Why can't duloxetine (cymbalta) be prescribed to me? Is there some kind of restriction in the UK.

May 17, 2012 9:44 AM

Why can't duloxetine (cymbalta) be prescribed to me? Is there some kind of restriction in the UK.

I am a suffer of neuropathic pain. I have been given amitriptyline previously which I have responded poorly to and which I do not wish to use again. I have been informed by a friend that duloxetine is often prescribed to treat such pain as mine. However, on asking my GP for this medication, I was informed that he does not have the ability to prescribe this drug, that I would have to see a psychiatrist and only then could it be prescribed.

Instead he will only suggest taking amitriptyline in combination with fluoxetine. A combination that I can't take without concentration problems and tiredness. He stated that there would be no greater efficacy from using duloxetine.

Is there a restriction on who can prescribe duloxetine in the UK? Is it super expensive or has the national institute of clinical excellence placed some other obstacle which prevents a GP from prescribing it?

I really do need something to provide pain relief so I find this very frustrating. I do want to know if what he has informed me is correct. Perhaps it is very expensive and the NHS is rationing it? But I don't really know and that is just a guess.

posted by conrad101 to health & fitness (7 answers total)

I take a medication that can only be prescribed by a psychiatrist, and if I feel it isn't working, my GP can only refer me to the psychiatrist for assessment rather than changing the doseage herself. I wonder if duloxetine is a similar drug?

Here;s the factsheet for it. It seems relatively cheap, but what sticks out to me here is that it is prescribed for 'major depressive episodes', leading me to think that it's more controlled than the drugs you've been given.

It might also depend on where you live and which local NHS trust covers you. Some are able to prescribe certain drugs more often than others. You do, of course, have the option of going privately via Bupa etc. if you feel you really need this drug, but not having been down that road I'm not sure how easy it might be.
posted by mippy at 9:56 AM on May 17, 2012

Here we go:

"Duloxetine was not included in the most
recent NICE guidance on the
management of depression, as it was not
licensed at the time of writing. The
current guidance recommends the SSRIs
as first-line antidepressants in routine
care. The guidance also recommends that
the SNRI, venlafaxine, should only be
used in treatment resistant depression in
patients who have not responded
adequately to two previous
antidepressants, and be initiated, and
supervised by, specialist mental health
medical practitioners or GPs with a
special interest in mental health.

As duloxetine is also an SNRI, and there
is a lack of data to differentiate it from
venlafaxine or to compare it to SSRIs, it
might be prudent to restrict the use of
duloxetine to those situations in which
venlafaxine use might be considered.
This may leave duloxetine as the main
SNRI that could be prescribed by GPs.
However, there are no data to support
the use of duloxetine in treatmentresistant
depression."
posted by mippy at 9:58 AM on May 17, 2012

Presumably, just because you're taking it for neuropathic pain doesn't mean it won't have the psychiatric effects it's more commonly prescribed for. Perhaps your GP is saying he doesn't have the specialized psychiatric expertise to prescribe it safely? I know a few people who've taken duloxetine and related SNRIs, and the process of starting and stopping is finicky and emotionally unpleasant, even aside from any rarer side effects.

Is it super expensive

Unlike the other drugs you mention, it is still under patent (in the US at least), so I'd guess it's more expensive.
posted by hattifattener at 10:13 AM on May 17, 2012

Thank you for your replies!

I live near Cambridge, so the local health care trust can place further restrictions on medications, I wasn't aware of that. Yes, I do suffer from depression also.

The idea with duloxetine is that it has dual benefits i.e. it is used as pain relief for types of pain but also helps with depression. I did not have a good experience taking 2 drugs - amitriptyline and fluoxetine. Having 1 drug which can do both strikes me as advantageous.
posted by conrad101 at 10:14 AM on May 17, 2012

Duloxetine is on the red list for Cambridge PCT meaning that NHS GP's can't prescribe it.

It's not particularly expensive. According to NHS statistics, Duloxetine is just under £1 per tablet. On the other hand, Amitryptine + Fluoxetine is under 10p, so maybe that's a factor.

A private GP will probably have no problems prescribing Duloxetine, although there's no guarantee of that. A private consultation is about £60-£70 normally and you'll have to pay the full price of any medication prescribed, plus any repeat prescription charges.
posted by xchmp at 11:08 AM on May 17, 2012

You should probably ask for a referral to a pain clinic, who'll undoubtedly be able to prescribe it, and also will help manage how pain affects your mood. I should have thought your GP would be OK to give you a referral to this, and if they don't then push back on them until they do.

(This is "do as I say, not do as I do", because there's a referral to a clinic I think I need from my GP, and I haven't built up to asking for it yet)
posted by ambrosen at 11:17 AM on May 17, 2012

I had a problem getting a prescription for duloxetine from my GP. I had to be referred to a psychiatrist, who gave me the prescription. I'm an international grad student in London btw. There was some discussion about getting a psychiatrist in the US to send me some, but when I told him it was cheaper here, he gave it to me right away.
posted by Partario at 1:18 PM on May 17, 2012