Effects of Varying Degrees of Renal Impairment on the Pharmacokinetics of Duloxetine

Lobo, Evelyn D.; Heathman, Michael; Kuan, Han-Yi; Reddy, Shobha; O’Brien, Lisa M.; Gonzales, Celedon; Skinner, Michael H.; Knadler, Mary Pat

doi:10.2165/11319330-000000000-00000

Cited by 41 publications

(13 citation statements)

References 27 publications

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“… 86 A pharmacokinetics study of 12 individuals with ESRD and 12 healthy controls found that the clearance of duloxetine was more than 2 times longer in patients with ESRD compared with controls. 88 The product insert for duloxetine in the United States currently recommends not using this medication when the creatinine clearance is <30 ml/min, due to decreased clearance by the kidneys. 86 However, regulatory agencies outside the United States have suggested that it can be used at lower doses with careful titration.…”

Section: Treatmentmentioning

confidence: 99%

See 1 more Smart Citation

Depression in Chronic Kidney Disease and End-Stage Renal Disease: Similarities and Differences in Diagnosis, Epidemiology, and Management

Shirazian

Grant

Aina

et al. 2017

Kidney International Reports

226

201

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Depression is highly prevalent and is associated with poor quality of life and increased mortality among adults with chronic kidney disease (CKD), including those with end-stage renal disease (ESRD). However, there are several important differences in the diagnosis, epidemiology, and management of depression between patients with non−dialysis-dependent CKD and ESRD. Understanding these differences may lead to a better understanding of depression in these 2 distinct populations. First, diagnosing depression using self-reported questionnaires may be less accurate in patients with ESRD compared with CKD. Second, although the prevalence of interview-based depression is approximately 20% in both groups, the risk factors for depression may vary. Third, potential mechanisms of depression might also differ in CKD versus ESRD. Finally, considerations regarding the type and dose of antidepressant medications vary between CKD and ESRD. Future studies should further examine the mechanisms of depression in both groups, and test interventions to prevent and treat depression in these populations.

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Section: Treatmentmentioning

confidence: 99%

“… 86 However, regulatory agencies outside the United States have suggested that it can be used at lower doses with careful titration. 88 …”

Section: Treatmentmentioning

confidence: 99%

Depression in Chronic Kidney Disease and End-Stage Renal Disease: Similarities and Differences in Diagnosis, Epidemiology, and Management

Shirazian

Grant

Aina

et al. 2017

Kidney International Reports

226

201

View full text Add to dashboard Cite

show abstract

“…Duloxetine undergoes hepatic metabolism and renal excretion. The parent drug is highly protein bound (95.7%) with a large volume of distribution, and is not well‐dialysed . The C max and AUC of duloxetine and its inactive metabolites were elevated at least twofold in ESRD patients.…”

Section: Neuropathic Painmentioning

confidence: 99%

An Approach to Pain Management in End Stage Renal Disease: Considerations for General Management and Intradialytic Symptoms

Koncicki

Brennan

Vinen

2015

Seminars in Dialysis

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The prevalence and severity of symptoms in patients with advanced chronic kidney disease is higher than those of the general population and comparable to those with other chronic and serious medical conditions. Despite the prevalence and severity in this population, symptoms continue to be under-recognized and inadequately managed. The recognition of specific intradialytic pain syndromes such as pain related to arteriovenous access, headaches, muscle cramps or generalized pain by providers may aid in improving patient compliance and quality of life. The approach to pain management in end stage renal disease patients follows that of the general population with specific considerations regarding clearance and potential side effects guiding selection of agents. Overall, evidence is limited regarding the pharmacology of many medications in this population.

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“…As a whole, all SNRIs are renally cleared and have associated dosing adjustments in CKD; however, it is only recommended that duloxetine should be avoided in patients with creatinine clearance <30 mL/min, primarily due to an ~2-fold higher area under the curve in those with ESRD 22,23. Venlafaxine is primarily metabolized by CYP2D6 into its active metabolite O-desmethyldesvenlafaxine, and to a lesser extent by CYP3A4 24.…”

mentioning

confidence: 99%

Pharmacotherapeutic considerations for chronic pain in chronic kidney and end-stage renal disease

Mathew¹,

Bettinger²,

Wegrzyn³

et al. 2016

JPR

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Effects of Varying Degrees of Renal Impairment on the Pharmacokinetics of Duloxetine

Cited by 41 publications

References 27 publications

Depression in Chronic Kidney Disease and End-Stage Renal Disease: Similarities and Differences in Diagnosis, Epidemiology, and Management

Depression in Chronic Kidney Disease and End-Stage Renal Disease: Similarities and Differences in Diagnosis, Epidemiology, and Management

An Approach to Pain Management in End Stage Renal Disease: Considerations for General Management and Intradialytic Symptoms

Pharmacotherapeutic considerations for chronic pain in chronic kidney and end-stage renal disease

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