Duloxetine Lilly
duloxetine
Keep this leaflet. You may need to read it again.
If you have any further questions, ask your doctor or pharmacist.
This medicine has been prescribed for you only. Do not pass it on to others. It may harm them, even if their signs of illness are the same as yours.
If you get any of the side effects talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. See section 4.
What Duloxetine Lilly is and what it is used for
What you need to know before you take Duloxetine Lilly
How to take Duloxetine Lilly
Possible side effects
How to store Duloxetine Lilly
Contents of the pack and other information
Duloxetine Lilly contains the active substance duloxetine. Duloxetine Lilly increases the levels of serotonin and noradrenaline in the nervous system.
Duloxetine Lilly is used in adults to treat:
depression
generalised anxiety disorder (chronic feeling of anxiety or nervousness)
diabetic neuropathic pain (often described as burning, stabbing, stinging, shooting or aching or like an electric shock. There may be loss of feeling in the affected area, or sensations such as touch, heat, cold or pressure may cause pain)
Duloxetine Lilly starts to work in most people with depression or anxiety within two weeks of starting treatment, but it may take 2-4 weeks before you feel better. Tell your doctor if you do not start to feel better after this time. Your doctor may continue to give you Duloxetine Lilly when you are feeling better to prevent your depression or anxiety from returning
In people with diabetic neuropathic pain it can take some weeks before you feel better. Talk to your doctor if you do not feel better after 2 months.
are allergic to duloxetine or any of the other ingredients of this medicine (listed in section 6)
have liver disease
have severe kidney disease
are taking or have taken within the last 14 days, another medicine known as a monoamine oxidase inhibitor (MAOI) (see ‘Other medicines and Duloxetine Lilly’)
are taking fluvoxamine which is usually used to treat depression, ciprofloxacin or enoxacin which are used to treat some infections
are taking other medicines containing duloxetine (see ‘Other medicines and Duloxetine Lilly’)
Talk to your doctor if you have high blood pressure or heart disease. Your doctor will tell you if you should be taking Duloxetine Lilly.
The following are reasons why Duloxetine Lilly may not be suitable for you. Talk to your doctor before you take Duloxetine Lilly if you:
are taking other medicines to treat depression (see ‘Other medicines and Duloxetine Lilly’)
are taking St. John’s Wort, a herbal treatment (Hypericum perforatum)
have kidney disease
have had seizures (fits)
have had mania
suffer from bipolar disorder
have eye problems, such as certain kinds of glaucoma (increased pressure in the eye)
have a history of bleeding disorders (tendency to develop bruises), especially if you are pregnant (see ‘Pregnancy and breast-feeding‘)
are at risk of low sodium levels (for example if you are taking diuretics, especially if you are elderly)
are currently being treated with another medicine which may cause liver damage
are taking other medicines containing duloxetine (see ‘Other medicines and Duloxetine Lilly’)
Duloxetine Lilly may cause a sensation of restlessness or an inability to sit or stand still. You should tell your doctor if this happens to you.
Medicines like Duloxetine Lilly (so called SSRIs/SNRIs) may cause symptoms of sexual dysfunction (see section 4). In some cases, these symptoms have continued after stopping treatment.
Thoughts of suicide and worsening of your depression or anxiety disorder
If you are depressed and/or have anxiety disorders you can sometimes have thoughts of harming or killing yourself. These may be increased when first starting antidepressants, since these medicines all take time to work, usually about two weeks but sometimes longer.
You may be more likely to think like this if you:
have previously had thoughts about killing or harming yourself
are a young adult. Information from clinical trials has shown an increased risk of suicidal behaviour in adults aged less than 25 years with psychiatric conditions who were treated with an antidepressant
You may find it helpful to tell a relative or close friend that you are depressed or have an anxiety disorder, and ask them to read this leaflet. You might ask them to tell you if they think your depression or anxiety is getting worse, or if they are worried about changes in your behaviour.
Children and adolescents under 18 years of age
Duloxetine Lilly should normally not be used for children and adolescents under 18 years. Also, you should know that patients under 18 have an increased risk of side-effects such as suicide attempt,
suicidal thoughts and hostility (predominantly aggression, oppositional behaviour and anger) when
they take this class of medicines. Despite this, your doctor may prescribe Duloxetine Lilly for patients under 18 because he/she decides that this is in their best interests. If your doctor has prescribed Duloxetine Lilly for a patient under 18 and you want to discuss this, please go back to your doctor. You should inform your doctor if any of the symptoms listed above develop or worsen when patients under 18 are taking Duloxetine Lilly. Also, the long-term safety effects concerning growth, maturation, and cognitive and behavioural development of Duloxetine Lilly in this age group have not yet been demonstrated.
Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines, including medicines obtained without a prescription.
The main ingredient of Duloxetine Lilly, duloxetine, is used in other medicines for other conditions:
diabetic neuropathic pain, depression, anxiety and urinary incontinence
Using more than one of these medicines at the same time should be avoided. Check with your doctor if you are already taking other medicines containing duloxetine.
Your doctor should decide whether you can take Duloxetine Lilly with other medicines. Do not start or stop taking any medicines, including those bought without a prescription and herbal remedies, before checking with your doctor.
You should also tell your doctor if you are taking any of the following:
Monoamine oxidase inhibitors (MAOIs): You should not take Duloxetine Lilly if you are taking, or have recently taken (within the last 14 days) another antidepressant medicine called a monoamine oxidase inhibitor (MAOI). Examples of MAOIs include moclobemide (an antidepressant) and linezolid (an antibiotic). Taking a MAOI together with many prescription medicines, including Duloxetine Lilly, can cause serious or even life-threatening side effects. You must wait at least
14 days after you have stopped taking an MAOI before you can take Duloxetine Lilly. Also, you need to wait at least 5 days after you stop taking Duloxetine Lilly before you take a MAOI.
Medicines that cause sleepiness: These include medicines prescribed by your doctor including benzodiazepines, strong painkillers, antipsychotics, phenobarbital and antihistamines.
Medicines that increase the level of serotonin: Triptans, tramadol, tryptophan, SSRIs (such as paroxetine and fluoxetine), SNRIs (such as venlafaxine), tricyclic antidepressants (such as clomipramine, amitriptyline), pethidine, St John’s Wort and MAOIs (such as moclobemide and linezolid). These medicines increase the risk of side effects; if you get any unusual symptom taking any of these medicines together with Duloxetine Lilly, you should see your doctor.
Oral anticoagulants or antiplatelet agents: Medicines which thin the blood or prevent the blood from clotting. These medicines might increase the risk of bleeding.
Duloxetine Lilly may be taken with or without food. Care should be taken if you drink alcohol while you are being treated with Duloxetine Lilly.
If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine.
Tell your doctor if you become pregnant, or you are trying to become pregnant, while you are taking Duloxetine Lilly. You should use Duloxetine Lilly only after discussing the potential benefits and any potential risks to your unborn child with your doctor.
Make sure your midwife and/or doctor knows you are on Duloxetine Lilly. When taken during pregnancy, similar drugs (SSRIs) may increase the risk of a serious condition in babies, called persistent pulmonary hypertension of the newborn (PPHN), making the baby breathe faster and appear bluish. These symptoms usually begin during the first 24 hours after the baby is born. If this happens to your baby you should contact your midwife and/or doctor immediately.
If you take Duloxetine Lilly near the end of your pregnancy, your baby might have some symptoms when it is born. These usually begin at birth or within a few days of your baby being born. These symptoms may include floppy muscles, trembling, jitteriness, not feeding properly, trouble with breathing and fits. If your baby has any of these symptoms when it is born, or you
are concerned about your baby’s health, contact your doctor or midwife who will be able to advise you.
If you take Duloxetine Lilly near the end of your pregnancy there is an increased risk of excessive vaginal bleeding shortly after birth, especially if you have a history of bleeding disorders. Your doctor or midwife should be aware that you are taking duloxetine so they can advise you.
Available data from the use of Duloxetine Lilly during the first three months of pregnancy do not show an increased risk of overall birth defects in general in the child. If Duloxetine Lilly is taken during the second half of pregnancy, there may be an increased risk that the infant will be born early (6 additional premature infants for every 100 women who take Duloxetine Lilly in the second half of pregnancy), mostly between weeks 35 and 36 of pregnancy.
Tell your doctor if you are breast-feeding. The use of Duloxetine Lilly while breastfeeding is not recommended. You should ask your doctor or pharmacist for advice.
Duloxetine Lilly may have a mild to moderate effect on your ability to drive and use machines. It may make you feel sleepy or dizzy. Do not drive or use any tools or machines until you know how Duloxetine Lilly affects you.
Duloxetine Lilly contains sucrose. If you have been told by your doctor that you have an intolerance to some sugars, contact your doctor before taking this medicinal product.
This medicine contains less than 1 mmol sodium (23 mg) per capsule, that is to say essentially ‘sodium-free’.
Always take this medicine exactly as your doctor or pharmacist has told you. Check with your doctor or pharmacist if you are not sure.
Duloxetine Lilly is for oral use. You should swallow your capsule whole with a drink of water.
For depression and diabetic neuropathic pain:
The usually recommended dose of Duloxetine Lilly is 60 mg once a day, but your doctor will prescribe the dose that is right for you.
For generalised anxiety disorder:
The usually recommended starting dose of Duloxetine Lilly is 30 mg once a day after which most patients will receive 60 mg once a day, but your doctor will prescribe the dose that is right for you.
The dose may be adjusted up to 120 mg a day based on your response to Duloxetine Lilly.
To help you remember to take Duloxetine Lilly, you may find it easier to take it at the same times every day.
Talk with your doctor about how long you should keep taking Duloxetine Lilly. Do not stop taking Duloxetine Lilly, or change your dose, without talking to your doctor. Treating your disorder properly is important to help you get better. If it is not treated, your condition may not go away and may become more serious and difficult to treat.
Call your doctor or pharmacist immediately if you take more than the amount of Duloxetine Lilly prescribed by your doctor. Symptoms of overdose include sleepiness, coma, serotonin syndrome (a
rare reaction which may cause feelings of great happiness, drowsiness, clumsiness, restlessness, feeling of being drunk, fever, sweating or rigid muscles), fits, vomiting and fast heart rate.
If you miss a dose, take it as soon as you remember. However, if it is time for your next dose, skip the missed dose and take only a single dose as usual. Do not take a double dose to make up for a forgotten
dose. Do not take more than the daily amount of Duloxetine Lilly that has been prescribed for you in
one day.
DO NOT stop taking your capsules without the advice of your doctor even if you feel better. If your doctor thinks that you no longer need Duloxetine Lilly he or she will ask you to reduce your dose over at least 2 weeks before stopping treatment altogether.
Some patients who stop taking Duloxetine Lilly suddenly have had symptoms such as:
dizziness, tingling feelings like pins and needles or electric shock-like feelings (particularly in the head), sleep disturbances (vivid dreams, nightmares, inability to sleep), fatigue, sleepiness, feeling restless or agitated, feeling anxious, feeling sick (nausea) or being sick (vomiting), shaking (tremor), headaches, muscle pain, feeling irritable, diarrhoea, excessive sweating or vertigo.
These symptoms are usually not serious and disappear within a few days, but if you have symptoms that are troublesome you should ask your doctor for advice.
If you have any further questions on the use of this medicine, ask your doctor or pharmacist.
Like all medicines, this medicine can cause side effects, although not everybody gets them. These effects are normally mild to moderate and often disappear after a few weeks.
headache, feeling sleepy
feeling sick (nausea), dry mouth
lack of appetite
trouble sleeping, feeling agitated, less sex drive, anxiety, difficulty or failure to experience orgasm, unusual dreams
dizziness, feeling sluggish, tremor, numbness, including numbness, pricking or tingling of the skin
blurred eyesight
tinnitus (hearing sound in the ear when there is no external sound)
feeling the heart pumping in the chest,
increased blood pressure, flushing
increased yawning
constipation, diarrhoea, stomach pain, being sick (vomiting), heartburn or indigestion, breaking wind
increased sweating, (itchy) rash
muscle pain, muscle spasm
painful urination, frequent urination
problems getting an erection, changes in ejaculation
falls (mostly in elderly people), fatigue
weight loss
Children and adolescents under 18 years of age with depression treated with this medicine had some weight loss when they first start taking this medicine. Weight increased to match other children and adolescents of their age and sex after 6 months of treatment.
throat inflammation that causes a hoarse voice
suicidal thoughts, difficulty sleeping, grinding or clenching the teeth, feeling disorientated, lack of motivation
sudden involuntary jerks or twitches of the muscles, sensation of restlessness or an inability to sit or stand still, feeling nervous, difficulty concentrating, changes in sense of taste, difficulty controlling movement e.g. lack of coordination or involuntary movements of the muscles, restless legs syndrome, poor sleep quality
large pupils (the dark centre of the eye), problems with eyesight
feeling of dizziness or “spinning” (vertigo), ear pain
fast and/or irregular heart beat
fainting, dizziness, lightheadedness or fainting on standing up, cold fingers and/or toes
throat tightness, nose bleeds
vomiting blood, or black tarry stools (faeces), gastroenteritis, burping, difficulty swallowing
inflammation of the liver that may cause abdominal pain and yellowing of the skin or whites of the eyes
night sweats, hives, cold sweats, sensitivity to sunlight, increased tendency to bruise
muscle tightness, muscle twitching
difficulty or inability to pass urine, difficulty to start urinating, needing to pass urine during the night, needing to pass more urine than normal, having a decreased urine flow
abnormal vaginal bleeding, abnormal periods, including heavy, painful, irregular or prolonged periods, unusually light or missed periods, pain in the testicles or scrotum
chest pain, feeling cold, thirst, shivering, feeling hot, abnormal gait
weight gain
Duloxetine Lilly may cause effects that you may not be aware of, such as increases in liver enzymes or blood levels of potassium, creatine phosphokinase, sugar, or cholesterol
serious allergic reaction which causes difficulty in breathing or dizziness with swollen tongue or lips, allergic reactions
decreased thyroid gland activity which can cause tiredness or weight gain
dehydration, low levels of sodium in the blood (mostly in elderly people; the symptoms may include feeling dizzy, weak, confused, sleepy or very tired, or feeling or being sick, more serious symptoms are fainting, fits or falls), syndrome of inappropriate secretion of anti-diuretic hormone (SIADH)
suicidal behaviour, mania (over activity, racing thoughts and decreased need for sleep), hallucinations, aggression and anger
“Serotonin syndrome” (a rare reaction which may cause feelings of great happiness, drowsiness, clumsiness, restlessness, feeling of being drunk, fever, sweating or rigid muscles), fits
increased pressure in the eye (glaucoma)
coughing, wheezing and shortness of breath which may be accompanied by a high temperature inflammation of the mouth, passing bright red blood in your stools, bad breath, inflammation of the large intestine (leading to diarrhoea)
liver failure, yellowing of the skin or whites of the eyes (jaundice)
Stevens-Johnson syndrome (serious illness with blistering of the skin, mouth, eyes and genitals), serious allergic reaction which causes swelling of the face or throat (angioedema)
contraction of the jaw muscle
abnormal urine odour
menopausal symptoms, abnormal production of breast milk in men or women
excessive vaginal bleeding shortly after birth (postpartum haemorrhage)
inflammation of the blood vessels in the skin (cutaneous vasculitis)
If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the national reporting system listed in Appendix V. By reporting side effects you can help provide more information on the safety of this medicine.
Do not use this medicine after the expiry date which is stated on the carton. Store in the original package to protect from moisture. Do not store above 30°C.
Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to throw away medicines you no longer use. These measures will help to protect the environment.
The active substance is duloxetine.
Each capsule contains 30 or 60 mg of duloxetine (as hydrochloride).
The other ingredients are:
Capsule content: hypromellose, hypromellose acetate succinate, sucrose, sugar spheres, talc, titanium dioxide (E171), triethyl citrate (See end of section 2 for further information on sucrose).
Capsule shell: gelatin, sodium lauryl sulfate, titanium dioxide (E171), indigo carmine (E132), yellow
iron oxide (E172) (60 mg only) and edible green ink (30 mg) or edible white ink (60 mg).
Edible green ink: synthetic black iron oxide (E172), synthetic yellow iron oxide (E172), propylene glycol, shellac.
Edible white ink: titanium dioxide (E171), propylene glycol, shellac, povidone.
Duloxetine Lilly is a hard gastro-resistant capsule. Each capsule of Duloxetine Lilly contains pellets of duloxetine hydrochloride with a covering to protect them from stomach acid.
Duloxetine Lilly is available in 2 strengths: 30 mg and 60 mg.
The 30 mg capsules are blue and white and are printed with ‘30 mg’ and the code ‘9543’. The 60 mg capsules are blue and green and are printed with ‘60 mg’ and the code ‘9542’.
Duloxetine Lilly 30 mg is available in packs of 7, 28 and 98 hard gastro-resistant capsules. Duloxetine Lilly 60 mg is available in packs of 28, 56, 84 and 98 hard gastro-resistant capsules and in multipacks containing 100 (5 packs of 20) and 500 (25 packs of 20) hard gastro-resistant capsules.
Not all pack sizes may be marketed.
Marketing Authorisation Holder: Eli Lilly Nederland B.V., Papendorpseweg 83, 3528 BJ Utrecht, The Netherlands.
Manufacturer: Lilly S.A., Avda. De la Industria, 30, 28108 Alcobendas, Madrid, Spain.
For any information about this medicine, please contact the local representative of the Marketing Authorisation Holder:
Eli Lilly Benelux S.A./N.V. Tél/Tel: + 32-(0)2 548 84 84
Eli Lilly Lietuva
Tel. +370 (5) 2649600
ТП "Ели Лили Недерланд" Б.В. - България тел. + 359 2 491 41 40
ELI LILLY ČR, s.r.o.
Tel: + 420 234 664 111
Lilly Hungária Kft. Tel: + 36 1 328 5100
Eli Lilly Danmark A/S Tlf: +45 45 26 60 00
Charles de Giorgio Ltd. Tel: + 356 25600 500
Lilly Deutschland GmbH Tel. + 49-(0) 6172 273 2222
Eli Lilly Nederland B.V. Tel: + 31-(0) 30 60 25 800
Eli Lilly Nederland B.V. Tel: +372 6 817 280
Eli Lilly Norge A.S. Tlf: + 47 22 88 18 00
ΦΑΡΜΑΣΕΡΒ-ΛΙΛΛΥ Α.Ε.Β.Ε. Τηλ: +30 210 629 4600
Eli Lilly Ges.m.b.H. Tel: + 43-(0) 1 711 780
Dista S.A.
Tel: + 34 91 623 17 32
Eli Lilly Polska Sp. z o.o. Tel: +48 22 440 33 00
Lilly France
Tél: +33-(0) 1 55 49 34 34
Lilly Portugal Produtos Farmacêuticos, Lda Tel: + 351-21-4126600
Eli Lilly Hrvatska d.o.o. Tel: +385 1 2350 999
Eli Lilly România S.R.L. Tel: + 40 21 4023000
Eli Lilly and Company (Ireland) Limited Tel: + 353-(0) 1 661 4377
Eli Lilly farmacevtska družba, d.o.o.
Tel: +386 (0)1 580 00 10
Icepharma hf.
Sími + 354 540 8000
Eli Lilly Italia S.p.A. Tel: + 39- 055 42571
Oy Eli Lilly Finland Ab Puh/Tel: + 358-(0) 9 85 45 250
Phadisco Ltd
Tηλ: +357 22 715000
Eli Lilly Sweden AB Tel: + 46-(0) 8 7378800
Eli Lilly (Suisse) S.A Pārstāvniecība Latvijā
Tel: +371 67364000