TEST CATALOG ORDERING & RESULTS SPECIMEN HANDLING CUSTOMER SERVICE EDUCATION & INSIGHTS
Test Catalog

Test ID: DULOX    
Duloxetine, Serum

Useful For Suggests clinical disorders or settings where the test may be helpful

Monitoring serum concentration during therapy 

 

Evaluating potential toxicity 

 

Evaluating patient compliance

Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

Duloxetine is an antidepressant of the serotonin-norepinephrine reuptake inhibitor class. It is effective in treating symptoms of depression, including physical pain associated with depression; other uses include therapy of neuropathic pain, fibromyalgia, and urinary stress incontinence. Duloxetine also inhibits serotonin uptake in human platelets, and may be associated with potentiation of bleeding.

 

Duloxetine undergoes extensive hepatic biotransformation to numerous inactive metabolites. The drug is metabolized by CYP1A2 and CYP2D6, with moderate potential for drug interactions (duloxetine is both a substrate and a moderate inhibitor of CYP2D6). The mean elimination half-life is 12.5 hours with steady-state concentrations occurring in about 3 days. Specimens for therapeutic monitoring should be drawn immediately before the next scheduled dose (ie, trough).

 

Duloxetine is not recommended for patients with hepatic impairment, substantial alcohol use, or chronic liver disease. Use in patients with renal disease significantly increases exposure to duloxetine due to decreased elimination. Patients with mild-to-moderate renal dysfunction should be monitored closely; use of duloxetine is not recommended in end-stage renal disease.

Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.

30-120 ng/mL

Interpretation Provides information to assist in interpretation of the test results

Therapeutic ranges are not well-established, but literature suggests that patients receiving duloxetine monotherapy for depression responded well when trough concentrations were 60 to 120 ng/mL. Higher levels may be tolerated by individual patients. The therapeutic relevance of this concentration range to other uses of duloxetine therapy is currently unknown.

Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances

Specimens that are obtained from gel tubes or anticoagulate collections can cause assay interference.

Clinical Reference Recommendations for in-depth reading of a clinical nature

1. Hiemke C, Bergemann N, Clement HW, et al: Consensus Guidelines for Therapeutic Drug Monitoring in Neuropsychopharmacology: Update 2017. Pharmacopsychiatry 2018 Jan;51(1-02):9-62

2. Westanmo AD, Gayken J, Haight R: Duloxetine: a balanced and selective norepinephrine- and serotonin-reuptake inhibitor. Am J Health-Syst Pharm 2005 Dec;62(23):2481-2490

3. Waldschmitt C, Vogel F, Pfuhlmann B, Hiemke C: Duloxetine serum concentrations and clinical effects. Data from a therapeutic drug monitoring (TDM) survey. Pharmacopsychiatry 2009 Sep;42(5):189-193

4. Feighner JP, Cohn JB: Double-blind comparative trials of Fluoxetine and doxepin in geriatric patients with major depressive disorder. J Clin Psychiatry 1985 Mar;46(3 Pt 2):20-25

5. Kelly MW, Perry PJ, Holstad SG, Garvey MJ: Serum fluoxetine and norfluoxetine concentrations and antidepressant response. Ther Drug Monit 1989;11:165-170

6. Benfield P, Heel RC, Lewis SP: Fluoxetine: a review of its pharmacodynamic and pharmacokinetic properties, and therapeutic efficacy in depressive illness. Drugs 1986 Dec;32(6):481-508

7. Wille SM, Cooreman SG, Neels, et al: Relevant issues in the monitoring and toxicology of antidepressants. Crit Rev Clin Lab Sci 2008;45(1):25-89