Duloxetine

• Moderate–severe stress urinary incontinence (adjunct to pelvic floor training)
• Depression / GAD / diabetic neuropathy

Serotonin + noradrenaline reuptake inhibition → central Onuf's nucleus stimulation → ↑ urethral sphincter tone.

• Physio + duloxetine >> either alone
• Start low — nausea is the top drop-out reason
• Suicidal ideation warning in <25s

SUI start

20 mg BD × 2 weeks

SUI maintain

40 mg BD

Depression

60 mg OD; max 120 mg/day

• AbsoluteConcurrent MAOI
• AbsoluteSevere hepatic/renal impairment
• AbsoluteUncontrolled narrow-angle glaucoma

• Nausea (50%)
• Dry mouth, constipation
• Insomnia, dizziness
• Hepatotoxicity, hypertension
• Discontinuation syndrome

• • Limited data — avoid in pregnancy; if unavoidable, standard SSRI/SNRI cautions apply

• MAOIs / tramadol / linezolid

  Avoid

  Serotonin syndrome

• CYP1A2 inhibitors (ciprofloxacin, fluvoxamine)

  Caution

  ↑ duloxetine levels

• 💡 Titrate slowly and take with food to survive the nausea window
• 💡 Assess at 3 months — if no benefit, stop and refer for surgical options