Dulan 60mg Capsule 10 'S

About

Dulan 60mg Capsule 10 'S is an antidepressant that belongs to the class Selective Serotonin Norepinephrine Reuptake Inhibitors (SSNRIs) which work by blocking the reuptake of serotonin and norepinephrine (neurotransmitters) and thereby increase their availability in the Central Nervous System. These two neurotransmitters cease the signaling of pain at the neuronal level. So their availability is required for pain management as well. Dulan 60mg Capsule 10 'S is used for mood elevation, fibromyalgia (pain in muscles leading to lethargy), anxiety associated with pain, diabetic neuropathy (pain and tingling sensations in hands and feet), chronic joint and muscles pain (osteoarthritis), and sometimes in urine incontinence in women (involuntary passage of urine during daily activities like laughing and sneezing).

Dulan 60mg Capsule 10 'S can be given to adults and children older than 7 years of age, who are facing excessive stress for the past 6 months. Dulan 60mg Capsule 10 'S is considered as a first-line agent in the management of chronic anxiety, especially for those who develop dependency. Withdrawal symptoms may appear if the treatment is ceased abruptly. The healthcare practitioners gradually reduce the dose of Dulan 60mg Capsule 10 'S rather than stopping the dose at once. 

If a person stops taking Dulan 60mg Capsule 10 'S abruptly, he may suffer from withdrawal symptoms such as anxiety, headache, numbness in hands, fatigue, dizziness, nausea, vomiting, diarrhea, sweating, and disturbed sleeping patterns. Dulan 60mg Capsule 10 'S renders a symptomatic treatment to major depressive disorder. It may take 1 to 4 weeks or more to show beneficial effects. Whenever you feel such symptoms after a reduction in the dose of Dulan 60mg Capsule 10 'S, you should consult your doctor. 

Indications

Dulan 60mg Capsule 10 'S is a prescription-only medicine that is indicated by a medical practitioner to treat the following conditions:

• Major Depressive Disorder 
• Diabetes Associated Neuropathic Pain
• Generalized Anxiety Disorder
• Fibromyalgia
• Stress Urinary Incontinence in Women 
• Musculoskeletal Pain
• Chemotherapy-Induced Neuropathy

How Does Dulan 60mg Capsule 10 'S Work

Dulan 60mg Capsule 10 'S works by selectively inhibiting the reuptake of two neurotransmitters in the central nervous system i.e. Serotonin and Norepinephrine. This way, Dulan 60mg Capsule 10 'S balances the availability of Serotonin and Norepinephrine which become imbalanced in a person suffering from depression and other aforementioned conditions. Depending on the dose, the extracellular levels of serotonin and norepinephrine are raised to reduce the threshold of pain, whether it is inflammatory or neuropathic.  

Dulan 60mg Capsule 10 'S also weakly blocks the reuptake of dopamine (a neurotransmitter in the brain responsible for reward-motivated behavior) and thereby works as a mood elevator. Dulan 60mg Capsule 10 'S doesn’t show any significant receptor-mediated adverse effects because of the lack of binding affinity with cholinergic, dopaminergic, histaminergic, and adrenergic receptors. 

How To Use Dulan 60mg Capsule 10 'S

Dulan 60mg Capsule 10 'S is taken orally (by mouth) and should not be crushed or chewed. Do not sprinkle the inner contents of the capsule on food. Doing this may affect the enteric coating of Dulan 60mg Capsule 10 'S that in turn affects the absorption rate.  Dulan 60mg Capsule 10 'S can be administered with or without a meal, but absorbs well on an empty stomach. 

The dose should be gradually reduced (over 1 to 2 weeks) rather than abrupt discontinuation. Otherwise, intolerable symptoms may appear. Minor withdrawal symptoms may also occur upon starting the reduced dose. Consult your doctor in that case. Your doctor might continue treatment with the previous dose or gradually follow dose redu. The treatment is usually started with a low dose that is gradually increased after a week and is ended by slowly tapering off. 

Dosage

Dulan 60mg Capsule 10 'S is available as a delayed-release capsule (a therapeutic agent is released in the intestine) to be administered orally (by mouth). 

Forms and strength:

Dulan 60mg Capsule 10 'S 20mg capsule

Dulan 60mg Capsule 10 'S 30mg capsule

Dulan 60mg Capsule 10 'S 60mg capsule

Major Depressive Disorder

The lowest starting dose is 30mg once daily that can, increasing daily after a week as a maintenance dose. 

Generalictionzed Anxiety Disorder 

• 30mg once daily is the recommended loading dose that can be increased to 60mg daily if there is insufficient response. 
• The dose from 30mg once daily can be increased after two weeks in the geriatric and pediatric populations. 

Diabetic Peripheral Neuropathy

Patients with diabetic neuropathy are treated with 60mg once daily dose which can be increased to 60mg twice daily if results are insufficient. The response is monitored after every two months of therapy. 

Fibromyalgia 

60mg once daily is the recommended dose for Fibromyalgia after keeping the patient on 30mg once daily for the first week of treatment. 

Stress urinary incontinence

The recommended initial dose is 20mg once daily that is switched to 20mg four times a day after 2 weeks of treatment. 

Chronic Musculoskeletal Pain

The dose should not be exceeded more than 60mg once a day. Initial therapy is 30mg once daily. 

If Creatinine Clearance is less than 30 ml/min in a renal impaired patient, usage of Dulan 60mg Capsule 10 'S should be avoided. 

Pregnancy and Lactation

Dulan 60mg Capsule 10 'S should be avoided in late pregnancy as postpartum hemorrhage is seen. However, Dulan 60mg Capsule 10 'S is safe to be administered in lactating mothers. There is no significant clinical data available that points to the safety of Dulan 60mg Capsule 10 'S in pregnancy. 

Contraindications

• People having any liver disease should avoid using Dulan 60mg Capsule 10 'S as it is metabolized in the liver and there are chances of liver dysfunction. 
• People with known hypersensitivity to Dulan 60mg Capsule 10 'S or its metabolites should avoid using Dulan 60mg Capsule 10 'S.
• Dulan 60mg Capsule 10 'S is contraindicated in patients who are on MAOIs (e.g. phenelzine, linezolid) to avoid serious drug interaction. 
• Usage of Dulan 60mg Capsule 10 'S is associated with dilation of pupils. So, people suffering from narrow-angle glaucoma should not use Dulan 60mg Capsule 10 'S because it may worsen the disease.
• Dulan 60mg Capsule 10 'S is contraindicated in patients with uncontrolled hypertension. Dulan 60mg Capsule 10 'S may cause a significant rise in blood pressure which can lead to hypertensive crises in patients with uncontrolled hypertension or other cardiac diseases.
• Dulan 60mg Capsule 10 'S is linked with severe skin conditions such as Steven Johnson Syndrome, and Erythema Multiforme. So people who are suffering from such skin conditions should not use Dulan 60mg Capsule 10 'S. 

Precautions

• There is a significant warning while using Dulan 60mg Capsule 10 'S due to the tendency of suicidal thoughts in the person suffering from anxiety and depression. Suicidal thoughts may occur at the beginning of treatment or after discontinuing the therapy. 
• A person who seems vulnerable to suicidal behavior should be closely monitored and dosage adjustment should be considered. Also, the caregiver should be alert towards his behavior and immediately seek professional advice if there are any suicidal tendencies. Youngsters are more vulnerable to mood changes and suicidal behaviors. 
• Dulan 60mg Capsule 10 'S should not be administered within 5 days and after at least 14 days of intake of MAO inhibitor (e.g. linezolid, methylene blue injection), to avoid a dangerous drug interaction. 
• Dulan 60mg Capsule 10 'S should not be stopped suddenly without a doctor's recommendation to avoid withdrawal symptoms or reversal of the disease. 
• Serotonin syndrome may arise if you consume any other stimulant medicines concomitantly with Dulan 60mg Capsule 10 'S. So, tell your consultant if you are consuming opioids (codeine, morphine, etc), herbal medicines, and medicines for other mental illnesses like Parkinson's disease. 
• Children below 7 years of age cannot consume Dulan 60mg Capsule 10 'S as it is not approved for treatment in this age group. 
• Before starting the treatment with Dulan 60mg Capsule 10 'S your doctor must know if you have hypertension, slow process of digestion, any drug addiction, a habit of alcohol consumption, bleeding issues, sexual problems, glaucoma, or bipolar disorder. 
• Get an eye check before starting treatment with Dulan 60mg Capsule 10 'S. Dulan 60mg Capsule 10 'S may worsen angle-closure glaucoma (increased intraocular pressure leading to loss of vision)  if taken without precaution. You should consider an examination if you are experiencing pain in one or both eyes, nausea, blurred vision, or viewing color rings, swelling, and redness in the eye. The doctor may start Dulan 60mg Capsule 10 'S after making sure there is no open-angle glaucoma. 
• Inform your consultant if you are taking Dulan 60mg Capsule 10 'S before having any surgery.
• If your liver profile shows raised hepatic enzymes or you are having some medicines associated with liver injury, you should tell your doctor. Because Dulan 60mg Capsule 10 'S tends to cause jaundice in that case. 
• Patients who are at risk of hyponatremia (low sodium levels in the blood) should be given Dulan 60mg Capsule 10 'S with caution. This population could be geriatrics, people suffering from cirrhosis and dehydration, and patients who are on diuretics. 

Interactions With Other Medications

Tell your doctor if you are on the following drugs before starting treatment with Dulan 60mg Capsule 10 'S:

• Antipsychotics (Olanzapine, Risperidone)
• Fluoroquinolones (Ciprofloxacin, Enoxacine)
• Thioridazine
• Triptans (Zolmitriptan, Rizatriptan etc)
• SSRIs (Fluvoxamine)
• Tricyclic Antidepressants (Desipramine, Amitriptyline)
• Monoamine Oxidase Inhibitors (Isocarboxazid, Phenelzine)
• Lithium
• Opioids (Fentanyl)
• Tramadol
• Amphetamines (Ritalin)
• Tryptophan
• Buspirone

Adverse Effects

Common Adverse Effects

• Increased heart rate and blood pressure
• Nausea
• Dizziness
• Dry mouth
• Fatigue
• Disturbed sleeping patterns
• Anorexia
• Sexual dysfunction
• Lethargy
• Sweating

These mild to moderate adverse effects tend to decrease with time depending on the treatment. 

Rare Adverse Effects

• Suicidal Tendency (Severe)
• Increase in liver enzymes
• Jaundice
• Skin rash
• Hyponatremia (low sodium levels in the blood)
• Serotonin Syndrome
• Photosensitivity

How To Cope With Some Of The Adverse Effects

• Dizziness - Lying down in a comfortable place helps minimize dizziness. Lifting heavy weights and driving should be avoided if you are feeling lightheaded.
• Stomach Upsets - Taking Oral Rehydration Salt helps in restoring water due to dehydration, also avoid overeating or eating spicy food. 
• Dry Mouth - Drink plenty of water, intake of mucilaginous products increases salivation. 
• Fatigue - Avoid restlessness and do not lift heavy articles. Muscle relaxants help reduce fatigue. 

Key Facts About Dulan 60mg Capsule 10 'S

• Dulan 60mg Capsule 10 'S can take 2 to 4 weeks to show effect if taken for depression and anxiety. It can take longer if taken to treat diabetic peripheral neuropathy. 
• Dry mouth, constipation, lethargy, drowsiness, and headache are the common side effects that may vanish within a few weeks of treatment.
• The dose of Dulan 60mg Capsule 10 'S should be reduced gradually, otherwise, withdrawal symptoms may develop. 
• If you feel dizzy at the start of treatment with Dulan 60mg Capsule 10 'S, you should stop lifting weights, driving, or consuming alcohol until your body gets used to it.

FAQs

Q. Can a patient of depression with physical injury (such as a car accident) take Dulan 60mg Capsule 10 'S?

Yes, he can. Dulan 60mg Capsule 10 'S is prescribed for depression accompanied by pain. But it can be taken upon the advice of a medical practitioner.

Q. What if I miss the dose?

In case you miss the dose, take it when you remember. You can skip the dose if it's time for the next dose.

Q. What to do if a change in dose is intolerable?

If you are experiencing intolerability after dose reduction, tell your doctor. He might switch you to the previous dose and dose reduction and more gradually dose reduction will be done

Q. Will dizziness occur while taking Dulan 60mg Capsule 10 'S?

Dizziness is common during the initial phase of treatment or when the dose is increased. Do not immediately get out of bed or immediately stand up. Practice this slowly and steadily by resting your feet on the floor for a few seconds.

Q. How do hypertensive patients respond to Dulan 60mg Capsule 10 'S?

Dulan 60mg Capsule 10 'S causes a rise in blood pressure. So Dulan 60mg Capsule 10 'S should not be taken until and unless your doctor doesn’t recommend it. He may start therapy after closely monitoring your blood pressure and suggesting hypertensive medicines in sufficient doses. Monitor your blood pressure daily if you are hypertensive.

Q. What are the recommended storage conditions of Dulan 60mg Capsule 10 'S?

Store Dulan 60mg Capsule 10 'S in a dry place at 25 °C and protect it from direct contact with the sunlight. If traveling, it can be stored at a temperature from 15°C to 30°C.

Q. Is Dulan 60mg Capsule 10 'S safe to use in pregnancy?

There are not any specific recommendations regarding the intake of Dulan 60mg Capsule 10 'S in pregnancy and lactation. However, if you were taking Dulan 60mg Capsule 10 'S before getting pregnant, you need to talk to your doctor.  If taken in the last month of pregnancy, Dulan 60mg Capsule 10 'S can cause postpartum bleeding and breathing problems in infants.

Q. Is there any special monitoring associated with the Dulan 60mg Capsule 10 'S?

Blood pressure monitoring is necessary if you are a hypertensive patient. Dulan 60mg Capsule 10 'S causes an elevation in liver enzymes. So monitoring is also important in case you have any liver disease.

Q. Can I consume alcohol with Dulan 60mg Capsule 10 'S?

As Dulan 60mg Capsule 10 'S causes sedation and dizziness, it is better to avoid alcohol until you get stable. Alcohol consumption should be stopped especially in the initial phase of treatment.

Q. Are there any dietary recommendations associated with Dulan 60mg Capsule 10 'S?

There are not any specific recommendations about diet while taking Dulan 60mg Capsule 10 'S. You can take it along with any food until your doctor limits it.