Yawin 30 Gia Nguyen medicine treats severe depression, peripheral neuropathy (3 blisters x 10 tablets)

Mental disorders: insomnia, sleep abnormalities, sexual desire disorders, anxiety disorders.

Liver disease is at risk of liver failure.

Severe renal failure (Creatinine clearance

Caution when using

Hung feels and convulsions

Should be cautious in patients with a history of manic, bipolar disorder and/or convulsions.

Delivering pupils

The pupil relaxation has been reported when using duloxetin. Therefore, it is necessary to be cautious when prescribing patients with glaucoma, or those at risk of acute angle hypertrophy.

Hypertension and heart rate

duloxetin can cause hypertension, and hypertension with clinical significance in some patients. Patients with hypertension and/or other heart disease need to monitor blood pressure, especially in the first months of treatment, especially in patients who may be damaged by an increase in heart rate or hypertension.

For patients who have used drugs and see continuous hypertension, should consider reducing the dose or stopping gradually. Do not use duloxetin for initial treatment for people with uncontrolled hypertension.

kidney failure

Increased duloxetin concentration in plasma occurs in patients with severe renal impairment, dialysis (creatinine clearance

Serotonin syndrome

As well as other serotonergic drugs, when using duloxetin can cause serotonin syndrome. Especially, when using the drug simultaneously with serotonergic drugs (SSRIs, SNRIS, three -round antidepressants or Triptans), the drug reduces the metabolism of serotonin. Anti -psychosis or other dopamine antagonists may affect serotonin neurotransmitter.

Serotonin syndrome symptoms may include mental changes (agitation, hallucinations, coma), autonomous neurological instability (tachycardia, unstable blood pressure, heat increase), neuromuscular deviation (increased reflexes, loss of coordination) and/or digestive disorders (nausea, vomiting, diarrhea).

Simultaneous treatment with duloxetin and other serotonin drugs may affect the serotonin and/or dopaminergic neurotransmitter systems. Therefore, pay attention to monitor patients, especially the time to start treatment and increase the dose.

suicide

Self -death behavior has been reported during duloxetin treatment or the first time after the treatment.

severe depression and spreading anxiety disorders

Depression is associated with increasing the risk of suicide thoughts, self -damage and suicide. This risk still exists until the symptoms of depression have been significantly improved.

Diabetic peripheral pain

Children and teenagers under 18 years old

Not used for children and teenagers under 18 years old. Suicide behavior (trying to commit suicide and suicidal thoughts) and violence (mainly aggression, opposition, anger) have been observed more often in clinical trials in children and young people treated with antidepressants compared to the placebo group.

Bleeding

There have been reports on bleeding such as bruising, hemorrhage, gastrointestinal bleeding when using Serotonin (SSRI) and SSADRENALIN (SNRI) (SNRI), including Duloxetin. Be careful in patients who are taking anticoagulants and/or drugs that affect platelet function (NSAIDs, acetylsalicylic acid) and in patients easily bleeding.

Hypothensi

Most cases of hypoglycet hypoglycemia have been reported in the elderly. Caution should be careful in patients with high risk of blood sodium lowering such as elderly patients, cirrhosis, dehydration, diuretics.

Stop treatment

Cetocial syndrome when stopping treatment occurs quite common, especially sudden treatment. The severity of the cessation syndrome may depend on many factors, including time, treatment dose and dose reduction rate. Most will have mild to medium cessation syndrome, in some patients may experience strong intensity within the first few days of treatment.

These symptoms are self -limited and usually ended within 2 weeks, a few cases may last (2-3 months or more). Therefore, gradually reducing the dose when stopping treatment for a period of more than 2 weeks according to the condition of the patient.

Elderly

Be careful when treating the elderly with a dose of 120 mg/day.

Akathisia/mental disorders

The use of duloxetin may increase the development of Akathisia, symptoms that are restlessly controlled, uncomfortable limbs, need to move, unable to sit or stand still. This is most likely within the first few weeks of treatment. For patients with increased symptoms, increased duloxetin dose may be harmful.

Hepatitis/liver enzyme

Cases of liver damage, increased liver enzyme (> 10 times the upper limit of normal levels), hepatitis, jaundice have been reported when using duloxetin. Most of the above symptoms occur in the first months of treatment, so be cautious in patients taking other drugs that cause liver damage.

Note about the composition of the drug:

The product contains sucrose, so patients with rare genetic disorders in fructose tolerance, glucose absorption disorders - galactose or sucrase deficiency - Isomaltase should not use this drug.

The ability to drive and operate machinery

There is no research on the impact on the ability to drive and use machines that have been done. Patients need advice if drowsiness or dizziness should avoid driving or operating dangerous machines.

Pregnancy

fertility

duloxetin does not affect male fertility, but toxicity on the mother.

pregnancy

There is no adequate data on duloxetin use in pregnant women. Potential risks to people are unclear.

Epidemiological data suggests that the use of SSRIs during pregnancy, especially at the end of pregnancy, can increase the risk of persistent lung hypertension in infants (PPHN). Although there has been no investigation of PPHN's linkage when treating SNRI, this potential risk cannot be excluded with duloxetin, taking into account the mechanisms related to behavior (inhibiting Serotonin reabsorption).

Like with other serotonin drugs, the symptoms of cessation can occur in newborns after the mother uses short -term duloxetin. Symptoms may include tone reduction, tremor, restlessness, difficulty swallowing, respiratory failure and convulsions. Most cases occur immediately after birth or within a few days after birth.

Consider medication during pregnancy when the benefit is better than the potential risks for the fetus. Women need to notify the doctor if they are pregnant, or intend to get pregnant during treatment.

The period of breastfeeding

The safety of duloxetin in children has not been clearly defined, the use of drugs during breastfeeding is not recommended.

Drug interaction

Monoamine Oxidase Inhitors (Maois)

Due to the risk of serotonin syndrome, duloxetin should not be used in combination with Maois or within at least 14 days from the date of stopping treatment with Maois. Should wait at least 5 days after stopping using duloxetin to start using Maois.

CYP1A2 inhibitors

CYP1A2 is involved in the metabolism of duloxetin. When used simultaneously duloxetin with strong inhibitors, CYP1A2 will increase the concentration of duloxetin. Eluvoxamine (100 mg/day), a strong CYP1A2 inhibitor has reduced the clearance of duloxetin by 77% and increased AUC0 - T 6 times.

The drug impacts on the central nervous system (CNS)

The risk of using duloxetin along with CNS drugs has not been systematically evaluated, except for cases described in this section. Therefore, it is necessary to be cautious when using the drug, along with CNS, alcohol and sedatives (benzodiazepines, morphinomimetics, psychotic anti -dysplasia, phenobarbital, antihistamine).

Serotonin derivatives

In rare cases, Serotonin syndrome has been reported in patients using SSRIs/SNRIS simultaneously with other serotonin substances. Be cautious when using duloxetin with serotonin substances such as SSRIs, SNRIS, three -round antidepressants (Clomipramin, Amitriptylin), Maois (Moclobemide, Linezolid), St John Vart Hypercium Perforatum), Triptans, Tramadol, Pethidin, and Tryptophan.

The influence of duloxetin on other drugs

The effect of other drugs on duloxetin