Duloxetine and venlafaxine

Duloxetine and venlafaxine

Drug monograph · NCLEX study reference
Trade names	Cymbalta, Effexor
Therapeutic class	Antidepressant, antianxiety, neuropathic analgesic
Pharmacologic class	Serotonin-norepinephrine reuptake inhibitors (SNRIs)
Onset / peak / duration	Mood effect over 2 to 4 weeks.
Half-life / level	Duloxetine about 12 hours, venlafaxine ER longer; level not routine.
Routes	PO (oral)
High-alert (ISMP)	No
Black box warning	Yes (see Safety)
Antidote / reversal	Supportive care.
Pregnancy / lactation	Use when benefit outweighs risk.

Nursing pharmacology study reference (NCLEX-style monograph). Numeric values are standard teaching ranges for study and must be verified against current manufacturer labeling before clinical use. This is educational content, not prescribing guidance.

Duloxetine and venlafaxine (brand names Cymbalta, Effexor) — Antidepressant, antianxiety, neuropathic analgesic; Serotonin-norepinephrine reuptake inhibitors (SNRIs).

Identification

• Therapeutic class: Antidepressant, antianxiety, neuropathic analgesic.
• Pharmacologic class: Serotonin-norepinephrine reuptake inhibitors (SNRIs).

Pharmacology

• Mechanism of action: Block reuptake of serotonin and norepinephrine.
• Onset / peak / duration: Mood effect over 2 to 4 weeks.
• Half-life / therapeutic level: Duloxetine about 12 hours, venlafaxine ER longer; level not routine.

Clinical use

• Indications: Depression, anxiety; duloxetine also diabetic neuropathy and fibromyalgia; venlafaxine also panic.
• Usual dose, route, frequency: PO daily; venlafaxine ER once daily.
• Maximum dose / adjustments: Avoid duloxetine in significant hepatic or renal impairment; taper to stop (venlafaxine withdrawal can be marked).

Safety

• Contraindications: MAO inhibitor within 14 days; duloxetine in uncontrolled narrow-angle glaucoma.
• Black box warning: Suicidality in those under 25.
• Interactions: Serotonergic drugs, NSAIDs and anticoagulants, other CYP interactions.
• Pregnancy / lactation: Use when benefit outweighs risk.
• High-alert: No.

Adverse effects

• Common side effects: Nausea, dry mouth, sweating, increased blood pressure (venlafaxine), insomnia.
• Serious effects to report: Suicidal thoughts, serotonin syndrome, hypertension (venlafaxine), hepatotoxicity (duloxetine), bleeding.
• Antidote / reversal: Supportive care.

Nursing process

• Assessment before administration: Mood and suicide risk, blood pressure, hepatic and renal function.
• Interventions during therapy: Monitor blood pressure (venlafaxine); taper to stop.
• Monitor: Mood, suicidality, blood pressure, LFTs (duloxetine).
• Evaluation / expected outcome: Improved mood, anxiety, or neuropathic pain.

Patient teaching

• Patient teaching: Do not stop abruptly; report worsening mood.
• Notify provider if: Suicidal thoughts, agitation with fever, severe headache (high blood pressure).
• Administration tips: Swallow ER and capsules whole; consistent timing.