Drug General Information (ID: DDIZY9MFWG)
Drug Name			Duloxetine		Drug Info		Oxymetazoline (nasal)		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Antidepressants				Decongestants
Structure

Mechanism of Duloxetine-Oxymetazoline (nasal) Interaction (Severity Level: Moderate)
Additive hypertensive effects Click to Show/Hide Mechanism Graph
Drug Name		Duloxetine				Oxymetazoline (nasal)
Mechanism 1		Hypertensive effects				Hypertensive effects
Key Mechanism Factor 1
		Factor Name		Hypertensive effects
		Factor Description		Hypertension is defined as a blood pressure reading above a prescribed limit (130/90 mmHg). Most people with hypertension have no signs or symptoms; others may experience: severe headache, shortness of breath, nosebleeds, severe anxiety, and feeling a tingling sensation in the neck or head.
Mechanism Description		Additive hypertensive effects by the combination of Duloxetine and Oxymetazoline (nasal)
Increased risk of rapid heart rate Click to Show/Hide Mechanism Graph
Drug Name		Duloxetine				Oxymetazoline (nasal)
Mechanism 2		Increased heart rate				Increased heart rate
Key Mechanism Factor 2
		Factor Name		Tachycardia
		Factor Description		A faster-than-normal heart rate, but the heart is beating normally. Tachycardia may not cause any symptoms or complications, but if left untreated, some forms of tachycardia can lead to serious health problems, including heart failure, stroke, or sudden cardiac death.
Mechanism Description		Increased risk of rapid heart rate by the combination of Duloxetine and Oxymetazoline (nasal)

Recommended Action
Management		Caution is advised if SNRIs are used with other drugs that can increase blood pressure and/or heart rate. Blood pressure and pulse should be measured prior to initiating SNRI therapy and monitored at regular intervals thereafter. Dose reduction or discontinuation of the SNRI should be considered in patients who experience a sustained increase in blood pressure or pulse rate.

References
1	Product Information. Cymbalta (duloxetine). Lilly, Eli and Company, Indianapolis, IN.
2	Product Information. Fetzima (levomilnacipran). Forest Pharmaceuticals, St. Louis, MO.
3	Product Information. Nucynta (tapentadol). PriCara Pharmaceuticals, Raritan, NJ.