Category C—Human Data Suggest Risk in 3rd Trimester
RID < 1%, the long-term effects on neurobehavior and cognitive development from exposure to potent SNRIs and SSRIs during a period of rapid CNS development have not been adequately studied. Therefore, the best course is to avoid duloxetine, if possible, during nursing. In 2001, the American Academy of Pediatrics classified antidepressants as drugs for which the effect on nursing infants is unknown but may be of concern.
Start at a 30 mg qd for 2 weeks before considering ↑ to 60 mg target dose; watch for hypoNa+ at doses > 60 mg in the elderly
Avoid use in patients with severe renal impairment, GFR <30 mL/min
Avoid use in patients with chronic liver disease or cirrhosis