Duloxetine for facial pain
If you have chronic pain in the face we might prescribe a medicine called duloxetine.
Duloxetine is an antidepressant medicine known as a serotonin-noradrenaline reuptake inhibitor (SNRI). SNRIs probably work by increasing the amount of mood-enhancing chemicals (serotonin and noradrenaline) in your brain.
Duloxetine is used to treat depression, anxiety and also nerve pain.
It comes as capsules and is only available on prescription.
It usually takes up to 8 weeks for duloxetine to improve nerve pain.
Always follow the amount (dose) prescribed by your doctor, and read the leaflet that comes with your medicine.
Taking an unlicensed medicine
The use of duloxetine for treating chronic facial pain is unlicensed.
This means that the manufacturer of the medicine has not specified it can be used in this way, but there is evidence that it works to treat this particular condition.
Swallow the capsules whole, with a drink of water or juice. Do not chew or crush them. You can take duloxetine with or without food, but it's best to take it at the same time each day.
How much to take (dose)
The starting dose is 30mg each day, and this can be increased to 60mg, taken 2 times each day.
30mg, one time each day
60mg, one time each day
30mg in the morning
60mg at night
60mg in the morning
60mg at night
If you forget to take the medicine
If you usually take duloxetine in 1 dose each day, take the missed dose as soon as you remember. If it's less than 12 hours until your next dose, leave out the missed dose, and take the next one at the usual time.
If you usually take duloxetine in 2 doses each day, take the missed dose as soon as you remember. If it's less than 4 hours until your next dose, leave out the missed dose, and take the next one at the usual time.
Never take 2 doses at the same time.
Never take an extra dose to make up for a forgotten one.
If you often forget doses, it might help to set an alarm to remind you. You can ask your pharmacist for advice on other ways to help you remember to take your medicine.
Side effects of duloxetine
Like all medicines, duloxetine can cause side effects, but lots of people have no side effects, or only minor ones.
Some of the common side effects gradually improve as your body gets used to the medicine.
When you first start taking duloxetine, it's a good idea to stop driving and cycling, and avoid using machinery or tools, until you know how this medicine affects you.
Common side effects
The common side effects occur in up to 1 in 10 people. They are usually mild and go away within 2 weeks.
If these side effects bother you, or do not go away, keep taking the medicine but talk to your doctor or pharmacist:
- Difficulty sleeping
- Blurred vision
- Finding it hard to poo (constipation)
- Feeling sick (nausea) or being sick (vomiting)
- Dry mouth
- Less appetite than usual and weight loss
- Feeling less interested in sex, or having problems keeping an erection or reaching orgasm
Serious side effects
Serious side effects of duloxetine are rare, and happen in less than 1 in 100 people.
Book an appointment with your GP if you get changes in your periods, such as heavy bleeding, spotting or bleeding between periods.
Call your GP or 111 immediately if you have:
- hallucinations (seeing or hearing things that are not real), or you become aggressive and angry
- feelings of excessive enthusiasm or excitement, or feeling restless so that you cannot sit or stand still
- constant headaches, long-lasting confusion or weakness, or frequent muscle cramps
- yellowing of the whites of your eyes, or your skin (less obvious on brown or black skin)
- eye pain or blurred vision
- black or red poo, or blood in your vomit (these can be signs of bleeding from your gut)
- coughed-up blood or have blood in your pee
- bleeding from your gums, or bruises that appear or get bigger without a reason
Serious allergic reaction
In rare cases, it is possible to have a serious allergic reaction (anaphylaxis) to duloxetine.
Call 999 or go to the emergency department (A&E) if:
- you get a skin rash that might include itchy, red, swollen, blistered or peeling skin
- you're wheezing
- you get tightness in the chest or throat
- you have trouble breathing or talking
- your mouth, face, lips, tongue or throat start swelling
These are not all the side effects of duloxetine. For a full list see the leaflet inside your medicine packet. You can report any suspected side effects to the UK safety scheme.
Pregnancy and breastfeeding
Duloxetine is generally not recommended in pregnancy because there is not enough information about whether it affects a developing baby. Discuss this with your doctor or midwife.
If your doctor or health visitor says your baby is healthy, you can take duloxetine while breastfeeding.
Taking duloxetine with other medicines
Lots of medicines can interfere with duloxetine, and increase the chance of side effects. Tell your doctor or pharmacist if you’re taking:
- any other medicines for depression
- medicine used to help prevent blood clots (blood thinners), such as warfarin
- diazepam, chlorphenamine or other medicines that can make you feel more sleepy
Do not take St John's wort, the herbal remedy, while you are being treated with duloxetine. It will increase your risk of side effects.
If you and your doctor decide you should stop taking duloxetine, they will recommend reducing your dose gradually over at least 2 weeks to help prevent withdrawal symptoms.
Do not stop taking duloxetine suddenly.
Your GP will give you a repeat prescription for duloxetine, which you can take to your local pharmacy.
Make sure you request your repeat prescription early so that you do not run out or risk missing any doses.
Resource number: 5352/VER1
Last reviewed: April 2023
Next review due: November 2025