Does duloxetine interact with diclofenac sodium? (1+ risks)

This article will discuss the potential interactions between duloxetine and diclofenac sodium. Additionally, the article will highlight the benefits of taking duloxetine and diclofenac sodium together for certain conditions. 

Lastly, the article will provide recommendations for safely using these medications concurrently.

Does duloxetine interact with diclofenac sodium?

Duloxetine may interact with diclofenac sodium. However, combining duloxetine and diclofenac sodium is typically considered safe for most people. 

Combining the two medications can increase the risk of bleeding due to their combined effect on platelet function. Both medications can increase the risk of gastrointestinal ulcers and bleeding when taken concurrently. In rare cases, they may also increase the risk of liver injury.

If you are concerned about the potential interactions between both medications, you should discuss this with your doctor.

What are the interactions between duloxetine and diclofenac sodium?

The most significant interactions that may occur between duloxetine and diclofenac are mentioned below:

Risk of increased bleeding

Serotonin is essential for preventing bleeding. When a blood vessel is injured, it undergoes temporary constriction to reduce blood loss. This triggers the activation of platelets, which then release serotonin [1].

Serotonin maintains the constriction of the vessel and also activates surrounding platelets and immune cells through serotonin receptors. Duloxetine is an SNRI that blocks the serotonin transporter (SERT), responsible for transporting serotonin back into nerve terminals and removing it from the synaptic cleft [1].

Since platelets also have serotonin transporters, using duloxetine may reduce serotonin storage in platelets, potentially decreasing platelet aggregation and increasing the risk of bleeding [1].

Diclofenac acts by blocking the synthesis of prostaglandins through the inhibition of cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2) enzymes. However, it should be noted that cyclooxygenase enzymes are also involved in the synthesis of thromboxane A2 [2].

As a result, diclofenac disrupts thromboxane-mediated platelet aggregation, leading to a delay in clotting and an increase in bleeding time. Therefore, taking both medications together can increase the risk of bleeding.

Other antidepressants that may similarly increase the risk of bleeding if taken with diclofenac sodium include Celexa and Sertraline.

Risk of liver injury

Chronic use of diclofenac has been linked to high serum aminotransferase levels in 15% of patients, with only 2–4% of these cases showing levels that are higher than 3x the upper limit. Over 100 cases of liver damage have been reported, making diclofenac one of the top 10 causes of drug-induced liver injury [3].

Furthermore, around 1% of patients taking duloxetine may experience liver test abnormalities. Moreover, although rare, there have been reported instances of acute liver injury in patients using duloxetine, with or without jaundice. This potential side effect can also lead to dark urine [4].

While duloxetine-induced hepatocellular liver injury is more common, mixed and cholestatic patterns have also been observed. Researchers have given it a hepatotoxicity likelihood score of B, indicating it is a likely cause of clinically apparent liver injury [4].

Thus, the concurrent use of diclofenac sodium and duloxetine has the potential to increase the risk of liver injury, particularly in individuals with existing liver disease or other risk factors.

What are the benefits of taking duloxetine and diclofenac sodium together?

There are multiple potential benefits of taking duloxetine and diclofenac sodium together.

For instance, combining duloxetine’s neuropathic pain-management properties with diclofenac’s analgesic and anti-inflammatory effects can enhance the treatment of osteoarthritis-related pain. This combination can especially enhance duloxetine’s effectiveness in reducing back pain in osteoarthritis. 

Furthermore, if someone who is taking duloxetine for depression or anxiety experiences pain, adding diclofenac sodium to their treatment regimen or taking it as needed can be helpful.

How to safely take duloxetine and diclofenac sodium together?

People who may experience interactions when taking duloxetine and diclofenac sodium together include those with pre-existing liver problems, a history of gastrointestinal bleeding, or individuals who are taking other medications that also increase the risk of bleeding or liver injury.

The following recommendations can help ensure the safe and effective use of duloxetine and diclofenac sodium:

Consult with your doctor and adhere to their advice

To safely take both medications together, it is recommended to consult with your healthcare provider first. They will review your medical history and assess your risks. This will help them determine the most appropriate way to take these medications together.

It is crucial to adhere to the prescribed dosages and take the doses at the times suggested by your doctor, as some individuals may unknowingly take high doses of diclofenac, increasing the risk of side effects. Therefore, understanding and following the appropriate dosages are essential.

Monitor signs of interactions

Furthermore, if you have risk factors for liver injury or bleeding, it is recommended that you regularly monitor your liver function tests, complete blood count (CBC), and bleeding time. This will aid in identifying any potential interactions or side effects early on.

Lastly, it is important to be aware of symptoms of liver injury or bleeding, such as abdominal pain, dark urine, unusual bruising, or prolonged bleeding. If you experience any unusual symptoms, informing your doctor as soon as possible is advised.

It is important to note that interactions between duloxetine and diclofenac sodium are generally considered to be safe for most individuals. However, it is always important to exercise caution when combining medications. In contrast, certain medications, such as lamotrigine, may have potential risks when combined with duloxetine. 

In conclusion, based on my research, I found that duloxetine may interact with diclofenac sodium, increasing the risk of bleeding and liver injury. However, I believe that combining these medications is generally considered safe for most individuals.

From my perspective, I recommend closely monitoring your liver function tests, complete blood count, and bleeding time if you have risk factors for liver injury or bleeding. It is also advisable to adhere to the prescribed dosages and regularly communicate with your doctor when taking both medications together. 

Furthermore, I believe that combining duloxetine’s neuropathic pain-management properties with diclofenac’s analgesic and anti-inflammatory effects can enhance the treatment of pain, specifically in osteoarthritis. However, it is essential to be aware of any unusual symptoms and inform your doctor promptly.

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