A subscription only based website aimed at Australian healthcare professionals is reporting that doctors in Australia are being urged to prescribe Eli Lilly's antidepressant Cymbalta (duloxetine) with caution after a 35-year-old Victorian truck driver died of serotonin syndrome from a dose increase.
Nicholas Moorby died in April 2013, four months after his GP increased his Cymbalta dose from the recommended maximum daily dose of 120mg (three 60 mg capsules) to 240mg/4 capsules per day.
According to the Australian Doctor website, "friends of Mr Moorby noticed he was "agitated", "really out of it", "blabbering" and "making no sense" in the days leading up to his death."
Moorby's GP, who increased the dose, admitted that he had made an "error of judgement" and did not face any criminal charges over the death.
This from the Australian Doctor:
His GP was told by Mr Moorby that his psychiatrist recommended the dose increase due to his severe depression. The unnamed GP told the told the Coroners Court of Victoria last month,“Unfortunately, a lot of the specialists nowadays do not write scripts, they would tell the patient, go and see your GP and get the GP to write them. There are many cases where specialists prescribe big doses of anti-depressive so while I go to one or two tablets it’s not unusual for specialists to go to four, so I did not question him on that,”
Moorby had amphetamine, methamphetamine, duloxetine, oxycodone, promethazine and alcohol in his system when he died. However, Forensic pathologist, Dr Heinrich Bouwer, told the court that an adverse drug reaction to excessive duloxetine could occur with or without the interaction of amphetamines.
The Australian medicines regulator, The Therapeutic Goods Administration, recorded 21 cases of serotonin syndrome due to duloxetine in their Dec 2013 report.
For those that don't know, serotonin syndrome, also known as serotonin toxicity, is a life threatening drug reaction that causes the body to have too much serotonin. This leads to excessive stimulation of the central nervous system and peripheral serotonin receptors.
When you take poor metabolizers into account and you see what the friends of Nicholas Moorby said... he was "agitated", "really out of it", "blabbering" and "making no sense" - there really is a strong argument that these drugs can induce suicide and homicidal acts. Alas, the pharmaceutical companies and the blinkered views of psychiatrists often blame the "underlying illness" for the cause of suicide and/or homicide.
In the United States Eli Lilly and Company are facing a number of lawsuits regarding Cymbalta.
Over 20 lawsuits have been filed in federal courts across the US which sees claims that Lilly deliberately omitted information about the true risk of withdrawal in the product label and in marketing materials.
More information about those lawsuits can be found on the Baum, Hedlund, Aristei & Goldman, P.C here.