Was this medicine useful for you?

 No   Yes 

• Duzela indications
• Uses of Duzela in details
• Duzela description
• Duzela dosage
• Duzela interactions
• Duzela side effects
• Duzela contraindications

What is Duzela?

Duzela is a selective serotonin and norepinephrine reuptake inhibitor antidepressant (SSNRI). Duzela affects chemicals in the brain that may become unbalanced and cause depression.

Duzela is used to treat major depressive disorder in adults. Duzela is also used to treat general anxiety disorder in adults and children who are at least 7 years old.

Duzela is also used in adults to treat fibromyalgia (a chronic pain disorder), or chronic muscle or joint pain (such as low back pain and osteoarthritis pain).

Duzela is also used to treat pain caused by nerve damage in adults with diabetes (diabetic neuropathy).

Duzela may also be used for purposes not listed in this medication guide.

Duzela indications

Duzela® is indicated for the treatment of:

• Major Depressive Disorder
• Generalized Anxiety Disorder
• Diabetic Peripheral Neuropathy
• Fibromyalgia
• Chronic Musculoskeletal Pain

How should I use Duzela?

Use Duzela delayed-release capsules as directed by your doctor. Check the label on the medicine for exact dosing instructions.

• Duzela delayed-release capsules comes with an extra patient information sheet called a Medication Guide. Read it carefully. Read it again each time you get Duzela delayed-release capsules refilled.
• Take Duzela delayed-release capsules by mouth with or without food. Taking it with food may help to decrease the chance of nausea or stomach upset.
• Swallow Duzela delayed-release capsules whole. Do not break, crush, or chew before swallowing. Do not open the capsule and sprinkle the contents on food or in liquid.
• Take Duzela delayed-release capsules on a regular schedule to get the most benefit from it. Taking Duzela delayed-release capsules at the same time each day will help you remember to take it.
• Continue to take Duzela delayed-release capsules even if you feel well. Do not miss any doses.
• Do not suddenly stop taking Duzela delayed-release capsules without checking with your doctor. Side effects may occur. They may include anxiety, numbness or tingling of the skin, diarrhea, dizziness, headache, increased sweating, irritability, nausea, trouble sleeping, unusual tiredness, or vomiting. If you need to stop Duzela delayed-release capsules, your doctor may need to gradually lower your dose.
• If you miss a dose of Duzela delayed-release capsules, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.

Ask your health care provider any questions you may have about how to use Duzela delayed-release capsules.

Uses of Duzela in details

Use: Labeled Indications

Fibromyalgia (delayed-release particles capsule only): Management of fibromyalgia.

Generalized anxiety disorder: Treatment of generalized anxiety disorder.

Major depressive disorder (unipolar): Treatment of unipolar major depressive disorder.

Musculoskeletal pain, chronic: Management of chronic musculoskeletal pain including osteoarthritis of the knee and low back pain.

Neuropathic pain associated with diabetes mellitus: Management of pain associated with diabetic peripheral neuropathy.

Off Label Uses

Chemotherapy-induced peripheral neuropathy

Data from a randomized, double-blind, placebo-controlled study support the use of Duzela in the treatment of pain, numbness, and tingling associated with chemotherapy-induced peripheral neuropathy. Subgroup analyses suggest efficacy may be greater for oxaliplatin-induced neuropathy as opposed to paclitaxel-induced neuropathy

American College of Physicians (ACP) guidelines on nonsurgical management of urinary incontinence recommend against pharmacologic therapy in women with stress urinary incontinence and note that although low-quality, placebo-controlled studies of Duzela demonstrate beneficial effects, these effects have not been confirmed by data from high-quality studies.

National Institute for Health and Care Excellence (NICE) evidence-based guidelines on the management of urinary incontinence and pelvic organ prolapse in women state that Duzela should not be considered as first-line treatment for women with predominant stress urinary incontinence nor routinely used as second-line treatment for women with stress urinary incontinence. However, Duzela may be considered as second-line therapy for women who decline surgical treatment or who are not suitable candidates for surgical treatment.

Duzela description

The active ingredient in Duzela is Duzela.

Each Duzela 30 mg & 60 mg capsule contains 30 mg & 60 mg of Duzela as Duzela respectively.

Excipients/Inactive Ingredients: Capsule Content: Hypromellose, hypromellose acetate succinate, sucrose, sugar spheres, talc, titanium dioxide (E171), triethyl citrate.

Capsule Shell: 30 mg: Gelatin, sodium lauryl sulfate, titanium dioxide (E171), indigo carmine (E132), edible green ink.

60 mg: Gelatin, sodium lauryl sulfate, titanium dioxide (E171), indigo carmine (E132), yellow iron oxide (E172), edible white ink.

Edible Green Ink Contains: Black Iron Oxide-Synthetic (E172), yellow iron oxide-synthetic (E172), propylene glycol, shellac.

Edible White Ink Contains: Titanium Dioxide (E171), propylene glycol, shellac, povidone.

Duzela dosage

Duzela Dosage

Generic name: Duzela 40mg

Dosage form: capsule, delayed release

The information at Drugs.com is not a substitute for medical advice. Always consult your doctor or pharmacist.

Swallow Duzela whole. Do not chew or crush. Do not open the capsule and sprinkle its contents on food or mix with liquids. All of these might affect the enteric coating. Duzela can be given without regard to meals. If a dose of Duzela is missed, take the missed dose as soon as it is remembered. If it is almost time for the next dose, skip the missed dose and take the next dose at the regular time. Do not take two doses of Duzela at the same time.

Dosage for Treatment of Major Depressive Disorder

Administer Duzela at a total dose of 40 mg/day (given as 20 mg twice daily) to 60 mg/day (given either once daily or as 30 mg twice daily). For some patients, it may be desirable to start at 30 mg once daily for 1 week, to allow patients to adjust to the medication before increasing to 60 mg once daily. While a 120 mg/day dose was shown to be effective, there is no evidence that doses greater than 60 mg/day confer any additional benefits. The safety of doses above 120 mg/day has not been adequately evaluated. Periodically reassess to determine the need for maintenance treatment and the appropriate dose for such treatment.

Dosage for Treatment of Generalized Anxiety Disorder

Adults

For most patients, initiate Duzela 60 mg once daily. For some patients, it may be desirable to start at 30 mg once daily for 1 week, to allow patients to adjust to the medication before increasing to 60 mg once daily. While a 120 mg once daily dose was shown to be effective, there is no evidence that doses greater than 60 mg/day confer additional benefit. Nevertheless, if a decision is made to increase the dose beyond 60 mg once daily, increase dose in increments of 30 mg once daily. The safety of doses above 120 mg once daily has not been adequately evaluated. Periodically reassess to determine the continued need for maintenance treatment and the appropriate dose for such treatment.

​ Elderly

​ Initiate Duzela at a dose of 30 mg once daily for 2 weeks before considering an increase to the target dose of 60 mg. Thereafter, patients may benefit from doses above 60 mg once daily. If a decision is made to increase the dose beyond 60 mg once daily, increase dose in increments of 30 mg once daily. The maximum dose studied was 120 mg per day. Safety of doses above 120 mg once daily has not been adequately evaluated.

​ Children and Adolescents (7 to 17 years of age)

​ Initiate Duzela at a dose of 30 mg once daily for 2 weeks before considering an increase to 60 mg. The recommended dose range is 30 to 60 mg once daily. Some patients may benefit from doses above 60 mg once daily. If a decision is made to increase the dose beyond 60 mg once daily, increase dose in increments of 30 mg once daily. The maximum dose studied was 120 mg per day. The safety of doses above 120 mg once daily has not been evaluated.

Dosage for Treatment of Diabetic Peripheral Neuropathic Pain

Administer Duzela 60 mg once daily. There is no evidence that doses higher than 60 mg confer additional significant benefit and the higher dose is clearly less well tolerated. For patients for whom tolerability is a concern, a lower starting dose may be considered.

Since diabetes is frequently complicated by renal disease, consider a lower starting dose and gradual increase in dose for patients with renal impairment.

Dosage for Treatment of Chronic Musculoskeletal Pain

Administer Duzela 60 mg once daily. Begin treatment at 30 mg for one week, to allow patients to adjust to the medication before increasing to 60 mg once daily. There is no evidence that higher doses confer additional benefit, even in patients who do not respond to a 60 mg dose, and higher doses are associated with a higher rate of adverse reactions.

Dosing in Special Populations

Hepatic Impairment

Avoid use in patients with chronic liver disease or cirrhosis.

Severe Renal Impairment

Avoid use in patients with severe renal impairment, GFR <30 mL/min.

Discontinuing Duzela

Adverse reactions after discontinuation of Duzela, after abrupt or tapered discontinuation, include: dizziness, headache, nausea, diarrhea, paresthesia, irritability, vomiting, insomnia, anxiety, hyperhidrosis, and fatigue. A gradual reduction in dosage rather than abrupt cessation is recommended whenever possible.

Switching a Patient to or from a Monoamine Oxidase Inhibitor (MAOI) Intended to Treat Psychiatric Disorders

At least 14 days should elapse between discontinuation of an MAOI intended to treat psychiatric disorders and initiation of therapy with Duzela. Conversely, at least 5 days should be allowed after stopping Duzela before starting an MAOI intended to treat psychiatric disorders.

Use of Duzela with Other MAOIs such as Linezolid or Methylene Blue

Do not start Duzela in a patient who is being treated with linezolid or intravenous methylene blue because there is an increased risk of serotonin syndrome. In a patient who requires more urgent treatment of a psychiatric condition, other interventions, including hospitalization, should be considered.

In some cases, a patient already receiving Duzela therapy may require urgent treatment with linezolid or intravenous methylene blue. If acceptable alternatives to linezolid or intravenous methylene blue treatment are not available and the potential benefits of linezolid or intravenous methylene blue treatment are judged to outweigh the risks of serotonin syndrome in a particular patient, Duzela should be stopped promptly, and linezolid or intravenous methylene blue can be administered. The patient should be monitored for symptoms of serotonin syndrome for 5 days or until 24 hours after the last dose of linezolid or intravenous methylene blue, whichever comes first. Therapy with Duzela may be resumed 24 hours after the last dose of linezolid or intravenous methylene blue.

The risk of administering methylene blue by non-intravenous routes (such as oral tablets or by local injection) or in intravenous doses much lower than 1 mg/kg with Duzela is unclear. The clinician should, nevertheless, be aware of the possibility of emergent symptoms of serotonin syndrome with such use.

More about Duzela (Duzela)

• Side Effects
• During Pregnancy or Breastfeeding
• Dosage Information
• Drug Images
• Drug Interactions
• Support Group
• Pricing & Coupons
• En Espanol
• 0 Reviews - Add your own review/rating

Consumer resources

• Duzela
• Duzela (Advanced Reading)

• Other brands: Duzela

Professional resources

• Duzela (FDA)
• Duzela (AHFS Monograph)

Related treatment guides

• Back Pain
• Chronic Pain
• Depression
• Diabetic Peripheral Neuropathy
• Generalized Anxiety Disorder
• More (1) »

Duzela interactions

See also:
What other drugs will affect Duzela?

Potential for Other Drugs to Affect Duzela

Both CYP1A2 and CYP2D6 are responsible for Duzela metabolism

Inhibitors of CYP1A2 Concomitant use of Duzela with fluvoxamine, an inhibitor of CYP1A2, results in approximately a 6-fold increase in AUC and about a 2.5-fold increase in Cmax of Duzela. Some quinolone antibiotics would be expected to have similar effects and these combinations should be avoided

Inhibitors of CYP2D6 Because CYP2D6 is involved in Duzela metabolism, concomitant use of Duzela with potent inhibitors of CYP2D6 may result in higher concentrations of Duzela. Paroxetine (20 mg QD) increased the concentration of Duzela (40 mg QD) by about 60%, and greater degrees of inhibition are expected with higher doses of paroxetine. Similar effects would be expected with other potent CYP2D6 inhibitors (e.g., fluoxetine, quinidine).

Potential for Duzela to Affect Other Drugs

Drugs Metabolized by CYP1A2 In vitro drug interaction studies demonstrate that Duzela does not induce CYP1A2 activity, and it is unlikely to have a clinically significant effect on the metabolism of CYP1A2 substrates.

Drugs Metabolized by CYP2D6 Duzela is a moderate inhibitor of CYP2D6. When Duzela was administered (at a dose of 60 mg BID) in conjunction with a single 50-mg dose of desipramine, a CYP2D6 substrate, the AUC of desipramine increased 3-fold. Therefore, co-administration of Duzela with other drugs that are extensively metabolized by this isozyme and which have a narrow therapeutic index, including certain antidepressants (tricyclic antidepressants [TCAs], such as nortriptyline, amitriptyline, and imipramine), phenothiazines and Type 1C antiarrhythmics (e.g., propafenone, flecainide), should be approached with caution. Plasma TCA concentrations may need to be monitored and the dose of the TCA may need to be reduced if a TCA is co-administered with Duzela. Because of the risk of serious ventricular arrhythmias and sudden death potentially associated with elevated plasma levels of thioridazine, Duzela and thioridazine should not be co-administered.

Drugs Metabolized by CYP3A Results of in vitro studies demonstrate that Duzela does not inhibit or induce CYP3A activity.

Duzela May Have a Clinically Important Interaction with the Following Other Drugs:

Alcohol When Duzela and ethanol were administered several hours apart so that peak concentrations of each would coincide, Duzela did not increase the impairment of mental and motor skills caused by alcohol.

In the Duzela clinical trials database, three Duzela-treated patients had liver injury as manifested by ALT and total bilirubin elevations, with evidence of obstruction. Substantial intercurrent ethanol use was present in each of these cases, and this may have contributed to the abnormalities seen

CNS Acting Drugs Given the primary CNS effects of Duzela, it should be used with caution when it is taken in combination with or substituted for other centrally acting drugs, including those with a similar mechanism of action.

Potential for Interaction with Drugs that Affect Gastric Acidity Duzela has an enteric coating that resists dissolution until reaching a segment of the gastrointestinal tract where the pH exceeds 5.5. In extremely acidic conditions, Duzela, unprotected by the enteric coating, may undergo hydrolysis to form naphthol. Caution is advised in using Duzela in patients with conditions that may slow gastric emptying (e.g., some diabetics). Drugs that raise the gastrointestinal pH may lead to an earlier release of Duzela. However, co-administration of Duzela with aluminum- and magnesium-containing antacids (51 mEq) or Duzela with famotidine, had no significant effect on the rate or extent of Duzela absorption after administration of a 40-mg oral dose. It is unknown whether the concomitant administration of proton pump inhibitors affects Duzela absorption.

Duzela side effects

See also:
What are the possible side effects of Duzela?

The following serious adverse reactions are described below and elsewhere in the labeling:

• Suicidal Thoughts and Behaviors in Children, Adolescents and Young Adults
• Hepatotoxicity
• Orthostatic Hypotension, Falls and Syncope
• Serotonin Syndrome
• Abnormal Bleeding
• Severe Skin Reactions
• Discontinuation of Treatment with Duzela
• Activation of Mania/Hypomania
• Angle-Closure Glaucoma
• Seizures
• Effect on Blood Pressure
• Clinically Important Drug Interactions
• Hyponatremia
• Urinary Hesitation and Retention

Clinical Trial Data Sources

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.

The stated frequencies of adverse reactions represent the proportion of individuals who experienced, at least once, a treatment-emergent adverse reaction of the type listed. A reaction was considered treatment-emergent if it occurred for the first time or worsened while receiving therapy following baseline evaluation. Reactions reported during the studies were not necessarily caused by the therapy, and the frequencies do not reflect investigator impression (assessment) of causality.

Adults

The data described below reflect exposure to Duzela in placebo-controlled trials for MDD (N=3779), GAD (N=1018), OA (N=503), CLBP (N=600), DPNP (N=906), and FM (N=1294). The population studied was 17 to 89 years of age; 65.7%, 60.8%, 60.6%, 42.9%, and 94.4% female; and 81.8%, 72.6%, 85.3%, 74.0%, and 85.7% Caucasian for MDD, GAD, OA and CLBP, DPNP, and FM, respectively. Most patients received doses of a total of 60 to 120 mg per day. The data below do not include results of the trial examining the efficacy of Duzela in patients ≥ 65 years old for the treatment of generalized anxiety disorder; however, the adverse reactions observed in this geriatric sample were generally similar to adverse reactions in the overall adult population.

Children And Adolescents

The data described below reflect exposure to Duzela in pediatric, 10-week, placebo-controlled trials for MDD (N=341) and GAD (N=135). The population studied (N=476) was 7 to 17 years of age with 42.4% children age 7 to 11 years of age, 50.6% female, and 68.6% white. Patients received 30-120 mg per day during placebo-controlled acute treatment studies. Additional data come from the overall total of 822 pediatric patients (age 7 to 17 years of age) with 41.7% children age 7 to 11 years of age and 51.8% female exposed to Duzela in MDD and GAD clinical trials up to 36-weeks in length, in which most patients received 30-120 mg per day.

Adverse Reactions Reported As Reasons For Discontinuation Of Treatment In Adult Placebo-Controlled Trials

Major Depressive Disorder

Approximately 8.4% (319/3779) of the patients who received Duzela in placebo-controlled trials for MDD discontinued treatment due to an adverse reaction, compared with 4.6% (117/2536) of the patients receiving placebo. Nausea (Duzela 1.1%, placebo 0.4%) was the only common adverse reaction reported as a reason for discontinuation and considered to be drug-related (i.e., discontinuation occurring in at least 1% of the Duzela-treated patients and at a rate of at least twice that of placebo).

Generalized Anxiety Disorder

Approximately 13.7% (139/1018) of the patients who received Duzela in placebo-controlled trials for GAD discontinued treatment due to an adverse reaction, compared with 5.0% (38/767) for placebo. Common adverse reactions reported as a reason for discontinuation and considered to be drug-related (as defined above) included nausea (Duzela 3.3%, placebo 0.4%), and dizziness (Duzela 1.3%, placebo 0.4%).

Diabetic Peripheral Neuropathic Pain

Approximately 12.9% (117/906) of the patients who received Duzela in placebo-controlled trials for DPNP discontinued treatment due to an adverse reaction, compared with 5.1% (23/448) for placebo. Common adverse reactions reported as a reason for discontinuation and considered to be drug-related (as defined above) included nausea (Duzela 3.5%, placebo 0.7%), dizziness (Duzela 1.2%, placebo 0.4%), and somnolence (Duzela 1.1%, placebo 0.0%).

Fibromyalgia

Approximately 17.5% (227/1294) of the patients who received Duzela in 3 to 6 month placebo-controlled trials for FM discontinued treatment due to an adverse reaction, compared with 10.1% (96/955) for placebo. Common adverse reactions reported as a reason for discontinuation and considered to be drug-related (as defined above) included nausea (Duzela 2.0%, placebo 0.5%), headache (Duzela 1.2%, placebo 0.3%), somnolence (Duzela 1.1%, placebo 0.0%), and fatigue (Duzela 1.1%, placebo 0.1%).

Chronic Pain Due To Osteoarthritis

Approximately 15.7% (79/503) of the patients who received Duzela in 13-week, placebo-controlled trials for chronic pain due to OA discontinued treatment due to an adverse reaction, compared with 7.3% (37/508) for placebo. Common adverse reactions reported as a reason for discontinuation and considered to be drug-related (as defined above) included nausea (Duzela 2.2%, placebo 1.0%).

Chronic Low Back Pain

Approximately 16.5% (99/600) of the patients who received Duzela in 13-week, placebo-controlled trials for CLBP discontinued treatment due to an adverse reaction, compared with 6.3% (28/441) for placebo. Common adverse reactions reported as a reason for discontinuation and considered to be drug-related (as defined above) included nausea (Duzela 3.0%, placebo 0.7%), and somnolence (Duzela 1.0%, placebo 0.0%).

Most Common Adult Adverse Reactions

Pooled Trials For All Approved Indications

The most commonly observed adverse reactions in Duzela-treated patients (incidence of at least 5% and at least twice the incidence in placebo patients) were nausea, dry mouth, somnolence, constipation, decreased appetite, and hyperhidrosis.

Diabetic Peripheral Neuropathic Pain

The most commonly observed adverse reactions in Duzela-treated patients (as defined above) were nausea, somnolence, decreased appetite, constipation, hyperhidrosis, and dry mouth.

Fibromyalgia

The most commonly observed adverse reactions in Duzela-treated patients (as defined above) were nausea, dry mouth, constipation, somnolence, decreased appetite, hyperhidrosis, and agitation.

Chronic Pain Due To Osteoarthritis

The most commonly observed adverse reactions in Duzela-treated patients (as defined above) were nausea, fatigue, constipation, dry mouth, insomnia, somnolence, and dizziness.

Chronic Low Back Pain

The most commonly observed adverse reactions in Duzela-treated patients (as defined above) were nausea, dry mouth, insomnia, somnolence, constipation, dizziness, and fatigue.

Adverse Reactions Occurring At An Incidence Of 5% Or More Among Duzela-Treated Patients In Adult Placebo-Controlled Trials

Table 2 gives the incidence of treatment-emergent adverse reactions in placebo-controlled trials for approved indications that occurred in 5% or more of patients treated with Duzela and with an incidence greater than placebo.

Table 2: Treatment-Emergent Adverse Reactions: Incidence of 5% or More and Greater than Placebo in Placebo-Controlled Trials of Approved Indications Also includes initial insomnia, insomnia, middle insomnia, and terminal insomnia.

Other adverse reactions that occurred at an incidence of less than 2% but were reported by more Duzela treated patients than placebo treated patients and are associated Duzela treatment: abnormal dreams (including nightmare), anxiety, flushing (including hot flush), hyperhidrosis, palpitations, pulse increased, and tremor.

Discontinuation-emergent symptoms have been reported when stopping Duzela. The most commonly reported symptoms following discontinuation of Duzela in pediatric clinical trials have included headache, dizziness, insomnia, and abdominal pain.

Growth (Height and Weight)