxic effects of salicylates. The risk of bleeding may increase. Monitor Therapy Selective Serotonin Reuptake Inhibitors: Can Improve THE Antiplatelet Effect of DULoxetine. Selective Serotonin reuptake inhibitors may improve the vertical toner effect of DULoxetine. This may result in serotonin syndrome. Management: Monitoring for signs and symptoms of Serotonin syndrome/Serotonin toxicity (e.g., hyperreflexia, clonus, hypertemperature, diaphoresis, shaking, mental state changes) when combining these agents. Also, monitor the signs and symptoms of bleeding. Exception: Daforkcetin; Fluoxetine; Fluvoxamine; PARoxetine. Monitor therapy selective serotonin reuptake inhibitors (strong CYP2D6 inhibitors): DULoxetine may improve the antiplatelet effect of selective serotonin reuptake inhibitors (strong CYP2D6 inhibitors). Duroxcetin can improve the vertical toner effect of selective serotonin reuptake inhibitors (strong CYP2D6 inhibitors). This may result in serotonin syndrome. Selective Serotonin Reuptake Inhibitors (strong CYP2D6 inhibitors) can increase serum concentrations of DULoxetine. Management: When these agents are combined, monitor for increased duloxetine effects /toxicity and signs and symptoms of serotonin toxicity (e.g., hypercalcemia, tremor, changes in mental state). Also, monitor the signs and symptoms of bleeding. Monitor Therapy : May improve the vertical tomatic effect of serotonin/norepinephrine reuptake inhibitors. This may result in serotonin syndrome. Avoid combination Selumetinib: May improve the antiplatelet effect of agents with antiplatelet properties. Monitor therapy vertical tonergic agent (high risk, other): Serotonin/Norepinephrine reuptake inhibitors can improve the vertical toner effect of the vertical toner (high risk, etc.). This may result in serotonin syndrome. Management: Monitoring for signs and symptoms of Serotonin syndrome/Serotonin toxicity (e.g., hyperreflexia, clononus, hyperthepsy, diaphoresis, tremor, autonomic instability, mental state changes) when combining these agents. Monitor Therapy Serotonin 5-HT1D Receptor Agons (): Can improve the vertical toner. Sertonergik formulations (high risk). This may result in serotonin syndrome. Management: Monitoring for signs and symptoms of Serotonin syndrome/Serotonin toxicity (e.g., hyperreflexia, clononus, hyperthepsy, diaphoresis, tremor, autonomic instability, mental state changes) when combining these agents. Exception: Almotryptan; . Monitor Therapy Serotonin/Norepinephrine Reuptake Inhibitors: Other Serotonin/Norepinephrine Reuptake Inhibitors May Improve Antiplatelet Effects of Reuptake Inhibitors. Serotonin/Norepinephrine reuptake inhibitors may improve the vertical toner effect of other serotonin/norepinephrine reuptake inhibitors. This may result in serotonin syndrome. Management: Monitoring for signs and symptoms of Serotonin syndrome/Serotonin toxicity (e.g., hyperreflexia, clonus, hypertemperature, diaphoresis, shaking, mental state changes) when combining these agents. Also, monitor the signs and symptoms of bleeding. Monitor Treatment St Zone Wort: Can improve the vertical toner effect of the vertical tonergy agent (high risk). This may result in serotonin syndrome. St. John's Wort can reduce the serum concentration of certonergique preparations (high risk). Management: Monitoring for signs and symptoms of Serotonin syndrome/Serotonin toxicity (e.g., hyperreflexia, clononus, hyperthepsy, diaphoresis, tremor, autonomic instability, mental state changes) when combining these agents. Monitor Therapy Syria Rue: May improve the vertical toner effect of the vertical tonergy formulation (high risk). This may result in serotonin syndrome. Management: Monitoring for signs and symptoms of Serotonin syndrome/Serotonin toxicity (e.g., hyperreflexia, clononus, hyperthepsy, diaphoresis, tremor, autonomic instability, mental state changes) when combining these agents. Monitor Therapy Tamoxifen: CYP2D6 inhibitors (usually) can reduce serum concentrations of active metabolites of tamoxifen. Specifically, CYP2D6 inhibitors can reduce the metabolic formation of highly powerful active metabolites. Management: If possible, consider an alternative to the use of suitable CYP2D6 inhibitors using tamoxifen. Consider therapeutic modificationsTamsulosin: CYP2D6 inhibitors (usually) can increase the serum concentration of tampulatosine. Monitor therapy tatrabenazine: CYP2D6 inhibitors (usually) may increase the serum concentration of tetrabenazine. Specifically, the active alpha-beta-dihydrotetrabenazine concentration of metabolites may be increased. Monitor therapy tiorimin: CYP2D6 inhibitor (usually) may increase the serum concentration of thiorimindocin. Combination blood clotasa assay agent: agents with antiplatelet properties can improve the anticoagulation effect of thrombosis formulations. Monitor Therapy (Telegraph): CYP2D6 inhibitors (usually) may increase serum concentrations of thymolol (body). Teranavir: Can improve the antiplatelet effect of agents with antiplatelet properties. Monitor therapy tobacco (smoked): it is can reduce the serum concentration of duroxetine. Monitor therapy tramadol: Duroxetine can improve the side effects / toxic effects of tramadol. Serotonin Syndrome/Serotonin toxicity and risk for seizures may be increased in combination. Duroxcetin can reduce the therapeutic effect of tramadol. Management: Monitoring signs and symptoms of Serotonin Syndrome/Serotonin toxicity (e.g., hyperreflexia, clonus, hypersis, diaphoresis, tremor, autonomy instability, mental state changes), reduced tramadol effects and seizures when these agents are combined. Monitor Therapy Razone: May improve the vertical tonic effect of serotonin/norepinephrine reuptake inhibitors. This may result in serotonin syndrome. Management: Monitoring for signs and symptoms of Serotonin syndrome/Serotonin toxicity (e.g., hyperreflexia, clononus, hyperthepsy, diaphoresis, tremor, autonomic instability, mental state changes) when combining these agents. Monitor Therapy Tricyclic Antidepressants: DULoxetine Tricicles May Improve the Vertical Toner Effect of Antidepressants. This may result in serotonin syndrome. Duroxetin may increase the serum concentration of tricicle liquid antidepressants. Management: Monitoring for signs and symptoms of Serotonin syndrome/Serotonin toxicity (e.g., hyperreflexia, clono, hyperfever, diaphoresis, tremor, autonomic instability, mental state changes) and increased TCA concentrations and effects when combining these agents. Monitor therapy Urokinase: agents with antiplatelet properties can improve the anticoagulant effect of urrokinase. Avoid the combination balbenaigne: CYP2D6 inhibitors (usually) may increase the serum concentration of the active metabolite of valbenajin. Monitor TreatmentVitamin E (telegraph): Can improve the antiplatelet effect of preparations with antiplatelet properties. Monitor Therapy Zanubrutinib: May improve the antiplatelet effect of agents with antiplatelet properties. Monitor therapy jucpenthizole: CYP2D6 inhibitors (usually) may increase the serum concentration of jucklfenthol. Monitor treatment adverse reactions >10%: Endocrine and metabolic: weight loss (children and adolescents: 14% receive 15%; adults: ≥1% gastrointestinal: abdominal pain (children and adolescents: 13%; adults: 5%), reduced appetite (6% receive Da 15% related), (18% recipients 25%; juvenile-related doses), vomiting (18% while receiving 25%; adolescents) adults: 3% to 4%, xerostomia (adults: 11% receiving 14%, dose-related); Children and adolescents: 2%) Nervous system: drowsiness (9% receiving 11%; dose-related), fatigue (5% receiving 11%; dose-related), headache (13% to 18%) 1% to 10%: Cardiovascular: flush (3%), increased blood pressure (2%), palpitations (2%) Dermatologist: Diarrhea (6%), Prince (≥1%) Endocrine and metabolic: decreased libido (3% [placebo: 1%]), Flash (≥1%), orgasm icing (2% [placebo: <1%]), weight= gain= (≥1%) gastrointestinal:= constipation= (9%= to = 10%;= dose= related),= diarrhea= (6%= to= 9%),= dysgeusia= (≥1%), =dyspepsia = (2%), =flatulence = (≥≥ /= viral= gastroenteritis= (adolescents:= 5%) genitourinary:= ejaculatory= disorder= (2%),= erectile= (4%= [placebo:= 1%]),= urinary= frequency= (≥1%) hepatic:= increased= serum= alanine = aminotransferase= (=gt;3xULN: 1%) Nervous system: abnormal dreams (≥1%), agitation (3%-4%), loss of appetite (≥1%), anxiety (3%), chills (≥1%), delayed ejaculation (2%[placebo: 1%); dose-related), dizziness (8%-9%), low congestion (≥1%), insomnia (7%-10%), coma (≥1%), pare [≥1%), strict (≥1%), sleep disorders (≥1%), dizziness ≥ (≥1%) Neuromuscular and skeletal: musculoskeletal pain (≥1%), tremor (2) % to 3%) Ophthalmology: blurred vision (3%): cough (children and adolescents: 3%), hydrophalatis (youth: 9%), nasal pain (children and adolescents: 4%; adults: ≥1%), upper respiratory tract infections (adolescents: 7%) <1%:Cardiovascular: Acute myocardial dark, cardiomyopathy (Takotsubo), cold extremity, orthostatic hypotension, tachychyDermatologic: Contact dermatitis, ecchymoses, erythema of skin, night sweats, skin photosensitivityendocrine & hyperemia; metabolicon, dyslipidia, hyperemia, increased, increased cholesterol, increased cholesterol menstrual diseaseGastrointestinal: Bruxism, dysphagia, eructation, gastroulcer, gastritis, gastroenteritis, gastrointestinal hemorrhage, halitosis, stomatitisGenitinary: Dysuria, malodorous urine, menopausal symptoms, nocturia, sexual disorder, urinary urgencyhelogiclogic (oncology) and nonthrombotic system: puricic : Abnormal gait, apathy, confusion, disorientation, disturbance in attention, dysarthria, falling, abnormal feeling, irritability, malaise, myoclonus, sensation of cold, suicidal tendenciesNeuromuscular & skeletal: Asthenia, , muscle spasm, muscle twitchingOphthmical: Dipilopa, dry eye syndrome, visual impairmentOtic: Otalgia, tinnitusRenal: PolyuriaRespiratory: Laryngitis, pharyngeal edemaFrequency not defined: Endocrine & metabolic: metabolic Decreased serum potassium, increased serum bicarbonate, increased serum potassiumhepatic: increased serum al-persaphatas, aminonervous serum aspartatransfer system : Suicidal ideation (Parikh 2008) Neuromuscular & skeletal: Bone fracture, increased creatinee phosphokinase in blood specimenPostmarketing:Cardiovascular: Cerebrovascular accident (Leong 2017), hypersensitivity angiitis, hypertensive crisis, sraventrtrtricci cardiaicularc arrhythmia, dermopealogiclogic, eryfora, eryfor. skin rash, Stevens-Johnson syndrome (Strawn 2011), urticariaEndocrine & metabolic: Galactorrhea not associated with childbirth, hyperglycemia, hyperprolactinemia, hyponatremia (Hu 2018), SIADH acute= myocardial= cardio,=cardio==takobotsuy= =cold= extrem= orortitititi. dermatologic:= contact= dermatitis ,= ecchymoses,= erythema= of= skin,= night= sweats,= skin= photosensitivityendocrine= & = metabolic:= dehydration,= hyperlipidemia,= hypothyroidism,= increased= serum= cholesterol,= increased= thirst,= menstrual= diseasegastrointestinal:= bruxism,= dysphagia,= eructation,= gastric= ulcer,= gastritis,= gastroenteritis,= gastrointestinal= hemorrhage,= halitosis,= stomatitisgenitourinary:= dysuria,= malodorous= urine,= menopausal= symptoms,= nocturia,= sexual= disorder,= urinary= urgencyhematologic= &= oncologic:= nonthrombocytopenic= purpuranervous= system:= abnormal= gait,= apathy,= confusion,= disorientation,= disturbance= in= attention,= dysarthria,= falling,= feeling= abnormal,= irritability,= malaise,= myoclonus,= sensation= of= cold,= suicidal= tendenciesneuromuscular= &= skeletal:= asthenia,= dyskinesia,= muscle= spasm,= muscle= twitchingophthalmic:= diplopia,= dry= eye= syndrome,= visual= impairmentotic:= otalgia,= tinnitusrenal:= polyuriarespiratory:= laryngitis,= pharyngeal= edemafrequency= not= defined:endocrine= &= metabolic:= decreased= serum= potassium,= increased= serum= bicarbonate,= increased= serum= potassiumhepatic:= increased= serum= alkaline= phosphatase,= increased= serum= aspartate= aminotransferasenervous= system:= suicidal= ideation= (parikh= 2008)neuromuscular= &= skeletal:= bone= fracture,= increased= creatinine= phosphokinase= in= blood= specimenpostmarketing:cardiovascular:= cerebrovascular= accident= (leong= 2017),= hypersensitivity= angiitis,= hypertensive= crisis ,= supraventricular= cardiac= arrhythmia,= syncopedermatologic:= erythema= multiforme,= skin= rash,= stevens-johnson= syndrome= (strawn= 2011),= urticariaendocrine= &= metabolic:= galactorrhea= not= associated= with= childbirth,= hyperglycemia,= hyperprolactinemia,= hyponatremia= (hu= 2018),= siadh=></1%:Cardiovascular: Acute myocardial infarction, cardiomyopathy (Takotsubo), cold extremity, orthostatic hypotension, tachycardiaDermatologic: Contact dermatitis, ecchymoses, erythema of skin, night sweats, skin photosensitivityEndocrine & metabolic: Dehydration, dyslipidemia, hyperlipidemia, hypothyroidism, increased serum cholesterol, increased thirst, menstrual diseaseGastrointestinal: Bruxism, dysphagia, eructation, gastric ulcer, gastritis, gastroenteritis, gastrointestinal hemorrhage, halitosis, stomatitisGenitourinary: Dysuria, malodorous urine, menopausal symptoms, nocturia, sexual disorder, urinary urgencyHematologic & oncologic: Nonthrombocytopenic purpuraNervous system: Abnormal gait, apathy, confusion, disorientation, disturbance in attention, dysarthria, falling, feeling abnormal, irritability, malaise, myoclonus, sensation of cold, suicidal tendenciesNeuromuscular & skeletal: Asthenia, dyskinesia, muscle spasm, muscle twitchingOphthalmic: Diplopia, dry eye syndrome , visual impairmentOtic: Otalgia, tinnitusRenal: PolyuriaRespiratory: Laryngitis, pharyngeal edemaFrequency not defined:Endocrine & metabolic: Decreased serum increased serum bicarbonate, increased serum potassiumHepatic: Increased serum alkaline phosphatase, increased serum aspartate aminotransferaseNervous system: Suicidal ideation (Parikh 2008)Neuromuscular & skeletal: Bone fracture, increased creatinine phosphokinase in blood specimenPostmarketing:Cardiovascular: Cerebrovascular accident (Leong 2017), hypersensitivity angiitis, hypertensive crisis, supraventricular cardiac arrhythmia, syncopeDermatologic: Erythema multiforme, skin rash, Stevens-Johnson syndrome (Strawn 2011), urticariaEndocrine & metabolic: Galactorrhea not associated with childbirth, hyperglycemia, hyperprolactinemia, hyponatremia (Hu 2018), SIADH > </1%]),> </1%]),> 2014) : acute pancreatitis, colitis, haege bleeding (Balhara 2007; Gicquel 2017)Genitourinary: Gynecological bleeding, postpartum hemorrhage (Huybrechts 2020), priapism (Wilkening 2016), urinary retentionHepatic: Acute hepatic failure (Hanje 2006), cholestatic hepatitis (Vuppalanchi 2010), cholestatic jaundice (Park 2010), hepatic necrosis (LiverTox NIH 2018), hepatitis (LiverTox NIH 2018), hepatocellular hepatitis (Vuppalanchi 2010), hepatotoxicity (Park 2013), increased serum transaminases (Kang 2011)Hypersensitivity: Anaphylaxis, angioedema, hypersensitivity reactionNervous system: Aggressive behavior (particularly early in treatment or after treatment discontinuation), extrapyramidal reaction, hypomania (Peritogiannis 2008), mania (Dunner 2005), outbursts of anger (particularly early in treatment or after treatment discontinuation), restless leg syndrome, seizure (with treatment discontinuation), serotonin syndrome (Gelener 2011), sleep disorder (rapid eye movement) (Tan 2017), trismus, withdrawal syndrome (Perahia 2005)Ophthalmic: Acute angle-closure glaucoma (Mahmut 2017), cataract (Erie 2014)Renal: Renal colic (Wilkening 2017) Suicidal thoughts and behavior : Antidepressants increase the risk of suicidal thoughts and behaviors in pediatric and young adult patients in short-term studies. For the appearance of clinical deterioration, suicidal thoughts and behaviors, all antidepressant treatment patients are closely monitored. Warning/Preventive Measures Key Mental Warning: Suicide Accidents/Behaviors: [US Box Warning]: Antidepressants increase the risk of suicide and behavior in children, adolescents and young adults (ages 18 to 24) with major depressive disorders (MDD) and other mental disorders. Consider the risks before prescribing. Short-term studies showed an increased risk in patients aged 24 and ≥ showed a reduced risk in patients aged 65. Closely monitored for clinical exacerbation, suicide, or unusual changes in behavior, especially during the early 1st month of treatment or during periods of dose adjustment (increase or decrease); The patient's family or caregiver should be instructed to closely monitor the patient and communicate the condition with the healthcare provider. A drug guide for antidepressant use in children and adolescents should be distributed with each prescription. • The likelihood of suicide attempts is inherent in major depression and may persist until relief occurs. Worsening depression and severe sudden suicide, which is not part of the presenting symptoms, may require discontinuation or modification of medication. Use caution in high-risk patients during the onset of therapy.• Prescriptions should be recorded for the smallest amount consistent with good patient care. The patient's family or caregiver should be warned. Monitor patients for the emergence of suicidal behaviors such as anxiety, agitation, panic attacks, insomnia, irritability, hostility, impulsiveness, acateia, hypotension, mania. The patient should be instructed to notify the healthcare provider if these symptoms or depression worsen. Side effects related to concerns: Bleeding risk: Increased risk of bleeding events can damage platelet aggregation, especially when used with aspirin or NSAIDs due to ulcers or NONSTEROIDCas due to its nasal potential. Bleeding associated with SNRI use has been reported in a variety of ways, ranging from relatively minor bruises and epistasis to life-threatening bleeding. • CNS Depression: Less likely to impair cognitive or athletic performance. Be ware of operating dangerous machines or driving.• Skin diseases: severe skin reactions (including Stevens-Johnson syndrome and erythema multiple form) have been reported; If you suspect any signs of blisters, peeling rashes, mucous membrane erosion or hypersensitivity reactions, stop immediately.• Fractures: Bone fractures are associated with antidepressant therapy. Consider the possibility of fragility fractures if the patient treats antidepressants with unexplained bone pain, point tenderness, swelling or bruising (Rabenda 2013; Rizzoli 2012.• Liver toxicity: To avoid use in patients with significant alcohol intake, evidence of liver disease or liver disorders. Rare cases of liver failure (including fatalities) have been reported as use. Hepatitis with abdominal pain, epilepsy, high transaminase levels > 20 times without jaundice have all been observed without jaundice. Do not resume treatment unless you stop treating with other signs of jaundice or liver dysfunction and do not resume treatment unless you identify other sources or causes.• Hyperglycemia: A modest increase in serum glucose and HbA1c levels has been observed in some diabetics diabetic peripheral neuropathy pain (DPNP).• Patients receiving duoxetine versus eye effects: Patients receiving eye effects for doulosetin may cause mild pupillary swelling that can lead to episodes of narrow angle glaucoma in vulnerable individuals. Consider evaluating patients who do not have iridectomy for narrow angle glaucoma risk factors.• Orthopedic hypotension / fainting: Especially within the first week of treatment and after increased dose, orthostatic hypotension/fainting can cause. Carefully monitor blood pressure with the onset of treatment, increasing dosage (especially in patients receiving >60 mg/day), or entailing vasodilators or CYP1A2 inhibitors when using. If rectified hypotension or fainting occurs, consider reducing or discontinuing doses of duloxetine.• Serotonin Syndrome (SS) reaction: Potentially life-threatening serotonin syndrome (SS) has occurred with serum toner (e.g., SSRIs, SNRIs). Vertical toner agents (e.g., tritan, triplellite antidepressants, fentanyl, lithium, tramadol, , busiron, st. john's wort) or drugs that impair serotonin metabolism (e.g., monoamine oxidase inhibitors, especially relizolid, methylene blue, and other mental disorders). Closely monitor patients for signs/symptoms of SS that may include changes in mental state (e.g., agitation, hallucinations, delirium), seizures, autonomic instability (e.g., tachycardia, dizziness, diarrhea), nerve muscle symptoms (e.g., tremor, stiffness, root insufficiency), or GI symptoms (e.g. nausea, vomiting, diarrhea). If signs/symptoms occur, immediate treatment (and all accompanying serum toneric agents) is discontinued.• Sexual dysfunction: May cause or worsen sexual dysfunction.• SIADH and hypoconceatoemia: SSRIs and SNRIs are associated with the development of SIADH. Hyponatremia has been rarely reported (including severe cases with serum sodium & lt;110 mmol/L), mostly in the elderly. Volume depletion and/or simultaneous use of diuretics may increase the risk. • Urinary tract sclerosis: may increase urinary resistance; Advise patients to report symptoms of urinary hesitation/difficulty. Disease concerns:• Use caution in patients with cardiovascular disease or cerebrovascular disease.• Perjury: Be careful in patients with perjury disorders (e.g. some diabetics). May affect the stability of the intraintestinal coating of capsules. • Liver disorders: Avoid use in patients with chronic liver disease or cirrhosis; Clearance decreases and half-life and plasma concentrations increase.• Hypertension: Be ware in hypertensive patients. Conventional hypertension should be treated before the initiation of treatment. Although statistically significant differences in the frequency of persistent altitude of BP were observed in clinical trials when compared with placebo, modest increased use in BP has been reported. In addition, rare cases of hypertension crisis have been reported; BP should be evaluated regularly before commencing treatment. Consider a reduction or gradual disruption of treatment in individuals with persistent hypertension during treatment. • Mania/hypomania: In patients with bipolar disorder, it can precipitate the transition to mania or low mania. Monotherapy in patients with bipolar disorder should be avoided. Combination therapy with antidepressants and mood stabilizers can be effective in the acute treatment of bipolar major depressive episodes, but should be avoided in acute mania or mixed episodes, as well as maintenance treatment of bipolar disorder due to the mood instability effects of antidepressants (CANMAT [CanMAT 2018]; WFSBP [Grunds 2018]. Patients presenting with depressive symptoms should be screened for bipolar disorder. Duloxetine is not FDA approved. Treatment of bipolar depression.• Kidney disorders: use with caution; Clearance decreases and plasma concentration increases. 용량 감소가 필요 할 수 있습니다.• 발작 장애: 이전 발작 장애 또는 발작에 걸리기 쉬운 상태에서 주의 사용, 뇌 손상 또는 알코올 사용 장애 등 (몽고메리 2005). Special population:• Fall risk: Falls with serious consequences including bone fractures and hospitalizations have been reported in patients receiving therapeutic doses of douloccetin. The risk of falling appears to be related to the degree of rectification reduction of BP. The risk may also be greater in elderly patients >. If a waterfall occurs, consider reducing the dose or discontinuing the oxetine. • Sucrate intolerance: Some formulations may contain sucing. Fructose intolerance, glucose-galactose absorption defects, or sucrase-isomaltase deficiency should be avoided. Other warnings/precautions:• Discontinued syndrome: Sudden or discontinued treatment of antidepressants has been associated with discontinued syndrome. Symptoms that occur may differ from antidepressants. However, they generally include nausea, vomiting, diarrhea, headache, dizziness, reduced appetite, sweating, chills, tremors, palestine, fatigue, somnolence and sleep disorders (e.g., vivid dreams, insomnia). Less common symptoms include sensations like electric shock, cardiac arrhythmias (more common as a triad antidepressant), muscle pain, Parkinson's disease, joint pain, and difficulty balancing. Psychological symptoms may also appear such as agitation, anxiety, akathisia, panic attacks, irritability, aggression, mood deterioration, anxiety, mood swings, hyperactivity, mania/lowmania, dehumanization, reduced concentration, slow thoughts, confusion, memory or concentration difficulties. A greater risk for developing discontinuation syndrome was associated with a short half-life, a long period of treatment, sudden disruption and antidepressants. For short or medium-term antidepressants, symptoms may appear within two to five days after discontinuation of treatment and last 7 to 14 days (APA 2010; Fava 2006; Haddad 2001; Shelton 2001; Warner 2006). Parameter blood pressure monitoring (baseline, then periodically, especially in patients with high baseline blood pressure) liver and renal function tests (baseline; as clinically indicated); Suicidal ideas (standards and dosage changes); Serum sodium in the at-risk group (as clinically indicated); Treatment of blood sugar and HbA1c (baseline and clinically indicated) reproductive considerations for major depressive disorders in diabetics For the first time in women planning to become pregnant, agents other than duloxetine are preferred (Larsen 2015). Pregnancy considerations Duoxetin crosses the placenta (Voices 2011; Briggs 2009; Colin Levesque 2018). Viteratogen side effects have been observed with benlafaxine or other SNRIs/SSRIs when used during pregnancy. Cyanide, apnea, shortness of breath, seizures, temperature instability, difficulty feeding, vomiting, hypoglycemia, hypoglycemia, hypoglycemia, hypersensitivity, irritability, persistent crying and tremor were reported in newborns immediately after exposure to benlapaksin, SSRIs, or other SNRIs. Long-term hospitalization, respiratory support or tube supply may be required. Some symptoms may be due to the toxicity of SNRIs/SSRIs or discontinued syndrome and may be consistent with serotonin syndrome associated with treatment. Duloxetine can damage platelet aggregation and increase the risk of bleeding. The risk of postpartum bleeding may increase when used within the month before delivery. Untreated or improperly treated mental illness can be poorly adhered to due to prenatal care. ACOG recommends that therapy with SSRIs or SNRIs be individualized during pregnancy. The use of a single agent is desirable. According to their recommendations, treatment of depression during pregnancy should incorporate the clinical expertise of mental health clinicians, obstetricians, primary care providers and pediatricians (ACOG 2008). If treatment for a major depressive disorder begins for the first time during pregnancy, agents other than duloxetine are preferred (Larsen 2015; McQueen 2016). Untreated fibromyalgia can be associated with adverse pregnancy outcomes, including placental suddenness, venous thrombosis, premature rupture of membranes, preterm birth and limiting intrauterine growth for gestational age/ small. It is not known if these results are specifically attributed to the advocated or comorbid condition. Due to limited data, the use of duloxetin for the treatment of pre-emanxiation syndrome (FMS) during pregnancy should be reserved for women with complex and serious forms of FMS with depressive symptoms that worsen during pregnancy. Close monitoring is recommended (Gentile 2019). Health care providers are encouraged to register women who have been exposed to duloxetine during pregnancy at the Symbalta Pregnancy Registry (866-814-6975 or ). Pregnant women who have been exposed to antidepressants during pregnancy are advised to register with the National Pregnancy Registry for antidepressants (NPRAD). Health care providers aged 18 to 45 can contact the registry by calling 844-405-6185. Registration should be made as soon as possible at the beginning of pregnancy. What is used for this drug to educate patients?• It is used to treat low mood. It is used to treat anxiety.• It is used to help painful neurological disorders and diabetic neurological problems.• It is used to treat long-term pain problems.• It is used to treat fibromyalgia.• It may be given to you for other reasons. Talk to your doctor. Any drug can cause side effects. However, many people have no side effects or only minor side effects. Call your doctor or get medical help if these or other side effects don't bother you or disappear: • Gastrointestinal • Throwing • Constipation • Diarrhea • Abdominal Pain • Dry mouth • Feeling sleepy, tired, or weak • Nasal or neck irritation • Weight loss • Don't be hungry • Don't sweat a lot • Don't sweat • Many people can take very bad drugs, but sometimes it can be very bad. Talk to your doctor or seek the help of your doctor immediately if you have any of the following signs or symptoms that may be related to very bad side effects: • Low sodium such as depression, mood swings, behavioral changes or confusion, such as suicide, anxiety, agitation, irritability, panic attacks, mood swings, behavioral changes or confusion • Bleeding like throwing blood like headaches, focus problems, memory, confusion, weakness, seizures or changes in balance; Blood in the urine; black, red or tarri chair; bleeding from the gums; Abnormal vaginal bleeding; Bruises or those without reason get bigger; Or any severe or persistent bleeding • Severe headaches • Dizziness • Passing out • Seizures • Inability to pass urine • Sexual dysfunction • Vision changes • Reduced sex drive • Eye pain • eye redness • eye swelling • Eye swelling • Serotonin syndrome like dizziness, severe headache, Agitation, detecting things that don't look like real, rapid heartbeat, abnormal heartbeat, flushing, trembling, sweating a lot, changing balance, severe stomach, or severe diarrhea • Liver problems such as dark urine, feeling tired, hungry, hungry, crying, stomach ache, throwing red skin or yellow skin or red eyes, red ness, redness, redness, redness, redness, redness, redness, redness, redness, redness, redness, redness, redness, redness, redness, redness, redness, redness, redness, redness, redness, redness, redness, redness, redness, redness, redness, redness, redness, redness, redness, redness, redness, redness, redness, redness, redness, redness, redness, redness, redness, redness, redness, redness, redness, redness, redness, redness, redness, redness, redness, redness, redness, redness, redness, redness, redness, redness, redness, redness, redness, redness, redness, redness, redness, redness, redness, redness, redness, redness, redness, redness, redness, redness, redness, redness, redness, redness, redness, redness, redness, redness, redness, Signs of allergic reactions such as sore throats, throats, nose or eyes; Urticaria; Itching; redness, swelling, blistering, or peeling on skin with or without heat; Wheezing; tightness in the chest or throat; difficulty in breathing, swallowing or speaking; Unusual hoarseness; or swelling of the mouth, face, lips, tongue or neck. Note: This is a comprehensive list of all side effects. Consult your doctor if you have any questions. Consumer Information Use and Disclaimer: This information should not be used to determine whether or not to take this or any other drug. Only healthcare providers are knowledgeable and educated to decide which one. Suitable for certain patients. This information does not warrant safe, effective, or approved medicines for the treatment of patients or health conditions. This is a limited summary of common information about the use of the drug in patient education flyers and is not comprehensive. This limited summary does not include any information available about possible uses, directions, warnings, precautions, interactions, side effects, or the risks that may apply to this drug. This information is not intended to provide medical advice, diagnosis, or treatment and does not replace information received from healthcare providers. For a detailed summary of the risks and benefits of this drug use, talk to your healthcare provider and review the full patient education flyer. For more information, please always contact your healthcare provider to ensure that the information displayed on this page applies to your personal circumstances. Related questions ssri vs. SNRI - what is the difference between them? Medical Disclaimer Disclaimer

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