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Duloxetine 20 mg gastro-resistant capsules, hard
Duloxetine 40 mg gastro-resistant capsules, hard
Duloxetine (as hydrochloride)
Read all of this leaflet carefully before you start using this
medicine because it contains important information for you.
- Keep this leaflet. You may need to read it again.
- If you have any further questions, ask your doctor or
- 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 side effects, talk to your doctor or pharmacist.
This includes any possible side effects not listed in this leaflet.
See section 4.
What is in this leaflet
1. What Duloxetine is and what it is used for
2. What you need to know before you take Duloxetine
3. How to take Duloxetine
4. Possible side effects
5. How to store Duloxetine
6. Contents of the pack and other information
1. What Duloxetine is and what it is used for
Duloxetine contains the active substance duloxetine. Duloxetine
increases the levels of serotonin and noradrenaline in the nervous
Duloxetine is a medicine to be taken by mouth to treat Stress
Urinary Incontinence (SUI) in women.
Stress urinary incontinence is a medical condition in which patients
have accidental loss or leakage of urine during physical exertion or
activities such as laughing, coughing, sneezing, lifting, or exercise.
Duloxetine is believed to work by increasing the strength of the
muscle that holds back urine when you laugh, sneeze, or perform
physical activities.
The efficacy of Duloxetine is reinforced when combined with a
training program called Pelvic Floor Muscle Training (PFMT).
2. What you need to know before you take Duloxetine
Do not take Duloxetine:
- 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')
- are taking fluvoxamine which is usually used to treat
depression, ciprofloxacin or enoxacin which are used to treat
some infections
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 if you:
- are taking medicines to treat depression (see 'Other medicines
and Duloxetine')
- are taking St. John's Wort, a herbal treatment (Hypericum
- 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
- 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')
Duloxetine may cause a sensation of restlessness or an inability to
sit or stand still. You should tell your doctor if this happens to you.
Thoughts of suicide and worsening of depression or anxiety
Although Duloxetine is not indicated for the treatment of
depression, its active ingredient (duloxetine) is used as an
antidepressant medicine. 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
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.
Children and adolescents under 18 years of age
Duloxetine should 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. Also,
the long-term safety effects concerning growth, maturation, and
cognitive and behavioural development of Duloxetine in this age
group have not yet been demonstrated.



Duloxetine 20 & 40 mg

Package leaflet: Information for the user


Duloxetine 20 & 40 mg

Pharmacode position may change as per Supplier's m/c requirement &additional
small pharma code may appear on the front / back panel

Other medicines and Duloxetine
Tell your doctor or pharmacist if you are taking, have recently taken
or might take any other medicines.
The main ingredient of Duloxetine, duloxetine, is used in other
medicines for other conditions:
• diabetic neuropathic pain, depression, anxiety and urinary
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 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
Monoamine oxidase inhibitors (MAOIs):You should not take
Duloxetine if you are taking or have recently taken (within the last
14 days) an 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. Also, you need to wait at least 5 days
after you stop taking Duloxetine before you take a MAOI.
Medicines that cause sleepiness:These include medicines
prescribed by your doctor including benzodiazepines, strong
painkillers, antipsychotics, phenobarbital and sedative
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, you should see your
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 with food ,drink and alcohol
Duloxetine may be taken with or without food. You should take
extra care if you drink alcohol while taking Duloxetine.
Pregnancy , breast-feeding and fertility
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.

You should use Duloxetine only after discussing the potential
benefits and any potential risks to your unborn child with your

Make sure your midwife and/or doctor knows you are on
Duloxetine. 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 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.

Tell your doctor if you are breast-feeding. The use of Duloxetine
while breastfeeding is not recommended. You should ask your
doctor or pharmacist for advice.

Driving and using machines
Duloxetine may make you feel sleepy or dizzy. Do not drive or use
any tools or machines until you know how Duloxetine affects you.
3. How to take Duloxetine
Always take this medicine exactly as your doctor or pharmacist
has told you. Check with your doctor or pharmacist if you are not
Duloxetine is for oral use. You should swallow your capsule whole
with a drink of water.
The recommended dose of Duloxetine is 40 mg twice a day (in the
morning and late afternoon/evening). Your doctor may decide to
start your treatment with 20 mg twice a day for two weeks before
increasing the dose to 40 mg twice a day.
To help you remember to take Duloxetine, you may find it easier to
take it at the same times every day.
Do not stop taking Duloxetine, 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 than you should
Call your doctor or pharmacist immediately if you take more than
the amount of Duloxetine 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
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 that has been prescribed for you in one day.

Some patients, who suddenly stop taking Duloxetine after more
than 1 week of therapy, 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 or nurse.

abnormal periods, including heavy, painful, irregular or
prolonged periods, unusually light or missed periods, abnormal
production of breast milk
falls (mostly in elderly people), abnormal gait

Very rare side effects (may affect up to 1 in 10,000 people)
• inflammation of the blood vessels in the skin (cutaneous
Reporting of side effects
If you get any side effects, talk to your doctor, pharmacist or
nurse.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 Yellow Card Scheme.
By reporting side effects, you can help provide more information on
the safety of this medicine.
5. How to store Duloxetine
Keep this medicine out of the sight and reach of children.

4. Possible side effects

This medicinal product does not require any special storage

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 short time.

Do not use this medicine after the expiry date which is stated on
the label, carton and bottle after EXP.The expiry date refers to the
last day of that month.

Very common side effects (may affect more than 1 in
10 people)
• feeling sick (nausea), dry mouth, constipation
• fatigue
Common side effects (may affect up to 1 in 10 people)
• lack of appetite
• trouble sleeping, feeling agitated, less sex drive, anxiety,
difficulty sleeping
• headache, dizziness, feeling sluggish, feeling sleepy, tremor,
numbness, including numbness, pricking or tingling of the skin
• blurred eyesight
• feeling of dizziness or “spinning” (vertigo)
• increased blood pressure, flushing
• diarrhoea, stomach pain, being sick (vomiting), heartburn or
• increased sweating
• weakness, shivering
Uncommon side effects (may affect up to 1 in 100 people )
• throat inflammation that causes a hoarse voice
• allergic reactions
• decreased thyroid gland activity which can cause tiredness or
weight gain
• dehydration
• grinding or clenching the teeth, feeling disorientated, lack of
motivation, difficulty or failure to experience orgasm, unusual
• feeling nervous, difficulty concentrating, changes in sense of
taste, poor sleep quality
• large pupils (the dark centre of the eye), problems with
eyesight, eyes feel dry
• tinnitus (hearing sound in the ear when there is no external
sound), ear pain
• feeling the heart pumping in the chest, fast and/or irregular
heart beat
• fainting
• increased yawning
• vomiting blood, or black tarry stools (faeces), gastroenteritis,
inflammation of the mouth, burping, difficulty swallowing,
breaking wind, bad breath
• inflammation of the liver that may cause abdominal pain and
yellowing of the skin or whites of the eyes
• (itchy) rash, night sweats, hives, cold sweats, increased
tendency to bruise
• muscle pain, muscle tightness, muscle spasm, contraction of
the jaw muscle
• difficulty to start urinating, painful urination, needing to pass
urine during the night, frequent urination, abnormal urine odour
• abnormal vaginal bleeding, menopausal symptoms
• chest pain, feeling cold, thirst, feeling hot
• weight loss, weight gain
• Duloxetine 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
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
• 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, suicidal thoughts, 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, sudden involuntary jerks or twitches of the
muscles, sensation of restlessness or an inability to sit or stand
still, difficulty controlling movement e.g. lack of coordination or
involuntary movements of the muscles, restless legs syndrome
• increased pressure in the eye (glaucoma)
• dizziness, lightheadedness or fainting on standing up, cold
fingers and/or toes
• throat tightness, nose bleeds
• passing bright red blood in your stools
• liver failure, yellowing of the skin or whites of the eyes
• 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),
sensitivity to sunlight
• muscle twitching
• difficulty or inability to pass urine, needing to pass more urine
than normal, having a decreased urine flow

Do not throw away any medicines via wastewater or household
waste. Ask your pharmacist how to throw away medicines no
longer required. These measures will help to protect the
6. Contents of the pack and other information
What Duloxetine contains
- The active substance is duloxetine.
Each capsule contains 20 mg of duloxetine (as hydrochloride).
Each capsule contains 40 mg of duloxetine (as hydrochloride).
- The other ingredients are
Capsule contents:
Sugar spheres, hypromellose, hydroxy propyl cellulose,
crospovidone (Type B), talc, triethylcitrate, titanium dioxide,
hypromellose phthalate
Capsule shell:
Cap: Iron oxide yellow (E172) (20 mg only), titanium dioxide, FD &
C Blue (20 mg only), indigo carmine (40 mg only), gelatin, sodium
lauryl sulfate.
Body: Iron oxide yellow (E172), iron oxide red (E172) (40 mg only),
titanium dioxide, FD & C Blue (20 mg only), gelatin, sodium lauryl
Printing ink: Shellac, propylene glycol, iron oxide black (E172),
potassium hydroxide.
What Duloxetine looks like and contents of the pack
Gastro-resistant capsule, hard
Duloxetine 20 mg gastro-resistant capsules, hard
Green opaque /green opaque, size “4” hard gelatin capsules filled
with white to off white pellets and imprinted with “DLX” on green
opaque cap and "20" on green opaque body with black ink
Duloxetine 40 mg gastro- resistant capsules, hard
Blue opaque /orange opaque, size “2” hard gelatin capsules filled
with white to off white pellets and imprinted with "DLX" on blue
opaque cap and "40" on orange opaque body with black ink
Duloxetine capsules are available in PVC/ Polyamide/ Aluminium
foil/ PVC Aluminium foil blister pack and HDPE bottle pack with
polypropylene closure containing silica gel as desiccant.
Pack sizes:
Blister packs: 14, 28, 56 and 98 capsules, hard
HDPE bottle pack: 30, 98, 250 and 1000 capsules, hard
Not all pack sizes may be marketed.
Marketing Authorisation Holder
Milpharm Limited
Ares Block, Odyssey Business Park
West End Road
Ruislip HA4 6QD
United Kingdom
APL Swift Services (Malta) Limited
HF26, Hal Far Industrial Estate, Hal Far
Birzebbugia, BBG 3000
Milpharm Limited
Ares Block, Odyssey Business Park
West End Road
Ruislip HA4 6QD
United Kingdom
This leaflet was last revised in 01/2016.


If you stop taking Duloxetine
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 he or she will ask you to reduce your dose
over 2 weeks.

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