विवरण
Duloxetine and pregabalin are commonly co-prescribed for neuropathic pain with complementary mechanisms; additive CNS effects including dizziness, somnolence, and cognitive impairment can occur.
तंत्र
Duloxetine inhibits serotonin and norepinephrine reuptake, also inhibiting CYP2D6; pregabalin modulates calcium channels; combined CNS depressant effects and weak inhibition of CYP2D6 by duloxetine does not affect pregabalin (not CYP-metabolised) but may potentiate sedation.
नैदानिक महत्व
Controlled trials confirm increased somnolence and dizziness with the combination compared to either agent alone; the combination is still commonly used for diabetic neuropathy.
प्रबंधन
Start at low doses and titrate cautiously; counsel patients on sedation and fall risk, particularly in the elderly.