🕷️ Crawler Inspector

URL Lookup

Direct Parameter Lookup

Raw Queries and Responses

1. Shard Calculation

Query:

Response:

Calculated Shard: 57 (from laksa073)

2. Crawled Status Check

Query:

curl -X POST \
  'http://laksa057.int.ahrefs:8124/' \
  -H 'Content-Type: text/plain' \
  -H 'X-ClickHouse-Database: crawler3' \
  -H 'Authorization: Basic YXBpOg==' \
  -d 'SELECT getAhrefsURLFromUnparsed(src_unparsed) AS found_url, ifNull(toUnixTimestamp(download_stamp), 0) AS crawl_time, ifNull(toUnixTimestamp(props_url_first_seen), 0) AS first_indexed_time, download_http_code AS http_code, src_unparsed AS src_unparsed, src_root_hash AS src_root_hash, history_drop_reason AS history_drop_reason, meta_title AS meta_title, meta_descriptions AS meta_descriptions, attrs_boilerpipe_text AS attrs_boilerpipe_text, attrs_markdown AS attrs_markdown, attrs_readable_markdown AS attrs_readable_markdown, meta_canonical AS meta_canonical FROM crawler3.page_info_local FINAL PREWHERE (src_root_hash, src_unparsed) IN ((getAhrefsRootHashFromUnparsed(getAhrefsUnparsedNoserviceFromURL(\'https://bnf.nice.org.uk/drugs/duloxetine/\')), getAhrefsUnparsedNoserviceFromURL(\'https://bnf.nice.org.uk/drugs/duloxetine/\'))) FORMAT JSONEachRow'

Response:

{"found_url":"https:\/\/bnf.nice.org.uk\/drugs\/duloxetine\/","crawl_time":1775604163,"first_indexed_time":1654306134,"http_code":200,"src_unparsed":"uk,org,nice!bnf,\/drugs\/duloxetine\/ s443","src_root_hash":"2740109274380393857","history_drop_reason":null,"meta_title":"Duloxetine | Drugs | BNF | NICE","meta_descriptions":["View duloxetine information, including dose, uses, side-effects, renal impairment, pregnancy, breast feeding, important safety information and drug action."],"attrs_boilerpipe_text":"Drug action\nDrug action\nFor duloxetine\nInhibits the re-uptake of serotonin and noradrenaline.\nIndications and dose\nFor duloxetine\nMajor depressive disorder\nfor duloxetine\nBy mouth\nAdult\n60 mg once daily, dose can be increased if necessary up to a maximum of 120 mg per day in patients who are responding to treatment and have a history of repeated episodes of major depression.\nGeneralised anxiety disorder\nfor duloxetine\nBy mouth\nAdult\nInitially 30 mg once daily, usual maintenance 60 mg once daily, dose can be increased if necessary up to a maximum of 120 mg per day.\nDiabetic neuropathy\nfor duloxetine\nBy mouth\nAdult\n60 mg once daily, discontinue if inadequate response after 2 months; review treatment at least every 3 months; dose can be increased if necessary up to a maximum of 120 mg daily in divided doses.\nModerate to severe stress urinary incontinence\nfor duloxetine\nBy mouth\nAdult (female)\n40 mg twice daily, patient should be assessed for benefit and tolerability after 2–4 weeks, alternatively initially 20 mg twice daily for 2 weeks, this can minimise side-effects, then increased to 40 mg twice daily, patient should be assessed for benefit and tolerability after 2–4 weeks.\nImportant safety information\nImportant safety information\nFor duloxetine\nSNRI antidepressant medicines: small increased risk of postpartum haemorrhage when used in the month before delivery\nSerotonin and noradrenaline re-uptake inhibitors (SNRIs) are known to increase the risk of bleeding due to their effect on platelet function. Observational data suggest that the use of SNRIs in the last month before delivery may increase the risk of postpartum haemorrhage. Healthcare professionals should continue to consider the benefits and risks of antidepressant use during pregnancy, and the risks of untreated depression in pregnancy.\nHealthcare professionals should also consider this finding in the context of individual patient risk factors for bleeding or thrombotic events. Anticoagulant medication in women at high risk of thrombotic events should not be stopped but healthcare professionals should be aware of the risk identified.\nCautions\nCautions\nFor duloxetine\nBleeding disorders; cardiac disease; elderly; history of mania; history of seizures; hypertension (avoid if uncontrolled); raised intra-ocular pressure; susceptibility to angle-closure glaucoma\nInteractions\nView interactions for\nduloxetine\nSide-effects\nSide-effects\nFor duloxetine\nCommon or very common\nAnxiety; appetite decreased; constipation; diarrhoea; dizziness; drowsiness; dry mouth; fall; fatigue; flushing; gastrointestinal discomfort; gastrointestinal disorders; headache; muscle complaints; nausea; pain; palpitations; paraesthesia; sexual dysfunction; skin reactions; sleep disorders; sweat changes; tinnitus; tremor; urinary disorders; vision disorders; vomiting; weight changes; yawning\nUncommon\nApathy; arrhythmias; behaviour abnormal; burping; chills; concentration impaired; disorientation; dysphagia; ear pain; feeling abnormal; gait abnormal; haemorrhage; hepatic disorders; hyperglycaemia; increased risk of infection; malaise; menstrual disorder; movement disorders; mydriasis; peripheral coldness; photosensitivity reaction; postural hypotension; suicidal behaviours; syncope; taste altered; temperature sensation altered; testicular pain; thirst; throat tightness; vertigo\nRare or very rare\nAngioedema; cutaneous vasculitis; dehydration; galactorrhoea; glaucoma; hallucination; hyperprolactinaemia; hypertensive crisis; hyponatraemia; hypothyroidism; interstitial lung disease; mania; menopausal symptoms; oral disorders; pneumonia eosinophilic; seizure; serotonin syndrome; SIADH; Stevens-Johnson syndrome; urine odour abnormal\nFrequency not known\nStress cardiomyopathy\nSide-effects, further information\nSymptoms of sexual dysfunction may persist after treatment has stopped.\nPregnancy\nPregnancy\nFor duloxetine\nToxicity in\nanimal\nstudies—avoid in patients with stress urinary incontinence; in other conditions use only if potential benefit outweighs risk. Risk of neonatal withdrawal symptoms if used near term.\nBreast feeding\nBreast feeding\nFor duloxetine\nPresent in milk—manufacturer advises avoid.\nHepatic impairment\nHepatic impairment\nFor duloxetine\nManufacturer advises avoid.\nRenal impairment\nRenal impairment\nFor duloxetine\nTreatment cessation\nTreatment cessation\nFor duloxetine\nNausea, vomiting, headache, anxiety, dizziness, paraesthesia, sleep disturbances, and tremor are the most common features of abrupt withdrawal or marked reduction of the dose; dose should be reduced over at least 1–2 weeks.\nPatient and carer advice\nPatient and carer advice\nFor duloxetine\nDriving and skilled tasks\nPatients and carers should be counselled on the effects on driving and performance of skilled tasks—increased risk of dizziness.\nNational funding\/access decisions\nNational funding\/access decisions\nFor Cymbalta®\nFor full details see funding body website.\nScottish Medicines Consortium (SMC) decisions\nFor Cymbalta®\nDuloxetine (\nCymbalta\n®) for diabetic peripheral neuropathic pain in adults (September 2006)\nFunding decision:\nRecommended with restrictions\nMedicinal forms\nThere can be variation in the licensing of different medicines containing the same drug.\nView  medicinal form and pricing information\nAntidepressant drugs\nDepression\nDiabetic complications\nUrinary incontinence and pelvic organ prolapse in women\nOther drugs in class\nOther drugs in class\nSerotonin and noradrenaline re-uptake inhibitors\nBupropion hydrochloride\nNaltrexone with bupropion\nVenlafaxine","attrs_markdown":"- [Skip to content](https:\/\/bnf.nice.org.uk\/drugs\/duloxetine\/#content-start)\n- [Accessibility help](https:\/\/www.nice.org.uk\/accessibility)\n\nMenu\n\n- [Guidance](https:\/\/www.nice.org.uk\/guidance)\n- [Standards and indicators](https:\/\/www.nice.org.uk\/standards-and-indicators)\n- [Clinical Knowledge Summaries (CKS)](https:\/\/cks.nice.org.uk\/)\n- [British National Formulary (BNF)](https:\/\/bnf.nice.org.uk\/)\n  - [![](data:image\/svg+xml;base64,<?xml version="1.0" encoding="UTF-8"?>
<svg id="Layer_1" data-name="Layer 1" xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink" viewBox="0 0 144.24 54.72">
  <image width="601" height="228" transform="scale(.24)" xlink:href="data:image/png;base64,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"/>
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[NICE](https:\/\/www.nice.org.uk\/)\n2. [BNF](https:\/\/bnf.nice.org.uk\/)\n3. [Drugs](https:\/\/bnf.nice.org.uk\/drugs\/)\n4. Duloxetine\n# Duloxetine\n## Navigate to section\n1. [Drug action](https:\/\/bnf.nice.org.uk\/drugs\/duloxetine\/#drug-action)\n2. [Indications and dose](https:\/\/bnf.nice.org.uk\/drugs\/duloxetine\/#indications-and-dose)\n3. [Important safety information](https:\/\/bnf.nice.org.uk\/drugs\/duloxetine\/#important-safety-information)\n4. [Cautions](https:\/\/bnf.nice.org.uk\/drugs\/duloxetine\/#cautions)\n5. [Interactions](https:\/\/bnf.nice.org.uk\/drugs\/duloxetine\/#interactions)\n6. [Side-effects](https:\/\/bnf.nice.org.uk\/drugs\/duloxetine\/#side-effects)\n7. [Pregnancy](https:\/\/bnf.nice.org.uk\/drugs\/duloxetine\/#pregnancy)\n8. [Breast feeding](https:\/\/bnf.nice.org.uk\/drugs\/duloxetine\/#breast-feeding)\n9. [Hepatic impairment](https:\/\/bnf.nice.org.uk\/drugs\/duloxetine\/#hepatic-impairment)\n10. [Renal impairment](https:\/\/bnf.nice.org.uk\/drugs\/duloxetine\/#renal-impairment)\n11. [Treatment cessation](https:\/\/bnf.nice.org.uk\/drugs\/duloxetine\/#treatment-cessation)\n12. [Patient and carer advice](https:\/\/bnf.nice.org.uk\/drugs\/duloxetine\/#patient-and-carer-advice)\n13. [National funding\/access decisions](https:\/\/bnf.nice.org.uk\/drugs\/duloxetine\/#national-funding-access-decisions)\n14. [Medicinal forms](https:\/\/bnf.nice.org.uk\/drugs\/duloxetine\/#medicinal-forms)\n15. [Related treatment summaries](https:\/\/bnf.nice.org.uk\/drugs\/duloxetine\/#related-treatment-summaries)\n16. [Other drugs in class](https:\/\/bnf.nice.org.uk\/drugs\/duloxetine\/#other-drugs-in-class)\n\n## Interactions\n[View interactions for duloxetine](https:\/\/bnf.nice.org.uk\/interactions\/duloxetine\/)\n\n## Medicinal forms and pricing\nThere can be variation in the licensing of different medicines containing the same drug.\n\n[View medicinal form and pricing information](https:\/\/bnf.nice.org.uk\/drugs\/duloxetine\/medicinal-forms\/)\n\n## Drug action\n### Drug action For duloxetine\nInhibits the re-uptake of serotonin and noradrenaline.\n\n## Indications and dose\n### For duloxetine\n#### Major depressive disorder for duloxetine\n##### By mouth\nAdult\n\n60 mg once daily, dose can be increased if necessary up to a maximum of 120 mg per day in patients who are responding to treatment and have a history of repeated episodes of major depression.\n\n#### Generalised anxiety disorder for duloxetine\n##### By mouth\nAdult\n\nInitially 30 mg once daily, usual maintenance 60 mg once daily, dose can be increased if necessary up to a maximum of 120 mg per day.\n\n#### Diabetic neuropathy for duloxetine\n##### By mouth\nAdult\n\n60 mg once daily, discontinue if inadequate response after 2 months; review treatment at least every 3 months; dose can be increased if necessary up to a maximum of 120 mg daily in divided doses.\n\n#### Moderate to severe stress urinary incontinence for duloxetine\n##### By mouth\nAdult (female)\n\n40 mg twice daily, patient should be assessed for benefit and tolerability after 2–4 weeks, alternatively initially 20 mg twice daily for 2 weeks, this can minimise side-effects, then increased to 40 mg twice daily, patient should be assessed for benefit and tolerability after 2–4 weeks.\n\n## Important safety information\n### Important safety information For duloxetine\n#### SNRI antidepressant medicines: small increased risk of postpartum haemorrhage when used in the month before delivery\nSerotonin and noradrenaline re-uptake inhibitors (SNRIs) are known to increase the risk of bleeding due to their effect on platelet function. Observational data suggest that the use of SNRIs in the last month before delivery may increase the risk of postpartum haemorrhage. Healthcare professionals should continue to consider the benefits and risks of antidepressant use during pregnancy, and the risks of untreated depression in pregnancy.\n\nHealthcare professionals should also consider this finding in the context of individual patient risk factors for bleeding or thrombotic events. Anticoagulant medication in women at high risk of thrombotic events should not be stopped but healthcare professionals should be aware of the risk identified.\n\n## Cautions\n### Cautions For duloxetine\nBleeding disorders; cardiac disease; elderly; history of mania; history of seizures; hypertension (avoid if uncontrolled); raised intra-ocular pressure; susceptibility to angle-closure glaucoma\n\n## Interactions\n[View interactions for duloxetine](https:\/\/bnf.nice.org.uk\/interactions\/duloxetine\/)\n\n## Side-effects\n### Side-effects For duloxetine\n#### Common or very common\nAnxiety; appetite decreased; constipation; diarrhoea; dizziness; drowsiness; dry mouth; fall; fatigue; flushing; gastrointestinal discomfort; gastrointestinal disorders; headache; muscle complaints; nausea; pain; palpitations; paraesthesia; sexual dysfunction; skin reactions; sleep disorders; sweat changes; tinnitus; tremor; urinary disorders; vision disorders; vomiting; weight changes; yawning\n\n#### Uncommon\nApathy; arrhythmias; behaviour abnormal; burping; chills; concentration impaired; disorientation; dysphagia; ear pain; feeling abnormal; gait abnormal; haemorrhage; hepatic disorders; hyperglycaemia; increased risk of infection; malaise; menstrual disorder; movement disorders; mydriasis; peripheral coldness; photosensitivity reaction; postural hypotension; suicidal behaviours; syncope; taste altered; temperature sensation altered; testicular pain; thirst; throat tightness; vertigo\n\n#### Rare or very rare\nAngioedema; cutaneous vasculitis; dehydration; galactorrhoea; glaucoma; hallucination; hyperprolactinaemia; hypertensive crisis; hyponatraemia; hypothyroidism; interstitial lung disease; mania; menopausal symptoms; oral disorders; pneumonia eosinophilic; seizure; serotonin syndrome; SIADH; Stevens-Johnson syndrome; urine odour abnormal\n\n#### Frequency not known\nStress cardiomyopathy\n\n### Side-effects, further information\nSymptoms of sexual dysfunction may persist after treatment has stopped.\n\n## Pregnancy\n### Pregnancy For duloxetine\nToxicity in *animal*  studies—avoid in patients with stress urinary incontinence; in other conditions use only if potential benefit outweighs risk. Risk of neonatal withdrawal symptoms if used near term.\n\n## Breast feeding\n### Breast feeding For duloxetine\nPresent in milk—manufacturer advises avoid.\n\n## Hepatic impairment\n### Hepatic impairment For duloxetine\nManufacturer advises avoid.\n\n## Renal impairment\n### Renal impairment For duloxetine\nAvoid if creatinine clearance less than 30 mL\/minute, [M](https:\/\/bnf.nice.org.uk\/about\/how-bnf-publications-are-constructed\/ \"Manufacturer information\")  see [Prescribing in renal impairment](https:\/\/bnf.nice.org.uk\/medicines-guidance\/prescribing-in-renal-impairment\/ \"Prescribing in renal impairment\").\n\n## Treatment cessation\n### Treatment cessation For duloxetine\nNausea, vomiting, headache, anxiety, dizziness, paraesthesia, sleep disturbances, and tremor are the most common features of abrupt withdrawal or marked reduction of the dose; dose should be reduced over at least 1–2 weeks.\n\n## Patient and carer advice\n### Patient and carer advice For duloxetine\n### Driving and skilled tasks\nPatients and carers should be counselled on the effects on driving and performance of skilled tasks—increased risk of dizziness.\n\n## National funding\/access decisions\n### National funding\/access decisions For Cymbalta®\nFor full details see funding body website.\n\n#### Scottish Medicines Consortium (SMC) decisions For Cymbalta®\n- [SMC No. 285\/06](https:\/\/www.scottishmedicines.org.uk\/medicines-advice\/duloxetine-30mg-and-60mg-capsules-cymbalta-fullsubmission-28506\/)\n  \n  Duloxetine (*Cymbalta* ®) for diabetic peripheral neuropathic pain in adults (September 2006)\n  \n  Funding decision:\n  \n  Recommended with restrictions\n\n## Medicinal forms\nThere can be variation in the licensing of different medicines containing the same drug.\n\n[View medicinal form and pricing information](https:\/\/bnf.nice.org.uk\/drugs\/duloxetine\/medicinal-forms\/)\n\n## Related treatment summaries\n1. [Antidepressant drugs](https:\/\/bnf.nice.org.uk\/treatment-summaries\/antidepressant-drugs\/)\n2. [Depression](https:\/\/bnf.nice.org.uk\/treatment-summaries\/depression\/)\n3. [Diabetic complications](https:\/\/bnf.nice.org.uk\/treatment-summaries\/diabetic-complications\/)\n4. [Urinary incontinence and pelvic organ prolapse in women](https:\/\/bnf.nice.org.uk\/treatment-summaries\/urinary-incontinence-and-pelvic-organ-prolapse-in-women\/)\n\n## Other drugs in class\n### Other drugs in classSerotonin and noradrenaline re-uptake inhibitors\n1. [Bupropion hydrochloride](https:\/\/bnf.nice.org.uk\/drugs\/bupropion-hydrochloride\/)\n2. [Naltrexone with bupropion](https:\/\/bnf.nice.org.uk\/drugs\/naltrexone-with-bupropion\/)\n3. [Venlafaxine](https:\/\/bnf.nice.org.uk\/drugs\/venlafaxine\/)\n\nBNF content is copyright © BMJ Publishing Group Ltd and Pharmaceutical Press, the Royal Pharmaceutical Society's knowledge business. By using BNF, you agree to the licence set out in the [BNF Publications End User Licence Agreement](https:\/\/bnf.nice.org.uk\/eula\/).\n\n[Back to top](https:\/\/bnf.nice.org.uk\/drugs\/duloxetine\/#top)\n\n- [Guidance](https:\/\/www.nice.org.uk\/guidance)\n- [Standards and indicators](https:\/\/www.nice.org.uk\/standards-and-indicators)\n- [Clinical Knowledge Summaries (CKS) Clinical Knowledge SummariesClinical Knowledge Summaries](https:\/\/cks.nice.org.uk\/)\n- [British National Formulary (BNF) British National FormularyBritish National Formulary](https:\/\/bnf.nice.org.uk\/)\n- [BNF for Children (BNFC) British National Formulary for ChildrenBritish National Formulary for Children](https:\/\/bnfc.nice.org.uk\/)\n- [Life sciences](https:\/\/www.nice.org.uk\/about\/what-we-do\/life-sciences)\n- [Library and knowledge services](https:\/\/www.nice.org.uk\/library-and-knowledge-services)\n\n- [What NICE does](https:\/\/www.nice.org.uk\/what-nice-does)\n- [Implementing NICE guidance](https:\/\/www.nice.org.uk\/implementing-nice-guidance)\n- [Get involved](https:\/\/www.nice.org.uk\/get-involved)\n- [About us](https:\/\/www.nice.org.uk\/about-us)\n- [Careers](https:\/\/www.nice.org.uk\/careers)\n- [News, blogs and podcasts](https:\/\/www.nice.org.uk\/news)\n- [Newsletters and alerts](https:\/\/www.nice.org.uk\/nice-newsletters-and-alerts)\n- [Contact us](https:\/\/www.nice.org.uk\/contact-us)\n- [Leave feedback](https:\/\/www.nice.org.uk\/forms\/leave-feedback)\n- [Reusing our content](https:\/\/www.nice.org.uk\/reusing-our-content)\n- [NICE UK Open Content Licence](https:\/\/www.nice.org.uk\/forms\/use-of-nice-content-in-the-uk)\n- [Syndicate our content](https:\/\/www.nice.org.uk\/about\/what-we-do\/nice-syndication-api)\n- [Events](https:\/\/www.nice.org.uk\/events)\n\n- [Facebook](https:\/\/en-gb.facebook.com\/NationalInstituteforHealthandCareExcellence\/)\n- [X](https:\/\/x.com\/NICEcomms)\n- [YouTube](https:\/\/www.youtube.com\/user\/NICEmedia)\n- [LinkedIn](https:\/\/www.linkedin.com\/company\/national-institute-for-health-and-clinical-excellence)\n\n- [Accessibility](https:\/\/www.nice.org.uk\/accessibility)\n- [Freedom of information](https:\/\/www.nice.org.uk\/freedom-of-information)\n- [Glossary](https:\/\/www.nice.org.uk\/glossary)\n- [Terms and conditions](https:\/\/www.nice.org.uk\/terms-and-conditions)\n- [Privacy notice](https:\/\/www.nice.org.uk\/privacy-notice)\n- [Cookies](https:\/\/www.nice.org.uk\/cookies)\n\n© NICE 2026. All rights reserved. Subject to [Notice of rights](https:\/\/www.nice.org.uk\/terms-and-conditions#notice-of-rights).","attrs_readable_markdown":"## Drug action\n### Drug action For duloxetine\nInhibits the re-uptake of serotonin and noradrenaline.\n\n## Indications and dose\n### For duloxetine\n#### Major depressive disorder for duloxetine\n##### By mouth\nAdult60 mg once daily, dose can be increased if necessary up to a maximum of 120 mg per day in patients who are responding to treatment and have a history of repeated episodes of major depression.\n\n#### Generalised anxiety disorder for duloxetine\n##### By mouth\nAdultInitially 30 mg once daily, usual maintenance 60 mg once daily, dose can be increased if necessary up to a maximum of 120 mg per day.\n\n#### Diabetic neuropathy for duloxetine\n##### By mouth\nAdult60 mg once daily, discontinue if inadequate response after 2 months; review treatment at least every 3 months; dose can be increased if necessary up to a maximum of 120 mg daily in divided doses.\n\n#### Moderate to severe stress urinary incontinence for duloxetine\n##### By mouth\nAdult (female)40 mg twice daily, patient should be assessed for benefit and tolerability after 2–4 weeks, alternatively initially 20 mg twice daily for 2 weeks, this can minimise side-effects, then increased to 40 mg twice daily, patient should be assessed for benefit and tolerability after 2–4 weeks.\n\n## Important safety information\n### Important safety information For duloxetine\n#### SNRI antidepressant medicines: small increased risk of postpartum haemorrhage when used in the month before delivery\nSerotonin and noradrenaline re-uptake inhibitors (SNRIs) are known to increase the risk of bleeding due to their effect on platelet function. Observational data suggest that the use of SNRIs in the last month before delivery may increase the risk of postpartum haemorrhage. Healthcare professionals should continue to consider the benefits and risks of antidepressant use during pregnancy, and the risks of untreated depression in pregnancy.\n\nHealthcare professionals should also consider this finding in the context of individual patient risk factors for bleeding or thrombotic events. Anticoagulant medication in women at high risk of thrombotic events should not be stopped but healthcare professionals should be aware of the risk identified.\n\n## Cautions\n### Cautions For duloxetine\nBleeding disorders; cardiac disease; elderly; history of mania; history of seizures; hypertension (avoid if uncontrolled); raised intra-ocular pressure; susceptibility to angle-closure glaucoma\n\n## Interactions\n[View interactions for duloxetine](https:\/\/bnf.nice.org.uk\/interactions\/duloxetine\/)\n\n## Side-effects\n### Side-effects For duloxetine\n#### Common or very common\nAnxiety; appetite decreased; constipation; diarrhoea; dizziness; drowsiness; dry mouth; fall; fatigue; flushing; gastrointestinal discomfort; gastrointestinal disorders; headache; muscle complaints; nausea; pain; palpitations; paraesthesia; sexual dysfunction; skin reactions; sleep disorders; sweat changes; tinnitus; tremor; urinary disorders; vision disorders; vomiting; weight changes; yawning\n\n#### Uncommon\nApathy; arrhythmias; behaviour abnormal; burping; chills; concentration impaired; disorientation; dysphagia; ear pain; feeling abnormal; gait abnormal; haemorrhage; hepatic disorders; hyperglycaemia; increased risk of infection; malaise; menstrual disorder; movement disorders; mydriasis; peripheral coldness; photosensitivity reaction; postural hypotension; suicidal behaviours; syncope; taste altered; temperature sensation altered; testicular pain; thirst; throat tightness; vertigo\n\n#### Rare or very rare\nAngioedema; cutaneous vasculitis; dehydration; galactorrhoea; glaucoma; hallucination; hyperprolactinaemia; hypertensive crisis; hyponatraemia; hypothyroidism; interstitial lung disease; mania; menopausal symptoms; oral disorders; pneumonia eosinophilic; seizure; serotonin syndrome; SIADH; Stevens-Johnson syndrome; urine odour abnormal\n\n#### Frequency not known\nStress cardiomyopathy\n\n### Side-effects, further information\nSymptoms of sexual dysfunction may persist after treatment has stopped.\n\n## Pregnancy\n### Pregnancy For duloxetine\nToxicity in *animal*  studies—avoid in patients with stress urinary incontinence; in other conditions use only if potential benefit outweighs risk. Risk of neonatal withdrawal symptoms if used near term.\n\n## Breast feeding\n### Breast feeding For duloxetine\nPresent in milk—manufacturer advises avoid.\n\n## Hepatic impairment\n### Hepatic impairment For duloxetine\nManufacturer advises avoid.\n\n## Renal impairment\n### Renal impairment For duloxetine\n\n## Treatment cessation\n### Treatment cessation For duloxetine\nNausea, vomiting, headache, anxiety, dizziness, paraesthesia, sleep disturbances, and tremor are the most common features of abrupt withdrawal or marked reduction of the dose; dose should be reduced over at least 1–2 weeks.\n\n## Patient and carer advice\n### Patient and carer advice For duloxetine\n### Driving and skilled tasks\nPatients and carers should be counselled on the effects on driving and performance of skilled tasks—increased risk of dizziness.\n\n## National funding\/access decisions\n### National funding\/access decisions For Cymbalta®\nFor full details see funding body website.\n\n#### Scottish Medicines Consortium (SMC) decisions For Cymbalta®\n- Duloxetine (*Cymbalta* ®) for diabetic peripheral neuropathic pain in adults (September 2006)\n  \n  Funding decision:Recommended with restrictions\n\n## Medicinal forms\nThere can be variation in the licensing of different medicines containing the same drug.\n\n[View medicinal form and pricing information](https:\/\/bnf.nice.org.uk\/drugs\/duloxetine\/medicinal-forms\/)\n\n1. [Antidepressant drugs](https:\/\/bnf.nice.org.uk\/treatment-summaries\/antidepressant-drugs\/)\n2. [Depression](https:\/\/bnf.nice.org.uk\/treatment-summaries\/depression\/)\n3. [Diabetic complications](https:\/\/bnf.nice.org.uk\/treatment-summaries\/diabetic-complications\/)\n4. [Urinary incontinence and pelvic organ prolapse in women](https:\/\/bnf.nice.org.uk\/treatment-summaries\/urinary-incontinence-and-pelvic-organ-prolapse-in-women\/)\n\n## Other drugs in class\n### Other drugs in classSerotonin and noradrenaline re-uptake inhibitors\n1. [Bupropion hydrochloride](https:\/\/bnf.nice.org.uk\/drugs\/bupropion-hydrochloride\/)\n2. [Naltrexone with bupropion](https:\/\/bnf.nice.org.uk\/drugs\/naltrexone-with-bupropion\/)\n3. [Venlafaxine](https:\/\/bnf.nice.org.uk\/drugs\/venlafaxine\/)","meta_canonical":null}

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Boilerpipe Text	Drug action Drug action For duloxetine Inhibits the re-uptake of serotonin and noradrenaline. Indications and dose For duloxetine Major depressive disorder for duloxetine By mouth Adult 60 mg once daily, dose can be increased if necessary up to a maximum of 120 mg per day in patients who are responding to treatment and have a history of repeated episodes of major depression. Generalised anxiety disorder for duloxetine By mouth Adult Initially 30 mg once daily, usual maintenance 60 mg once daily, dose can be increased if necessary up to a maximum of 120 mg per day. Diabetic neuropathy for duloxetine By mouth Adult 60 mg once daily, discontinue if inadequate response after 2 months; review treatment at least every 3 months; dose can be increased if necessary up to a maximum of 120 mg daily in divided doses. Moderate to severe stress urinary incontinence for duloxetine By mouth Adult (female) 40 mg twice daily, patient should be assessed for benefit and tolerability after 2–4 weeks, alternatively initially 20 mg twice daily for 2 weeks, this can minimise side-effects, then increased to 40 mg twice daily, patient should be assessed for benefit and tolerability after 2–4 weeks. Important safety information Important safety information For duloxetine SNRI antidepressant medicines: small increased risk of postpartum haemorrhage when used in the month before delivery Serotonin and noradrenaline re-uptake inhibitors (SNRIs) are known to increase the risk of bleeding due to their effect on platelet function. Observational data suggest that the use of SNRIs in the last month before delivery may increase the risk of postpartum haemorrhage. Healthcare professionals should continue to consider the benefits and risks of antidepressant use during pregnancy, and the risks of untreated depression in pregnancy. Healthcare professionals should also consider this finding in the context of individual patient risk factors for bleeding or thrombotic events. Anticoagulant medication in women at high risk of thrombotic events should not be stopped but healthcare professionals should be aware of the risk identified. Cautions Cautions For duloxetine Bleeding disorders; cardiac disease; elderly; history of mania; history of seizures; hypertension (avoid if uncontrolled); raised intra-ocular pressure; susceptibility to angle-closure glaucoma Interactions View interactions for duloxetine Side-effects Side-effects For duloxetine Common or very common Anxiety; appetite decreased; constipation; diarrhoea; dizziness; drowsiness; dry mouth; fall; fatigue; flushing; gastrointestinal discomfort; gastrointestinal disorders; headache; muscle complaints; nausea; pain; palpitations; paraesthesia; sexual dysfunction; skin reactions; sleep disorders; sweat changes; tinnitus; tremor; urinary disorders; vision disorders; vomiting; weight changes; yawning Uncommon Apathy; arrhythmias; behaviour abnormal; burping; chills; concentration impaired; disorientation; dysphagia; ear pain; feeling abnormal; gait abnormal; haemorrhage; hepatic disorders; hyperglycaemia; increased risk of infection; malaise; menstrual disorder; movement disorders; mydriasis; peripheral coldness; photosensitivity reaction; postural hypotension; suicidal behaviours; syncope; taste altered; temperature sensation altered; testicular pain; thirst; throat tightness; vertigo Rare or very rare Angioedema; cutaneous vasculitis; dehydration; galactorrhoea; glaucoma; hallucination; hyperprolactinaemia; hypertensive crisis; hyponatraemia; hypothyroidism; interstitial lung disease; mania; menopausal symptoms; oral disorders; pneumonia eosinophilic; seizure; serotonin syndrome; SIADH; Stevens-Johnson syndrome; urine odour abnormal Frequency not known Stress cardiomyopathy Side-effects, further information Symptoms of sexual dysfunction may persist after treatment has stopped. Pregnancy Pregnancy For duloxetine Toxicity in animal studies—avoid in patients with stress urinary incontinence; in other conditions use only if potential benefit outweighs risk. Risk of neonatal withdrawal symptoms if used near term. Breast feeding Breast feeding For duloxetine Present in milk—manufacturer advises avoid. Hepatic impairment Hepatic impairment For duloxetine Manufacturer advises avoid. Renal impairment Renal impairment For duloxetine Treatment cessation Treatment cessation For duloxetine Nausea, vomiting, headache, anxiety, dizziness, paraesthesia, sleep disturbances, and tremor are the most common features of abrupt withdrawal or marked reduction of the dose; dose should be reduced over at least 1–2 weeks. Patient and carer advice Patient and carer advice For duloxetine Driving and skilled tasks Patients and carers should be counselled on the effects on driving and performance of skilled tasks—increased risk of dizziness. National funding/access decisions National funding/access decisions For Cymbalta® For full details see funding body website. Scottish Medicines Consortium (SMC) decisions For Cymbalta® Duloxetine ( Cymbalta ®) for diabetic peripheral neuropathic pain in adults (September 2006) Funding decision: Recommended with restrictions Medicinal forms There can be variation in the licensing of different medicines containing the same drug. View medicinal form and pricing information Antidepressant drugs Depression Diabetic complications Urinary incontinence and pelvic organ prolapse in women Other drugs in class Other drugs in class Serotonin and noradrenaline re-uptake inhibitors Bupropion hydrochloride Naltrexone with bupropion Venlafaxine
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</svg>)](https://bnf.nice.org.uk/) - [Drugs](https://bnf.nice.org.uk/drugs/) - [Interactions](https://bnf.nice.org.uk/interactions/) - [Treatment summaries](https://bnf.nice.org.uk/treatment-summaries/) - [What's changed?](https://bnf.nice.org.uk/about/changes/) - [About BNF](https://bnf.nice.org.uk/about/) - [BNF for Children (BNFC)](https://bnfc.nice.org.uk/) - [Life sciences](https://www.nice.org.uk/about/what-we-do/life-sciences) - More from NICE [Skip More from NICE submenu](https://bnf.nice.org.uk/drugs/duloxetine/#content-start) ## Explore more from NICE - [What NICE does](https://www.nice.org.uk/what-nice-does) - [About us](https://www.nice.org.uk/about-us) - [Reusing our content](https://www.nice.org.uk/reusing-our-content) - [Implementing NICE guidance](https://www.nice.org.uk/implementing-nice-guidance) - [News, blogs and podcasts](https://www.nice.org.uk/news) - [Contact us](https://www.nice.org.uk/contact-us) - [Get involved](https://www.nice.org.uk/get-involved) - [Careers](https://www.nice.org.uk/careers) *** - [Join a committee](https://www.nice.org.uk/get-involved/our-committees) - [Comment on a consultation](https://www.nice.org.uk/get-involved/consultations) Close menu Currently viewing BNF.BNF[switch to BNFC](https://bnfc.nice.org.uk/drugs/duloxetine/?ref=switch) 1. [NICE](https://www.nice.org.uk/) 2. [BNF](https://bnf.nice.org.uk/) 3. [Drugs](https://bnf.nice.org.uk/drugs/) 4. Duloxetine # Duloxetine ## Navigate to section 1. [Drug action](https://bnf.nice.org.uk/drugs/duloxetine/#drug-action) 2. [Indications and dose](https://bnf.nice.org.uk/drugs/duloxetine/#indications-and-dose) 3. [Important safety information](https://bnf.nice.org.uk/drugs/duloxetine/#important-safety-information) 4. [Cautions](https://bnf.nice.org.uk/drugs/duloxetine/#cautions) 5. [Interactions](https://bnf.nice.org.uk/drugs/duloxetine/#interactions) 6. [Side-effects](https://bnf.nice.org.uk/drugs/duloxetine/#side-effects) 7. [Pregnancy](https://bnf.nice.org.uk/drugs/duloxetine/#pregnancy) 8. [Breast feeding](https://bnf.nice.org.uk/drugs/duloxetine/#breast-feeding) 9. [Hepatic impairment](https://bnf.nice.org.uk/drugs/duloxetine/#hepatic-impairment) 10. [Renal impairment](https://bnf.nice.org.uk/drugs/duloxetine/#renal-impairment) 11. [Treatment cessation](https://bnf.nice.org.uk/drugs/duloxetine/#treatment-cessation) 12. [Patient and carer advice](https://bnf.nice.org.uk/drugs/duloxetine/#patient-and-carer-advice) 13. [National funding/access decisions](https://bnf.nice.org.uk/drugs/duloxetine/#national-funding-access-decisions) 14. [Medicinal forms](https://bnf.nice.org.uk/drugs/duloxetine/#medicinal-forms) 15. [Related treatment summaries](https://bnf.nice.org.uk/drugs/duloxetine/#related-treatment-summaries) 16. [Other drugs in class](https://bnf.nice.org.uk/drugs/duloxetine/#other-drugs-in-class) ## Interactions [View interactions for duloxetine](https://bnf.nice.org.uk/interactions/duloxetine/) ## Medicinal forms and pricing There can be variation in the licensing of different medicines containing the same drug. [View medicinal form and pricing information](https://bnf.nice.org.uk/drugs/duloxetine/medicinal-forms/) ## Drug action ### Drug action For duloxetine Inhibits the re-uptake of serotonin and noradrenaline. ## Indications and dose ### For duloxetine #### Major depressive disorder for duloxetine ##### By mouth Adult 60 mg once daily, dose can be increased if necessary up to a maximum of 120 mg per day in patients who are responding to treatment and have a history of repeated episodes of major depression. #### Generalised anxiety disorder for duloxetine ##### By mouth Adult Initially 30 mg once daily, usual maintenance 60 mg once daily, dose can be increased if necessary up to a maximum of 120 mg per day. #### Diabetic neuropathy for duloxetine ##### By mouth Adult 60 mg once daily, discontinue if inadequate response after 2 months; review treatment at least every 3 months; dose can be increased if necessary up to a maximum of 120 mg daily in divided doses. #### Moderate to severe stress urinary incontinence for duloxetine ##### By mouth Adult (female) 40 mg twice daily, patient should be assessed for benefit and tolerability after 2–4 weeks, alternatively initially 20 mg twice daily for 2 weeks, this can minimise side-effects, then increased to 40 mg twice daily, patient should be assessed for benefit and tolerability after 2–4 weeks. ## Important safety information ### Important safety information For duloxetine #### SNRI antidepressant medicines: small increased risk of postpartum haemorrhage when used in the month before delivery Serotonin and noradrenaline re-uptake inhibitors (SNRIs) are known to increase the risk of bleeding due to their effect on platelet function. Observational data suggest that the use of SNRIs in the last month before delivery may increase the risk of postpartum haemorrhage. Healthcare professionals should continue to consider the benefits and risks of antidepressant use during pregnancy, and the risks of untreated depression in pregnancy. Healthcare professionals should also consider this finding in the context of individual patient risk factors for bleeding or thrombotic events. Anticoagulant medication in women at high risk of thrombotic events should not be stopped but healthcare professionals should be aware of the risk identified. ## Cautions ### Cautions For duloxetine Bleeding disorders; cardiac disease; elderly; history of mania; history of seizures; hypertension (avoid if uncontrolled); raised intra-ocular pressure; susceptibility to angle-closure glaucoma ## Interactions [View interactions for duloxetine](https://bnf.nice.org.uk/interactions/duloxetine/) ## Side-effects ### Side-effects For duloxetine #### Common or very common Anxiety; appetite decreased; constipation; diarrhoea; dizziness; drowsiness; dry mouth; fall; fatigue; flushing; gastrointestinal discomfort; gastrointestinal disorders; headache; muscle complaints; nausea; pain; palpitations; paraesthesia; sexual dysfunction; skin reactions; sleep disorders; sweat changes; tinnitus; tremor; urinary disorders; vision disorders; vomiting; weight changes; yawning #### Uncommon Apathy; arrhythmias; behaviour abnormal; burping; chills; concentration impaired; disorientation; dysphagia; ear pain; feeling abnormal; gait abnormal; haemorrhage; hepatic disorders; hyperglycaemia; increased risk of infection; malaise; menstrual disorder; movement disorders; mydriasis; peripheral coldness; photosensitivity reaction; postural hypotension; suicidal behaviours; syncope; taste altered; temperature sensation altered; testicular pain; thirst; throat tightness; vertigo #### Rare or very rare Angioedema; cutaneous vasculitis; dehydration; galactorrhoea; glaucoma; hallucination; hyperprolactinaemia; hypertensive crisis; hyponatraemia; hypothyroidism; interstitial lung disease; mania; menopausal symptoms; oral disorders; pneumonia eosinophilic; seizure; serotonin syndrome; SIADH; Stevens-Johnson syndrome; urine odour abnormal #### Frequency not known Stress cardiomyopathy ### Side-effects, further information Symptoms of sexual dysfunction may persist after treatment has stopped. ## Pregnancy ### Pregnancy For duloxetine Toxicity in animal studies—avoid in patients with stress urinary incontinence; in other conditions use only if potential benefit outweighs risk. Risk of neonatal withdrawal symptoms if used near term. ## Breast feeding ### Breast feeding For duloxetine Present in milk—manufacturer advises avoid. ## Hepatic impairment ### Hepatic impairment For duloxetine Manufacturer advises avoid. ## Renal impairment ### Renal impairment For duloxetine Avoid if creatinine clearance less than 30 mL/minute, [M](https://bnf.nice.org.uk/about/how-bnf-publications-are-constructed/ "Manufacturer information") see [Prescribing in renal impairment](https://bnf.nice.org.uk/medicines-guidance/prescribing-in-renal-impairment/ "Prescribing in renal impairment"). ## Treatment cessation ### Treatment cessation For duloxetine Nausea, vomiting, headache, anxiety, dizziness, paraesthesia, sleep disturbances, and tremor are the most common features of abrupt withdrawal or marked reduction of the dose; dose should be reduced over at least 1–2 weeks. ## Patient and carer advice ### Patient and carer advice For duloxetine ### Driving and skilled tasks Patients and carers should be counselled on the effects on driving and performance of skilled tasks—increased risk of dizziness. ## National funding/access decisions ### National funding/access decisions For Cymbalta® For full details see funding body website. #### Scottish Medicines Consortium (SMC) decisions For Cymbalta® - [SMC No. 285/06](https://www.scottishmedicines.org.uk/medicines-advice/duloxetine-30mg-and-60mg-capsules-cymbalta-fullsubmission-28506/) Duloxetine (Cymbalta ®) for diabetic peripheral neuropathic pain in adults (September 2006) Funding decision: Recommended with restrictions ## Medicinal forms There can be variation in the licensing of different medicines containing the same drug. [View medicinal form and pricing information](https://bnf.nice.org.uk/drugs/duloxetine/medicinal-forms/) ## Related treatment summaries 1. [Antidepressant drugs](https://bnf.nice.org.uk/treatment-summaries/antidepressant-drugs/) 2. [Depression](https://bnf.nice.org.uk/treatment-summaries/depression/) 3. [Diabetic complications](https://bnf.nice.org.uk/treatment-summaries/diabetic-complications/) 4. [Urinary incontinence and pelvic organ prolapse in women](https://bnf.nice.org.uk/treatment-summaries/urinary-incontinence-and-pelvic-organ-prolapse-in-women/) ## Other drugs in class ### Other drugs in classSerotonin and noradrenaline re-uptake inhibitors 1. [Bupropion hydrochloride](https://bnf.nice.org.uk/drugs/bupropion-hydrochloride/) 2. [Naltrexone with bupropion](https://bnf.nice.org.uk/drugs/naltrexone-with-bupropion/) 3. 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Readable Markdown	## Drug action ### Drug action For duloxetine Inhibits the re-uptake of serotonin and noradrenaline. ## Indications and dose ### For duloxetine #### Major depressive disorder for duloxetine ##### By mouth Adult60 mg once daily, dose can be increased if necessary up to a maximum of 120 mg per day in patients who are responding to treatment and have a history of repeated episodes of major depression. #### Generalised anxiety disorder for duloxetine ##### By mouth AdultInitially 30 mg once daily, usual maintenance 60 mg once daily, dose can be increased if necessary up to a maximum of 120 mg per day. #### Diabetic neuropathy for duloxetine ##### By mouth Adult60 mg once daily, discontinue if inadequate response after 2 months; review treatment at least every 3 months; dose can be increased if necessary up to a maximum of 120 mg daily in divided doses. #### Moderate to severe stress urinary incontinence for duloxetine ##### By mouth Adult (female)40 mg twice daily, patient should be assessed for benefit and tolerability after 2–4 weeks, alternatively initially 20 mg twice daily for 2 weeks, this can minimise side-effects, then increased to 40 mg twice daily, patient should be assessed for benefit and tolerability after 2–4 weeks. ## Important safety information ### Important safety information For duloxetine #### SNRI antidepressant medicines: small increased risk of postpartum haemorrhage when used in the month before delivery Serotonin and noradrenaline re-uptake inhibitors (SNRIs) are known to increase the risk of bleeding due to their effect on platelet function. Observational data suggest that the use of SNRIs in the last month before delivery may increase the risk of postpartum haemorrhage. Healthcare professionals should continue to consider the benefits and risks of antidepressant use during pregnancy, and the risks of untreated depression in pregnancy. Healthcare professionals should also consider this finding in the context of individual patient risk factors for bleeding or thrombotic events. Anticoagulant medication in women at high risk of thrombotic events should not be stopped but healthcare professionals should be aware of the risk identified. ## Cautions ### Cautions For duloxetine Bleeding disorders; cardiac disease; elderly; history of mania; history of seizures; hypertension (avoid if uncontrolled); raised intra-ocular pressure; susceptibility to angle-closure glaucoma ## Interactions [View interactions for duloxetine](https://bnf.nice.org.uk/interactions/duloxetine/) ## Side-effects ### Side-effects For duloxetine #### Common or very common Anxiety; appetite decreased; constipation; diarrhoea; dizziness; drowsiness; dry mouth; fall; fatigue; flushing; gastrointestinal discomfort; gastrointestinal disorders; headache; muscle complaints; nausea; pain; palpitations; paraesthesia; sexual dysfunction; skin reactions; sleep disorders; sweat changes; tinnitus; tremor; urinary disorders; vision disorders; vomiting; weight changes; yawning #### Uncommon Apathy; arrhythmias; behaviour abnormal; burping; chills; concentration impaired; disorientation; dysphagia; ear pain; feeling abnormal; gait abnormal; haemorrhage; hepatic disorders; hyperglycaemia; increased risk of infection; malaise; menstrual disorder; movement disorders; mydriasis; peripheral coldness; photosensitivity reaction; postural hypotension; suicidal behaviours; syncope; taste altered; temperature sensation altered; testicular pain; thirst; throat tightness; vertigo #### Rare or very rare Angioedema; cutaneous vasculitis; dehydration; galactorrhoea; glaucoma; hallucination; hyperprolactinaemia; hypertensive crisis; hyponatraemia; hypothyroidism; interstitial lung disease; mania; menopausal symptoms; oral disorders; pneumonia eosinophilic; seizure; serotonin syndrome; SIADH; Stevens-Johnson syndrome; urine odour abnormal #### Frequency not known Stress cardiomyopathy ### Side-effects, further information Symptoms of sexual dysfunction may persist after treatment has stopped. ## Pregnancy ### Pregnancy For duloxetine Toxicity in animal studies—avoid in patients with stress urinary incontinence; in other conditions use only if potential benefit outweighs risk. Risk of neonatal withdrawal symptoms if used near term. ## Breast feeding ### Breast feeding For duloxetine Present in milk—manufacturer advises avoid. ## Hepatic impairment ### Hepatic impairment For duloxetine Manufacturer advises avoid. ## Renal impairment ### Renal impairment For duloxetine ## Treatment cessation ### Treatment cessation For duloxetine Nausea, vomiting, headache, anxiety, dizziness, paraesthesia, sleep disturbances, and tremor are the most common features of abrupt withdrawal or marked reduction of the dose; dose should be reduced over at least 1–2 weeks. ## Patient and carer advice ### Patient and carer advice For duloxetine ### Driving and skilled tasks Patients and carers should be counselled on the effects on driving and performance of skilled tasks—increased risk of dizziness. ## National funding/access decisions ### National funding/access decisions For Cymbalta® For full details see funding body website. #### Scottish Medicines Consortium (SMC) decisions For Cymbalta® - Duloxetine (Cymbalta ®) for diabetic peripheral neuropathic pain in adults (September 2006) Funding decision:Recommended with restrictions ## Medicinal forms There can be variation in the licensing of different medicines containing the same drug. [View medicinal form and pricing information](https://bnf.nice.org.uk/drugs/duloxetine/medicinal-forms/) 1. [Antidepressant drugs](https://bnf.nice.org.uk/treatment-summaries/antidepressant-drugs/) 2. [Depression](https://bnf.nice.org.uk/treatment-summaries/depression/) 3. [Diabetic complications](https://bnf.nice.org.uk/treatment-summaries/diabetic-complications/) 4. [Urinary incontinence and pelvic organ prolapse in women](https://bnf.nice.org.uk/treatment-summaries/urinary-incontinence-and-pelvic-organ-prolapse-in-women/) ## Other drugs in class ### Other drugs in classSerotonin and noradrenaline re-uptake inhibitors 1. [Bupropion hydrochloride](https://bnf.nice.org.uk/drugs/bupropion-hydrochloride/) 2. [Naltrexone with bupropion](https://bnf.nice.org.uk/drugs/naltrexone-with-bupropion/) 3. [Venlafaxine](https://bnf.nice.org.uk/drugs/venlafaxine/)
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