DULOXETINE 30 MG HARD GASTRO-RESISTANT CAPSULES - patient leaflet, side effects, dosage

1. What Duloxetine capsule is and what it is used for

bought without a prescription and herbal remedies, before checking with your doctor.

Duloxetine capsule contains the active substance duloxetine. Duloxetine capsule increases the levels of serotonin and noradrenaline in the nervous system.

Duloxetine capsule 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 capsules 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 capsules 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.

You should also tell your doctor if you are taking any of the following:

Monoamine oxidase inhibitors (MAOIs): You should not take Duloxetine capsules 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, 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 capsules. Also, you need to wait at least 5 days after you stop taking Duloxetine capsules 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

2. What you need to know before you take Duloxetine capsules

venlafaxine), tricyclic antidepressants (such as clomipramine, amitriptyline), pethidine, buprenorphine, St John's Wort and mAois (such as moclobemide and

DO NOT take Duloxetine capsules if you:

• - 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 capsules’)

• - 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 capsules’)

Talk to your doctor if you have high blood pressure or heart disease. Your doctor will tell you if you should be taking duloxetine.

Warnings and precautions

The following are reasons why duloxetine may not be suitable for you. Talk to your doctor before you take Duloxetine capsules if you:

• - are taking other medicines to treat depression (see ‘Other medicines and Duloxetine capsules’)

• - 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 capsules’)

Duloxetine capsules 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 capsules (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

linezolid). These medicines increase the risk of side effects; if you get any unusual symptom taking any of these medicines together with duloxetine, 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 capsules with food, drink and alcohol Duloxetine capsules may be taken with or without food. Care should be taken if you drink alcohol while you are being treated with Duloxetine capsules.

Pregnancy and breast-feeding

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 capsules. You should use duloxetine 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 capsules. 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 capsules 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.
• Ifyou take Duloxetine capsules nearthe end ofyour 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 advice you.
• Tell your doctor if you are breast-feeding. The use of Duloxetine capsules while breastfeeding is not recommended. You should ask your doctor or pharmacist for advise.

Driving and using machines

Duloxetine capsules may make you feel sleepy or dizzy. Do not drive or use any tools or machines until you know how Duloxetine capsules affects you.

Duloxetine capsules contains sucrose

Duloxetine capsule 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.

If you have thoughts of harming or killing yourself at any time, contact your doctor or go to a hospital straight away.

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.

3. How to take Duloxetine capsules

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 capsule is for oral use. You should swallow your capsule whole with a drink of water. Do not crush or chew.

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For depression and diabetic neuropathic pain:

The usual dose of Duloxetine capsule is 60 mg once a day, but your doctor will prescribe the dose that is right for you.

For generalised anxiety disorder:

The usual starting dose of Duloxetine capsule 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.

To help you remember to take Duloxetine capsules, 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 capsules. Do not stop taking Duloxetine capsules, 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.

If you take more Duloxetine capsules than you should Call your doctor or pharmacist immediately if you take more than the amount of Duloxetine capsules 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 forget to take Duloxetine capsules

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 capsules that has been prescribed for you in one day.

If you stop taking Duloxetine capsules

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 capsules 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 capsules 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.

Rare side effects (may affect up to 1 in 1000 people)

• 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)

Very rare side effects (may affect up to 1 in 10,000 people)

• inflammation of the blood vessels in the skin (cutaneous vasculitis)

Reporting of side effects

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

For UK

Yellow Card Scheme

Website: or search for MHRA Yellow Card in the Google Play or Apple App Store

For Malta

ADR Reporting

Website: By reporting side effects you can help provide more information on the safety of this medicine.

4. Possible side effects

5. How to store Duloxetine capsules

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.

Very common side effects (may affect more than 1 in 10 people)

• 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.

Uncommon side effects (may affect up to 1 in 100 people)

• 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 capsules 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

6. Contents of the pack and other information

What Duloxetine capsule contains The active substance is duloxetine.

Each capsule contains 30 or 60 mg of duloxetine (as hydrochloride).

The other ingredients are:

Capsule content: sugar spheres (containing maize starch and sucrose), hypromellose 2910 (E464), crospovidone (type B), talc, sucrose, carboxy methyl ethyl cellulose, povidone, titanium dioxide (E171), Macrogol (E1521), Polysorbate 80 (E433) (See end of section 2 for further information on sucrose).

Capsule shell (for 30 mg strength): gelatin, titanium dioxide (E171), sodium laurilsulphate, indigo carmine (E132).

Capsule shell (for 60 mg strength): gelatin, titanium dioxide (E171), sodium laurilsulphate, indigo carmine (E132), Iron oxide yellow (E172).

Edible gold ink (for 30 mg strength): shellac (E904), propylene glycol, yellow iron oxide (E172).

Edible white ink (for 60 mg strength): shellac (E904), propylene glycol, potassium hydroxide, titanium dioxide (E171).

What Duloxetine capsule looks like and contents of the pack

Duloxetine capsule is a gastro-resistant capsule, hard. Each capsule of Duloxetine capsule contains pellets of duloxetine hydrochloride with a covering to protect them from stomach acid.

Duloxetine capsule is available in 30 mg and 60 mg strengths.

The 30 mg capsules are opaque blue cap and opaque white body size “3” (15.80 ± 0.40 mm), imprinted with “H” on cap and “191” on body, filled with white to off with colored pellets.

The 60 mg capsules are opaque blue cap and opaque green body size “1” (19.30 ± 0.40 mm), imprinted with “H” on cap and “192” on body, filled with white to off with colored pellets.

Duloxetine capsule is available in:

30 mg: blister packs of 7, 10, 14, 28, 28×1, 30, 90, 98, 98×1 and 100 capsules.

60 mg: blister packs of 10, 14, 28, 28×1, 30, 90, 98, 98×1 and 100 capsules.

Not all pack sizes may be marketed.

Marketing Authorisation Holder and Manufacturer:

Marketing Authorisation Holder

United Kingdom

Accord Healthcare Limited Sage House, 319 Pinner Road North Harrow, Middlesex, HA1 4HF, United Kingdom

Malta

Accord Healthcare Ireland Limited Euro House, Euro Business Park Little Island, Cork T45 K857, Ireland

Manufacturer:

Pharmadox Healthcare Ltd.

KW20A Kordin Industrial Park, Paola, PLA 3000, Malta

This leaflet was last revised in 09/2020.

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