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Licensed to fill prescriptions for patients in RI, MA, CT, NJ, NH, FL, ME and PA. New York patients are served on a limited basis while nonresident registration is pending.
Prepared to a prescriber's order for one patient. Not FDA-approved.
Duloxetine is a serotonin and norepinephrine reuptake inhibitor (SNRI) antidepressant and pain modulator, commonly compounded into oral capsules at strengths not manufactured.
Duloxetine is an SNRI. It raises the activity of serotonin and norepinephrine in the brain and in the descending spinal pathways that dampen pain signals, and it has little effect on muscarinic, histamine or alpha-2 receptors, so anticholinergic side effects are low. The manufactured product, Cymbalta delayed-release capsules (duloxetine hydrochloride) and its generics, is FDA-approved for major depressive disorder, generalized anxiety disorder, diabetic peripheral neuropathic pain, fibromyalgia and chronic musculoskeletal pain. The capsule is enteric coated because duloxetine breaks down in stomach acid; the label says not to open, crush or sprinkle it. Prescribers order duloxetine compounded when they need a strength between or below the manufactured ones, a gradual taper, or a vehicle free of a particular excipient. Compounded preparations are not FDA-approved and require a prescription.
The manufactured label carries a boxed warning: antidepressants increase the risk of suicidal thoughts and behavior in children, adolescents and young adults, and anyone starting treatment should be watched for worsening mood. Duloxetine must not be taken with an MAO inhibitor or within 14 days of one, or started while taking linezolid or intravenous methylene blue; the label also says it should not be combined with thioridazine because of the risk of serious heart rhythm changes. Other label warnings cover rare liver failure (avoid with heavy alcohol use or chronic liver disease), fainting from low blood pressure, serotonin syndrome, bleeding with NSAIDs or blood thinners, severe skin reactions, angle-closure glaucoma, low sodium, urinary retention and withdrawal symptoms if stopped abruptly. Strong CYP1A2 or CYP2D6 inhibitors raise duloxetine levels. Third-trimester use can cause newborn adaptation symptoms. Duloxetine passes into breast milk in small amounts; watch infants for sedation and poor feeding. Common side effects are nausea, dry mouth, sleepiness and sweating. Talk to your prescriber or pharmacist before stopping, and report jaundice, bleeding or mood changes right away.
Duloxetine inhibits serotonin and norepinephrine reuptake, with indirect prefrontal dopamine effects via norepinephrine transporters. Absorption from the enteric-coated capsule begins after a median lag of about 2 hours with peak plasma concentration at about 6 hours (10 hours with food); elimination half-life is about 12 hours (range 8 to 17) and plasma protein binding exceeds 90 percent, mainly albumin and alpha-1 acid glycoprotein. Metabolism is by CYP1A2 and CYP2D6; duloxetine is itself a moderate CYP2D6 inhibitor. Smokers have about one-third lower exposure. In moderate hepatic impairment clearance falls to about 15 percent of normal and half-life roughly triples, and the label advises avoiding use in chronic liver disease. Unprotected duloxetine hydrolyzes to naphthol in acid, so any compounded oral form must preserve enteric protection. Labeled indications (Cymbalta): MDD, GAD, diabetic peripheral neuropathic pain, fibromyalgia and chronic musculoskeletal pain. StatPearls lists off-label use of the manufactured drug in stress urinary incontinence and chemotherapy-induced peripheral neuropathy. Dosing is per prescriber. Monitor blood pressure, suicidality at initiation and dose changes, transaminases, sodium in older adults, and glycemic control in diabetes. Not a controlled substance.
Shake the bottle well before every dose so the medication is evenly mixed. Measure with the oral syringe or dosing cup provided, using the milliliter markings, and never a kitchen spoon. Take it by mouth as your label directs. Rinse the syringe after use and recap the bottle.
Water-based suspensions are aqueous preparations. Under USP <795>, a preserved suspension usually carries a beyond-use date of up to 35 days at room temperature or refrigerated; an unpreserved one is refrigerated for up to 14 days. Oil-based suspensions are nonaqueous and may carry up to 90 days. Your label states storage and the beyond-use date. Keep out of reach of children and discard after that date.
This formulation is compounded by Bayview Pharmacy on a prescriber's order for an individual patient. It is not an FDA-approved drug product, and the FDA has not evaluated it for safety, effectiveness, or manufacturing quality.
A valid prescription is required. Availability depends on Bayview's licensure in your state. This page is general information, not medical advice. Discuss your situation with a licensed healthcare provider.
Search by NCPDP 4106882, or by name and ZIP: Bayview Pharmacy, Warwick, RI 02886. Select it as the destination pharmacy and save it as a favorite. Click any value to copy it.
Compounded preparations have no NDC, so this formula will not appear in your EHR's drug search. Use your system's compound, non-formulary, or free-text prescription entry and name the preparation exactly as written in step 3. If your EHR forces you to pick a listed drug, pick the closest entry for the active ingredient and put the full formula in the prescription body (the Sig or directions field), not in Notes to Pharmacy.
Compounded preparations have no NDC and will not appear in your drug search. For EPCS to validate, select a drug entry your EHR recognizes as controlled, usually the bulk powder entry for the active ingredient (for example Ketamine (bulk) powder, not a branded product), then put the full formula from step 3 in the prescription body. A free-text entry that does not validate as controlled will be rejected by your EPCS module.
Quantity and directions are starting points for this dose form, not treatment recommendations. Dosing remains the prescriber's responsibility.
Transmit from your EHR. For this non-controlled preparation we also accept fax to (401) 284-4506 and phoned orders at (401) 284-4505. Order forms are on the formulation pages and in the prescriber portal.
Transmit with two-factor authentication through your EPCS-enabled EHR. No order form is offered for this preparation; e-prescribing guides for our controlled preparations are on the formulation pages.
Licensed to dispense in RI, MA, CT, NJ, NH, FL, ME, and PA; New York is served on a limited basis while nonresident registration is pending. Compounded preparations are not FDA-approved. A valid prescription is required. Full guide, including steps by EHR: How to e-prescribe to Bayview. Questions about this formula: call (401) 284-4505.
Take orally
