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Duloxetine Sprinkle Capsules and Quin-G

Determining the interaction of Duloxetine Sprinkle Capsules and Quin-G and the possibility of their joint administration.

Check result:
Duloxetine Sprinkle Capsules <> Quin-G
Relevance: 13.11.2022 Reviewer: Shkutko P.M., M.D., in

In the database of official manuals used in the service creation an interaction registered by statistical results of studies was found, which can either lead to negative consequences for the patient health or strengthen a mutual positive effect. A doctor should be consulted to address the issue of joint drug administration.

Consumer:

QuiNIDine may increase the blood levels and effects of DULoxetine. You may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. Let your doctor know if your condition changes or you experience increased side effects of DULoxetine such as nausea, dry mouth, insomnia, drowsiness, constipation, or any unusual symptoms. If you have high blood pressure, you may need closer monitoring of your blood pressure while you are receiving these medications. You should also avoid activities requiring mental alertness such as driving or operating machinery until you know how these medications affect you. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Professional:

MONITOR: Coadministration with inhibitors of CYP450 2D6 may increase the plasma concentrations of duloxetine, which is partially metabolized by the isoenzyme. According to the product labeling, concomitant use of duloxetine (40 mg once daily) with paroxetine (20 mg once daily) resulted in an approximately 60% increase in duloxetine systemic exposure (AUC), and greater degrees of inhibition are expected with higher dosages of paroxetine. Although not studied, a similar interaction should be anticipated with other potent CYP450 2D6 inhibitors such as fluoxetine or quinidine. Theoretically, high plasma levels of duloxetine may increase the risk of serious adverse effects such as hypertension, hypertensive crisis, increased heart rate, orthostatic hypotension, syncope, and serotonin syndrome. Serotonin syndrome is a rare but serious and potentially fatal condition thought to result from hyperstimulation of brainstem 5-HT1A and 2A receptors. Symptoms may include mental status changes such as irritability, altered consciousness, confusion, hallucinations, and coma; autonomic dysfunction such as tachycardia, hyperthermia, diaphoresis, shivering, blood pressure lability, and mydriasis; neuromuscular abnormalities such as hyperreflexia, myoclonus, tremor, and ataxia; and gastrointestinal symptoms such as abdominal cramping, nausea, vomiting, and diarrhea.

MANAGEMENT: Caution is advised if duloxetine is used in combination with CYP450 2D6 inhibitors, particularly potent ones like paroxetine, fluoxetine, or quinidine. Pharmacologic response to duloxetine should be monitored more closely whenever a CYP450 2D6 inhibitor is added to or withdrawn from therapy, and the dosage adjusted as necessary.

References
  • Skinner MH, Kuan HY, Pan A, et al. "Duloxetine is both an inhibitor and a substrate of cytochrome P4502D6 in healthy volunteers." Clin Pharmacol Ther 73 (2003): 170-7
  • "Product Information. Cymbalta (duloxetine)." Lilly, Eli and Company, Indianapolis, IN.
Duloxetine Sprinkle Capsules

Generic Name: duloxetine

Brand name: Cymbalta, Irenka, Drizalma Sprinkle

Synonyms: Duloxetine, DULoxetine

Quin-G

Generic Name: quinidine

Brand name: Quin-G, Cardioquin, Quinora, Quinidex Extentabs, Quinaglute Dura-Tabs, Quin-Release

Synonyms: n.a.

In the course of checking the drug compatibility and interactions, data from the following reference sources was used: Drugs.com, Rxlist.com, Webmd.com, Medscape.com.

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