Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults (18-24 years of age) with major depressive disorder and other psychiatric disorders. Duloxetine is not FDA approved for use in children. May worsen psychosis in some patients or precipitate a shift to mania or hypomania in bipolar disorder. Monotherapy in bipolar disorder should be avoided. Duloxetine is not FDA approved for the treatment of bipolar depression. Bleeding risk. Has a low potential to impair cognitive or motor performance. Hepatotoxicity (avoid use in substantial ethanol intake, evidence of chronic liver disease or hepatic impairment). Rare cases of hepatic failure (including fatalities) reported with use. Hyperglycemia observed in some diabetic patients receiving duloxetine therapy for diabetic peripheral neuropathy. May cause orthostatic hypotension/syncope, especially within the first week of therapy and after dose increases. May cause or exacerbate sexual dysfunction. SSRIs and SNRIs associated with the development of SIADH. Hyponatremia reported rarely (including severe cases with serum sodium <110 mmol/L), predominately in the elderly. May cause increased urinary resistance. Use with caution in hypertension (rare cases of hypertensive crisis reported in pre-existing hypertension). Increased risk of mydriasis in controlled narrow-angle glaucoma. Not recommended for use in CrCl <30 mL/minute or end-stage renal disease. Not recommended for use in hepatic impairment. Use caution with previous seizure disorder, condition predisposing to seizures, or concurrent therapy with other drugs which lower the seizure threshold. Use caution with concomitant use of NSAIDs, ASA, or other drugs that affect coagulation (risk of bleeding may be potentiated). Caution in concomitant use with CYP1A2 inhibitors (e.g. fluvoxamine, ciprofloxacin)(may increase levels/adverse effects of duloxetine). Potential for severe reaction when used with MAO inhibitors. Serotonin syndrome may occur with concomitant proserotonergic drugs (i.e. SSRIs/SNRIs or triptans) or agents which reduce the metabolism of duloxetine. Concurrent use of serotonin precursors (e.g. tryptophan) is not recommended. Concomitant use with thioridazine is contraindicated. Formulation contains sucrose. May increase the risks associated with electroconvulsive therapy. May cause withdrawal syndrome.