Medication Monday...Irenka...DULOXETINE HCL

Before we get to the medication I need to remind you...

• that what I am providing is NOT meant in any way to replace the conversation between you, your doctor, or your pharmacist
  
• please do not self-diagnose or make medical decisions about this drug without talking with qualified professionals
  

• the information provided here is the reference sheet you would find at WebMD. During my journey I found this site to be helpful in providing support. All credit for this information belongs to them. I copied it right from their website and I have removed the hyper-links. Please visit their site if you would like to read further.

For this installment, I have chosen Irenka
GENERIC NAME(S): DULOXETINE HCL

Uses: Duloxetine is used to treat depression and anxiety. In addition, duloxetine is used to help relieve nerve pain (peripheral neuropathy) in people with diabetes or ongoing pain due to medical conditions such as arthritis, chronic back pain, or fibromyalgia (a condition that causes widespread pain).

**Please read this information carefully** 
 If you have any questions about what is provided here....talk with your doctor or pharmacist please.

Irenka
GENERIC NAME(S): DULOXETINE HCL

Uses
Duloxetine is used to treat depression and anxiety. In addition, duloxetine is used to help relieve nerve pain (peripheral neuropathy) in people with diabetes or ongoing pain due to medical conditions such as arthritis, chronic back pain, or fibromyalgia (a condition that causes widespread pain).

Duloxetine may improve your mood, sleep, appetite, and energy level, and decrease nervousness. It can also decrease pain due to certain medical conditions. Duloxetine is known as a serotonin-norepinephrine reuptake inhibitor (SNRI). This medication works by helping to restore the balance of certain natural substances (serotonin and norepinephrine) in the brain.

How to use Irenka
Read the Medication Guide and, if available, the Patient Information Leaflet provided by your pharmacist before you start using duloxetine and each time you get a refill. If you have any questions, ask your doctor or pharmacist.

Take this medication by mouth as directed by your doctor, usually 1 or 2 times a day with or without food. If you have nausea, it may help to take this drug with food. Swallow the capsule whole. Do not crush or chew the capsule or mix the contents with food or liquid. Doing so can release all of the drug at once, increasing the risk of side effects.

The dosage is based on your age, medical condition and response to treatment. To reduce your risk of side effects, your doctor may direct you to start this medication at a low dose and gradually increase your dose. Follow your doctor's instructions carefully. Take this medication regularly to get the most benefit from it. To help you remember, take it at the same time(s) each day.

It is important to continue taking this medication as prescribed even if you feel well. Do not stop taking this medication without consulting your doctor. Some conditions may become worse when this drug is suddenly stopped. Also, you may experience symptoms such as dizziness, confusion, mood swings, headache, tiredness, diarrhea, sleep changes, and brief feelings similar to electric shock. Your dose may need to be gradually decreased to reduce side effects. Report any new or worsening symptoms immediately.

Tell your doctor if your condition persists or worsens.

WARNINGS: 

Antidepressant medications are used to treat a variety of conditions, including depression and other mental/mood disorders. These medications can help prevent suicidal thoughts/attempts and provide other important benefits. However, a small number of people (especially people younger than 25) who take antidepressants for any condition may experience worsening depression, other mental/mood symptoms, or suicidal thoughts/attempts. Therefore, it is very important to talk with the doctor about the risks and benefits of antidepressant medication (especially for people younger than 25), even if treatment is not for a mental/mood condition.

Tell the doctor immediately if you notice worsening depression/other psychiatric conditions, unusual behavior changes (including possible suicidal thoughts/attempts), or other mental/mood changes (including new/worsening anxiety, panic attacks, trouble sleeping, irritability, hostile/angry feelings, impulsive actions, severe restlessness, very rapid speech). Be especially watchful for these symptoms when a new antidepressant is started or when the dose is changed.

Side Effects
See also Warning section.

Nausea, dry mouth, constipation, loss of appetite, tiredness, drowsiness, or increased sweating may occur. If any of these effects persist or worsen, tell your doctor promptly.

Dizziness or lightheadedness may occur, especially when you first start or increase your dose of this drug. To reduce the risk of dizziness, lightheadedness, or falling, get up slowly when rising from a sitting or lying position.

Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

Duloxetine may increase your blood pressure. Check your blood pressure regularly and tell your doctor of any high results.

Tell your doctor right away if any of these serious side effects occur: confusion, easy bruising/bleeding, decreased interest in sex, changes in sexual ability, muscle cramps/weakness, shaking (tremor), difficulty urinating, unusual decrease in the amount of urine, signs of liver problems (such as stomach/abdominal pain, persistent nausea, vomiting, yellowing eyes/skin, dark urine).

Get medical help right away if you have any very serious side effects, including: black/bloody stools, vomit that looks like coffee grounds, seizure, eye pain/swelling/redness, vision changes (such as seeing rainbows around lights at night, blurred vision).

This medication may increase serotonin and rarely cause a very serious condition called serotonin syndrome/toxicity. The risk increases if you are also taking other drugs that increase serotonin, so tell your doctor or pharmacist of all the drugs you take (see Drug Interactions section). Get medical help right away if you develop some of the following symptoms: fast heartbeat, hallucinations, loss of coordination, severe dizziness, severe nausea/vomiting/diarrhea, twitching muscles, unexplained fever, unusual agitation/restlessness.

A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing, skin blisters, mouth sores.

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

In the US - Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

Side Effects List
The following side effects are associated with Irenka:

Common side effects of Irenka:
·                                 Chronic Trouble Sleeping Less Severe

·                                 Diarrhea Less Severe

·                                 Dizzy Less Severe

·                                 Drowsiness Less Severe

·                                 Dry Mouth Less Severe

·                                 Excessive Sweating Less Severe

·                                 Feel Like Throwing Up Less Severe

·                                 Incomplete or Infrequent Bowel Movements Less Severe

·                                 Loss of Appetite Less Severe

·                                 Low Energy Less Severe

Infrequent side effects of Irenka:
·                                 Feeling Faint Severe

·                                 Abnormal Dreams Less Severe

·                                 Altered Interest in Having Sexual Intercourse Less Severe

·                                 Anxious Less Severe

·                                 Blurred Vision Less Severe

·                                 Chills Less Severe

·                                 Cough Less Severe

·                                 Feeling Restless Less Severe

·                                 Feeling Weak Less Severe

·                                 Gas Less Severe

·                                 Head Pain Less Severe

·                                 Inability to have an Erection Less Severe

·                                 Indigestion Less Severe

·                                 Involuntary Quivering Less Severe

·                                 Itching Less Severe

·                                 Muscle Spasm Less Severe

·                                 Orgasm Problems Less Severe

·                                 Problem with Ejaculation Less Severe

·                                 Sensation of Spinning or Whirling Less Severe

·                                 Sleep Disorder Less Severe

·                                 Sluggishness Less Severe

·                                 Temporary Redness of Face and Neck Less Severe

·                                 Urination During the Night Less Severe

·                                 Weight Gain Less Severe

·                                 Weight Loss Less Severe

·                                 Yawning Less Severe

Rare side effects of Irenka:
·                                 Abnormal Liver Function Tests Severe

·                                 Angle-Closure Glaucoma caused by Another Disease Severe

·                                 Behaving with Excessive Cheerfulness and Activity Severe

·                                 Bleeding of the Stomach or Intestines Severe

·                                 Burning Stomach Severe

·                                 Erythema Multiforme Severe

·                                 Extrapyramidal Reaction Severe

·                                 Feeling of Throat Tightness Severe

·                                 Giant Hives Severe

·                                 Having a Rapid Heart Action - Supraventricular Tachycardia Severe

·                                 Having Thoughts of Suicide Severe

·                                 Heart Attack Severe

·                                 Hemorrhage Severe

·                                 Hepatitis Severe

·                                 Increased Risk of Bleeding Severe

·                                 Inflammation of Blood Vessels in the Skin Severe

·                                 Inflammation of the Large Intestine Severe

·                                 Life Threatening Allergic Reaction Severe

·                                 Liver Failure Severe

·                                 Low Amount of Sodium in the Blood Severe

·                                 Mild Degree of Mania Severe

·                                 Myoclonus Severe

·                                 Seizures Severe

·                                 Serotonin Syndrome - Adverse Drug Interaction Severe

·                                 Stevens-Johnson Syndrome Severe

·                                 Stomach Ulcer Severe

·                                 Suicidal Severe

·                                 Syndrome of Inappropriate Antidiuretic Hormone Secretion Severe

·                                 Underactive Thyroid Severe

·                                 Voluntary Movement Difficulty Severe

·                                 Yellowing of Skin or Eyes from Bile Flow Problems Severe

·                                 Abnormal Manner of Walking Less Severe

·                                 Aggressive Behavior Less Severe

·                                 Bad Breath Less Severe

·                                 Bleeding Not Related to Menstrual Period Less Severe

·                                 Blood Pressure Drop Upon Standing Less Severe

·                                 Bruise Less Severe

·                                 Burping Less Severe

·                                 Cannot Empty Bladder Less Severe

·                                 Collection of Clotted Blood in an Organ, Space or Tissue Less Severe

·                                 Confused Less Severe

·                                 Contact Dermatitis Less Severe

·                                 Difficult or Painful Urination Less Severe

·                                 Difficulty Speaking Less Severe

·                                 Dilated Pupil Less Severe

·                                 Discharge of Milk in Men or Women when Not Breastfeeding Less Severe

·                                 Dry Eye Less Severe

·                                 Earache Less Severe

·                                 Easily Angered or Annoyed Less Severe

·                                 Excess Urination Less Severe

·                                 Excessive Thirst Less Severe

·                                 Extreme Discomfort in Calves when Sitting or Lying Down Less Severe

·                                 Fast Heartbeat Less Severe

·                                 Feeling Cold Less Severe

·                                 Grinding of the Teeth Less Severe

·                                 Heart Throbbing or Pounding Less Severe

·                                 Hemorrhage of Blood Under the Skin Less Severe

·                                 High Blood Pressure Less Severe

·                                 High Blood Sugar Less Severe

·                                 High Cholesterol Less Severe

·                                 Hives Less Severe

·                                 Indifferent Behavior Less Severe

·                                 Lockjaw Less Severe

·                                 Mood Changes Less Severe

·                                 Needing to Urinate Immediately Less Severe

·                                 Night Sweats Less Severe

·                                 Nosebleed Less Severe

·                                 Not Feeling Well Less Severe

·                                 Numbness Less Severe

·                                 Numbness and Tingling Less Severe

·                                 Painful, Red or Swollen Mouth Less Severe

·                                 Rash Less Severe

·                                 Redness of Skin Less Severe

·                                 Ringing in the Ears Less Severe

·                                 Stomach Cramps Less Severe

·                                 Sun-Sensitive Skin Less Severe

·                                 Taste Problems Less Severe

·                                 Testicular Pain Less Severe

·                                 Throat Pain Less Severe

·                                 Twitching Less Severe

Precautions
Before taking duloxetine, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially of: personal or family history of psychiatric disorders (such as bipolar/manic-depressive disorder), personal or family history of suicide attempts, bleeding problems, personal or family history of glaucoma (angle-closure type), kidney disease, liver disease, seizure disorder, stomach problems (such as slow emptying of the stomach), use/abuse of alcohol.

This drug may make you dizzy or drowsy. Do not drive, use machinery, or do any activity that requires alertness until you are sure you can perform such activities safely. Avoid alcoholic beverages.

If you have diabetes, duloxetine may affect your blood sugar levels. Check your blood sugar levels regularly as directed by your doctor. Your doctor may need to adjust your diabetes medication, exercise program, or diet.

Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).

Older adults may be more sensitive to the side effects of this drug, especially bleeding, dizziness, lightheadedness, or loss of coordination. Older adults may also be more likely to develop a type of salt imbalance (hyponatremia), especially if they are taking "water pills" (diuretics). Dizziness, lightheadedness, or loss of coordination can increase the risk of falling.

Children may be more sensitive to the side effects of this drug, especially loss of appetite and weight loss. Monitor weight and height in children who are taking this drug. See also Warning.

During pregnancy, this medication should be used only when clearly needed. It may harm an unborn baby. Also, babies born to mothers who have used this drug during the last 3 months of pregnancy may infrequently develop withdrawal symptoms such as feeding/breathing difficulties, seizures, muscle stiffness, or constant crying. If you notice any of these symptoms in your newborn, tell the doctor promptly.

Since untreated mental/mood problems (such as depression, anxiety) can be a serious condition, do not stop taking this medication unless directed by your doctor. If you are planning pregnancy, become pregnant, or think you may be pregnant, immediately discuss the benefits and risks of using this medication during pregnancy with your doctor.

This drug passes into breast milk and may have undesirable effects on a nursing infant. Consult your doctor before breast-feeding.

Interactions
Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.

Some products that may interact with this drug include: other drugs that can cause bleeding/bruising (including antiplatelet drugs such as clopidogrel, NSAIDs such as ibuprofen, "blood thinners" such as warfarin).

Other medications can affect the removal of duloxetine from your body, which may affect how duloxetine works. Examples include cimetidine, certain quinolone antibiotics (such as ciprofloxacin, enoxacin), among others.

This medication can slow down the removal of other medications from your body, which may affect how they work. Examples of affected drugs include antiarrhythmic drugs (such as propafenone, flecainide, quinidine), antipsychotics (such as thioridazine), tricyclic antidepressants (such as desipramine, imipramine), among others.

Taking MAO inhibitors with this medication may cause a serious (possibly fatal) drug interaction. Avoid taking MAO inhibitors (isocarboxazid, linezolid, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, selegiline, tranylcypromine) during treatment with this medication. Most MAO inhibitors should also not be taken for two weeks before and at least 5 days after treatment with this medication. Ask your doctor when to start or stop taking this medication.

The risk of serotonin syndrome/toxicity increases if you are also taking other drugs that increase serotonin. Examples include street drugs such as MDMA/"ecstasy," St. John's wort, certain antidepressants (including SSRIs such as fluoxetine/paroxetine, other SNRIs such as desvenlafaxine/venlafaxine), tryptophan, among others. The risk of serotonin syndrome/toxicity may be more likely when you start or increase the dose of these drugs.

Tell your doctor or pharmacist if you are taking other products that cause drowsiness including alcohol, antihistamines (such as cetirizine, diphenhydramine), drugs for sleep or anxiety (such as alprazolam, diazepam, zolpidem), muscle relaxants, and narcotic pain relievers (such as codeine). Check the labels on all your medicines (such as allergy or cough-and-cold products) because they may contain ingredients that cause drowsiness. Ask your pharmacist about using those products safely.

Aspirin can increase the risk of bleeding when used with this medication. However, if your doctor has directed you to take low-dose aspirin for heart attack or stroke prevention (usually at dosages of 81-325 milligrams a day), you should continue taking it unless your doctor instructs you otherwise.

Overdose
If overdose is suspected, contact a poison control center or emergency room immediately. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: severe drowsiness, fainting.

Notes
Do not share this medication with others.

Keep all regular medical and psychiatric appointments. Laboratory and/or medical tests (such as blood pressure, liver function) should be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.

Missed Dose
If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose and resume your usual dosing schedule. Do not double the dose to catch up.

Storage
Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.

Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

Information last revised March 2015. Copyright(c) 2015 First Databank, Inc.