Article

Duloxetine
February 05, 201901,360

Duloxetine (Cymbalta): Uses, Dosage, Side Effects and Abuses

 What is Duloxetine?

Duloxetine is an antidepressant medication used to treat major depressive disorder (MDD), generalized anxiety disorder (GAD), chronic muscle and bone pain, diabetic neuropathy (damage to nerves in diabetics) and fibromyalgia (a chronic condition that causes muscle pain, stiffness and tiredness).1

Duloxetine needs to be prescribed by a doctor. It is available under the brand names of Cymbalta, Yentreve, Xeristar or Ariclaim.2

Duloxetine belongs to a class of medications called selective serotonin and norepinephrine reuptake inhibitors (SSNRIs). SSNRIs increase the activity of serotonin and norepinephrine – natural hormones responsible for maintaining a healthy psychological state and blocking pain signals in the brain. 3

 The above image illustrates how serotonin and norepinephrine (neurotransmitters) work in the brain.4

 What is Duloxetine Used For?

 Major Uses of Duloxetine

Duloxetine for the Treatment of Depression and Generalized Anxiety Disorder (GAD)

Depression and Generalized Anxiety Disorder (GAD) are generally caused by an imbalance of hormones in the brain. Duloxetine helps to correct the balance of these hormones and to improve your brain’s reaction to emotions and pain.5

 Symptoms of depression include6:

  • often feeling sad, empty and tearful
  • decreased interest in most activities
  • changes in appetite
  • changes in sleep patterns
  • loss of energy
  • difficulty concentrating
  • feeling worthless, guilty, hopeless or helpless
  • suicidal thoughts

Symptoms of GAD include1:

  • excessive anxiety or worry for at least six months
  • restlessness
  • loss of energy
  • difficulty concentrating
  • irritability
  • sleep disturbance
  • muscle tension

Duloxetine for the Treatment of Diabetic Neuropathy

Diabetes can sometimes cause nerve damage. This is known as diabetic neuropathy and is characterized by a burning or tingling sensation in the hands or feet. Duloxetine helps to block the movement of pain messages in the brain. This may help to reduce the symptoms of diabetic neuropathy. 6

 

Duloxetine for the Treatment of Fibromyalgia

Fibromyalgia is a chronic pain disorder that causes generalized aches and pains all over your body. Other symptoms include3:

  • pain, muscle stiffness and tenderness
  • tiredness
  • difficulty falling asleep or staying asleep

Since duloxetine blocks pain messages in the brain, it is sometimes used to reduce the aches and pains caused by fibromyalgia. 3

Minor Uses of Duloxetine

Duloxetine can be used to treat conditions other than those listed above. Your doctor may prescribe duloxetine if you have one of the following conditions:

  • binge eating disorder7
  • bulimia nervosa7
  • obsessive compulsive disorder7
  • panic disorder7
  • body dysmorphic disorder7
  • phobias7
  • urinary incontinence caused by stress3

Duloxetine Dosage

Duloxetine comes as a delayed-release capsule — this means that the medication is released into your intestine instead of your stomach. Delayed-release capsules prevent the medication from being destroyed by stomach acid.3

There are three strengths available – 20 milligrams (mg), 30 mg and 60 mg capsules. The strength that your doctor prescribes will depend on the condition you have and how severe it is.2

Adult Dosage

For Treatment of Anxiety8:

  • The initial dose is usually 60 mg once a day.
  • Your doctor may initially prescribe 30 mg once a day for one week before increasing the dose up to 60 mg once a day.
  • If you are 60 years and older, your doctor may initially prescribe 30 mg once a day for two weeks before increasing the dose up to 60 mg once a day.
  • Your doctor may increase your dose as needed, but not usually up to more than 120 mg per day.

For Treatment of Chronic Muscle Pain8:

  • The initial dose is usually 60 mg once per day.
  • You may start off at 30 mg once a day for one week before your dose is increased to 60 mg once a day.

For Treatment of Depression8:

  • The initial dose is usually 40 mg per day (given as 20 mg twice a day) to 60 mg per day (given either once a day or as 30 mg twice a day).
  • Your doctor may increase your dose as needed, but not usually up to more than 120 mg per day.

For treatment of diabetic neuropathy8:

  • 60 mg once a day.

For Treatment of Fibromyalgia8:

  • The initial dose is usually 60 mg once per day.
  • Your doctor may initially prescribe 30 mg once a day for one week before increasing the dose up to 60 mg once a day.

Child Dosage

For Treatment of Anxiety8:

  • Children 7 years and older:
    • The initial dose is usually 30 mg once a day for two weeks.
    • This will then be increased up to 60 mg once a day.
    • Your doctor may increase your dose as needed, but not usually up to more than 120 mg per day.
  • Children younger than 7 years:
    • Use and dose must be determined by your doctor.

For Treatment of Chronic Muscle Pain, Depression, Diabetic Neuropathy and Fibromyalgia8:

  • Children of all ages:
    • Use and dose must be determined by your doctor.

Missed Dose

If you miss a dose of duloxetine, take it as soon as you realize. If it is almost time for your next dose, rather wait for the next dose. Do not double dose.8

Duloxetine (Cymbalta) Side Effects

More Common Side Effects

Speak to your doctor if you experience any of these symptoms3:

  • gastrointestinal symptoms:
    • nausea
    • vomiting
    • constipation
    • diarrhea
    • heartburn
    • stomach pain
    • decreased appetite
    • dry mouth
  • increased urination or difficulty passing urine
  • increased sweating or night sweats
  • neurological symptoms:
    • dizziness
    • headache
    • tiredness
    • weakness
    • drowsiness
  • muscle cramps or pain
  • changes in sexual performance or desire
  • uncontrollable shaking of a part of the body

Serious Side Effects

If you are taking duloxetine to treat depression, your symptoms may worsen when you first start treatment. The US Food and Drug Administration (FDA) found that antidepressants increased suicidal thoughts and behaviors in people under 25 years old.9 It is very important to report any worsening or new symptoms to your doctor, such as5:

  • mood or behavior changes
  • anxiety or panic attacks
  • difficulty sleeping
  • impulsive feelings, irritability, agitation, hostility, aggressiveness, restlessness or hyperactivity
  • suicidal or self-harming thoughts

Duloxetine may also cause other serious side effects. If you experience any of the following symptoms, call your doctor immediately or get emergency medical help3:

  • skin symptoms:
    • blisters or peeling skin
    • rash
    • hives
    • itching
  • gastrointestinal symptoms:
    • loss of appetite
    • pale stools
  • pain in the upper right part of the stomach
  • swelling of the abdomen
  • unusual bruising or bleeding
  • yellowing of the skin or eyes
  • dark colored urine
  • extreme tiredness or weakness
  • confusion
  • flu-like symptoms
  • fever, sweating, confusion, fast or irregular heartbeat
  • severe muscle stiffness
  • difficulty breathing or swallowing
  • swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs
  • hoarseness

 

Warnings for Duloxetine Use

General Warnings

Before Taking Duloxetine

  • Inform your doctor if you are allergic to duloxetine, any other medication or any of the ingredients in duloxetine. Ask your doctor or pharmacist for a list of the ingredients.3
  • Let your doctor know if you are taking any of the following medications3:
    • thioridazine or a monoamine oxidase (MAO) inhibitor – isocarboxazid (Marplan), linezolid (Zyvox) – or if you have stopped taking an MAO in the past 14 days
    • methylene blue
    • phenelzine (Nardil) or selegiline (Eldepryl, Emsam, Zelapar)
    • tranylcypromine (Parnate)
  • Let your doctor know if you are taking any prescription medication, non-prescription medication, nutritional supplements or herbal medication, especially products containing St. John’s wort or tryptophan.3
  • Tell your doctor if you drink alcohol or have ever abused alcohol, street drugs or prescription medication.3
  • Also let your doctor know if you have ever had3:
    • seizures
    • coronary artery disease (blockage or narrowing of the blood vessels that leads to heart attacks or strokes)
    • heart, liver, or kidney disease
  • Duloxetine can affect blood sugar levels, so it is important to let your doctor know if you are diabetic. If your doctor still decides to prescribe duloxetine for you, you will need to monitor your blood sugar levels carefully and report any changes to your doctor.10
  • Let your doctor know if you are pregnant, planning on falling pregnant or if you are breastfeeding. Duloxetine may cause problems with newborns if it is taken in the last trimester of pregnancy.3

Precautions When Taking Duloxetine

  • Always swallow delayed-release capsules whole with or without. Do not split them open or chew them. Do not mix the contents of capsules with liquid or food.3
  • Make sure you follow your prescription exactly. Read the Medication Guide that comes with the medication and ask your doctor if you have any questions.8
  • It is best not to operate heavy machinery or drive a car when you first start taking duloxetine. You do not know how it affects you yet. Duloxetine could possibly cause symptoms of dizziness, light-headedness or fainting, which could be dangerous in these situations. This can be worsened by alcohol consumption.3
  • If you need any kind of surgery during duloxetine treatment, including dental surgery, let your doctor or surgeon know that you are taking duloxetine.3
  • Duloxetine can increase your blood pressure. It is important to check your blood pressure before and regularly during treatment.3
  • Smoking can decrease the effectiveness of duloxetine and worsen side effects. It is best not to smoke tobacco while taking duloxetine.3
  • Duloxetine can also cause a condition known as angle-closure glaucoma – where the fluid in the eye is blocked and cannot flow out. This can result in a sudden loss of vision. It is a good idea to get an eye examination before starting duloxetine If you experience nausea, changes in vision or redness and swelling in or around your eye, call your doctor immediately.3

How Long Does Duloxetine Take to Start Working?

Duloxetine can take some time to begin working. You may experience an improvement in your sleep, appetite and energy levels within one to two weeks. This indicates that the medication is working for you. Symptoms of depression, such as low mood and disinterest in activities, can continue for six to eight weeks before improving.1

Withdrawal Symptoms

Duloxetine helps to reduce your symptoms, but does not cure your condition. Keep taking it even if you feel well. Do not suddenly stop taking duloxetine without speaking to your doctor first. You may experience withdrawal symptoms if your dose is not decreased gradually.3

Common withdrawal symptoms of duloxetine3:

  • nausea
  • vomiting
  • diarrhea
  • anxiety
  • dizziness
  • tiredness
  • headache
  • pain, burning, numbness, or tingling in the hands or feet
  • irritability
  • difficulty falling asleep or staying asleep
  • sweating
  • nightmares

If you experience any of these withdrawal symptoms when your doctor is decreasing your dose, inform them as soon as possible.3

Warnings for Special Groups

Warnings for Pregnancy or Lactation

It is common to experience symptoms of depression either during or after pregnancy. It is very important to speak to your doctor if you begin experiencing signs of depression. Depression can affect your desire to eat well and to keep physically active. This can affect both your health and your baby’s health.11

Duloxetine may be prescribed to reduce these symptoms, but the effects on the unborn baby are questionable. 11

Duloxetine may affect your baby in the following ways11:

  • constant crying
  • feeding difficulty
  • hyperreflexia (overactive reflexes)
  • irritability

It is also not yet known whether duloxetine passes through breast milk to your baby, so duloxetine use during lactation is not recommended.11

Warnings for Children

Duloxetine is generally safe for the treatment of children seven years and older. It is not yet known whether duloxetine treatment of children under seven years old is safe or not. It is best to speak to your doctor if you are concerned about your child’s anxiety and what the best form of treatment is.8

Warnings for the Elderly

Duloxetine is generally safe for the elderly to take, but they are at a higher risk of developing side effects, and are more likely to develop low sodium blood levels. The neurological side effects of duloxetine could also increase their risk of falling and getting injured. Your doctor will be able to suggest the best form of treatment for you.19

Duloxetine Compared to Other Similar Drugs

Duloxetine vs. Gabapentin

Gabapentin is in a class of drugs called anticonvulsants. It is used to treat seizures by decreasing excitement in the brain. It is also used to treat the pain experienced after a shingles attack and is sometimes used to treat restless leg syndrome.12

Gabapentin is not usually used to treat depression or anxiety, but has been found to be more effective than duloxetine at treating diabetic neuropathy.13

Duloxetine vs. Trazodone

Trazodone is used similarly to duloxetine. Its main function is to treat depression. It belongs to a group of medications called serotonin modulators. These work by increasing serotonin levels in the brain, which helps maintain mental balance.14

Trazodone is an effective sedative, but when given at higher doses needed to treat depression, it may cause worse side effects than duloxetine.14

Duloxetine vs. Amitriptyline

Amitriptyline is also used to treat depression. It belongs to a class of medications known as tricyclic antidepressants.  These work by increasing levels of serotonin and norepinephrine in the brain.15

Amitriptyline is also used to treat eating disorders, the pain experienced after shingles, diabetic neuropathy and to prevent migraines.15 It is equally effective to duloxetine for treating diabetic neuropathy13 and depression.16

Duloxetine vs. Citalopram

Citalopram is used mainly to treat depression. It belongs to a class of medications called selective serotonin reuptake inhibitors (SSRIs).17 SSRIs increase the activity of serotonin only, whereas duloxetine increases the activity of both serotonin and norepinephrine.1,17 This means that duloxetine may cause fewer side effects.

Besides treating depression, citalopram is also sometimes used to treat eating disorders, alcoholism, panic disorder, premenstrual stress and social phobia.17

 

Duloxetine vs. Fluoxetine

Fluoxetine (Prosac) is in the same class of medications as citalopram – SSRIs. It is used to treat depression, obsessive-compulsive disorder, some eating disorders and panic attacks. Fluoxetine is sometimes used to relieve the symptoms of premenstrual stress, including mood swings, irritability, bloating and breast tenderness.18

Fluoxetine is equally effective at treating depression as duloxetine.19

Fluoxetine is sometimes also used to treat alcoholism, attention-deficit disorder, borderline personality disorder, sleep disorders, headaches, mental illness, posttraumatic stress disorder, Tourette’s syndrome, obesity, sexual problems and phobias.18

Duloxetine Drug Interactions

Certain medications may interact when used at the same time. These interactions could either reduce the strength of the medications or worsen the side effects caused by them.20

It is very important to let your doctor know if you are taking any of the following medications before starting duloxetine treatment. Your doctor may need to adjust the dose prescribed or may choose to prescribe a different medication altogether.20

These medications should not be used with duloxetine (your doctor may prescribe a different medication for you)20:

  • Bromopride
  • Linezolid
  • Isocarboxazid
  • Metoclopramide
  • Procarbazine
  • Rasagiline
  • Selegiline
  • Tranylcypromine
  • Methylene Blue
  • Phenelzine
  • Safinamide
  • Thioridazine

These medications may be used with duloxetine if absolutely necessary, but it is not usually recommended (your doctor may adjust the doses)20:

  • Abciximab
  • Aceclofenac
  • Acemetacin
  • Almotriptan
  • Amtolmetin Guacil
  • Anagrelide
  • Apixaban
  • Asenapine
  • Aspirin
  • Brexpiprazole
  • Bromfenac
  • Bufexamac
  • Buprenorphine
  • Bupropion
  • Celecoxib
  • Choline Salicylate
  • Cifenline
  • Cilostazol
  • Citalopram
  • Clonixin
  • Clopidogrel
  • Cyclobenzaprine
  • Darunavir
  • Deferasirox
  • Desvenlafaxine
  • Dexibuprofen
  • Dexketoprofen
  • Dextromethorphan
  • Diclofenac
  • Diflunisal
  • Dipyridamole
  • Dipyrone
  • Dolasetron
  • Donepezil
  • Doxorubicin
  • Doxorubicin Hydrochloride Liposome
  • Droxicam
  • Edoxaban
  • Eletriptan
  • Eliglustat
  • Encainide
  • Epoprostenol
  • Eptifibatide
  • Escitalopram
  • Etodolac
  • Etofenamate
  • Etoricoxib
  • Felbinac
  • Fenoprofen
  • Fentanyl
  • Fepradinol
  • Feprazone
  • Flecainide
  • Floctafenine
  • Flufenamic Acid
  • Fluoxetine
  • Flurbiprofen
  • Fluvoxamine
  • Frovatriptan
  • Granisetron
  • Hydroxytryptophan
  • Ibuprofen
  • Iloprost
  • Indecainide
  • Indomethacin
  • Iobenguane I 123
  • Ketoprofen
  • Ketorolac
  • Lamifiban
  • Levomilnacipran
  • Lexipafant
  • Lithium
  • Lorcainide
  • Lorcaserin
  • Lornoxicam
  • Loxoprofen
  • Lumiracoxib
  • Meclofenamate
  • Mefenamic Acid
  • Meloxicam
  • Meperidine
  • Methadone
  • Milnacipran
  • Mirtazapine
  • Morniflumate
  • Nabumetone
  • Naproxen
  • Naratriptan
  • Nebivolol
  • Nepafenac
  • Niflumic Acid
  • Nimesulide
  • Nimesulide Beta Cyclodextrin
  • Oxaprozin
  • Oxycodone
  • Oxyphenbutazone
  • Palonosetron
  • Parecoxib
  • Paroxetine
  • Phenylbutazone
  • Piketoprofen
  • Piroxicam
  • Pixantrone
  • Pranoprofen
  • Proglumetacin
  • Propafenone
  • Propyphenazone
  • Proquazone
  • Recainam
  • Rivaroxaban
  • Rizatriptan
  • Rofecoxib
  • Salicylic Acid
  • Salsalate
  • Sertraline
  • Sibrafiban
  • Sodium Salicylate
  • St John’s Wort
  • Sulfinpyrazone
  • Sulindac
  • Sulodexide
  • Sumatriptan
  • Tapentadol
  • Tenoxicam
  • Tiaprofenic Acid
  • Ticlopidine
  • Tirofiban
  • Tolfenamic Acid
  • Tolmetin
  • Tramadol
  • Trazodone
  • Tryptophan
  • Valdecoxib
  • Venlafaxine
  • Vilazodone
  • Vortioxetine
  • Xemilofiban
  • Ziprasidone
  • Zolmitriptan19

These medications may worsen the side effects caused by duloxetine (your doctor may adjust the doses)20:

  • Acenocoumarol
  • Phenprocoumon
  • Warfarin

Abuses of Duloxetine

Duloxetine is not addictive, but you may experience withdrawal symptoms you suddenly stop taking it. It is best to decrease your duloxetine dose over several weeks. This should be done under your doctor’s guidance.20

In the case of duloxetine overdose, call your local poison control center at 1-800-222-1222. If the person is not moving, call your local emergency services at 911.3

Signs of duloxetine overdose may include the following3:

  • agitation
  • fast heartbeat
  • loss of coordination
  • fever
  • drowsiness
  • lightheadedness
  • hallucinating (seeing things or hearing voices that do not exist)
  • nausea
  • vomiting
  • diarrhea
  • seizures
  • dizziness
  • fainting
  • unresponsiveness

Other Important Information

Keep all appointments with your doctor. Let them know if you are experiencing any side effects.

Do not let anyone else take your medication, even if they have the same symptoms as you. Duloxetine could be harmful to them.

Always keep a list of all the prescription and non-prescription medications you are taking, as well as any nutritional supplements or herbal products. You should bring this list with you every time you visit your doctor or go into hospital.3

Duloxetine FAQs

  • When is the best time to take Cymbalta? Morning or evening?
    • Duloxetine needs to be taken at the same time every day.6
    • It does not matter whether this is in the morning or evening.6
    • Choose a time each day that you will remember.6
  • Is Cymbalta a narcotic?
    • No, duloxetine is a prescription drug and is not addictive. It can cause withdrawal symptoms if suddenly stopped.21
    • As long as you stop taking duloxetine over several weeks, you should not experience withdrawal symptoms.21
  • Can duloxetine get you high?
    • No, duloxetine does not instantly affect your mental state.1
    • It takes several weeks of duloxetine treatment before an improvement in your mental state is experienced.1
  • How many duloxetine pills can you take to overdose?
    • You should not take more than 120 mg of duloxetine in one day.8
    • Anything above this amount could cause serious side effects.8
    • Fatal overdoses have been reported at doses as low as 1000 mg.22
  • Generic Cymbalta does not work for me. Why and what can I do?
    • If the generic duloxetine is not working for you, it is best to speak to your doctor.
    • Your doctor may prescribe a different medication for you to try.
  • Where to buy Cymbalta?
    • You should be able to find Cymbalta at your local pharmacy.3

 

References

  1. National Alliance on Mental Illness (NAMI). Duloxetine. Published June 2017. https://www.nami.org/Learn-More/Treatment/Mental-Health-Medications/Duloxetine-(Cymbalta). Accessed August 22, 2017.
  2. Drugbank. Duloxetine. Last updated September 01, 2017. https://www.drugbank.ca/drugs/DB00476. Accessed September 2, 2017.
  3. MedlinePlus. Duloxetine. Last updated May 15, 2017. https://medlineplus.gov/druginfo/meds/a604030.html. Accessed August 22, 2017.
  4. Structure of a typical chemical synapse. Neurotransmitter release mechanisms [illustration]. (2016). Retrieved 30 August 2017, from http://www.istockphoto.com/za/vector/structure-of-a-typical-chemical-synapse-neurotransmitter-release-mechanisms-gm532971186-94360535.
  5. Michigan Medicine. Duloxetine. Last updated September 25, 2015. http://www.uofmhealth.org/health-library/d05355a1. Accessed August 22, 2017.
  6. NAMI Minnesota. Cymbalta (duloxetine). Last updated August 2006. http://www.namihelps.org/assets/PDFs/fact-sheets/Medications/Cymbalta.pdf. Accessed August 22, 2017.
  7. Headmeds. Duloxetine: use and action. Last updated 2017. http://www.headmeds.org.uk/medications/94-duloxetine/use_and_action. Accessed August 22, 2017.
  8. Mayo Clinic. Duloxetine (Oral Route): Proper Use, accessed 22/08/2017. http://www.mayoclinic.org/drugs-supplements/duloxetine-oral-route/proper-use/drg-20067247
  9. US Food and Drug Administration. Antidepressant Use in Children, Adolescents, and Adults. Revisions to product labelling. https://www.fda.gov/downloads/Drugs/DrugSafety/InformationbyDrugClass/UCM173233.pdf. Accessed August 22, 2017.
  10. Mayo Clinic. Duloxetine (Oral Route): Precautions. Last updated March 01, 2017. http://www.mayoclinic.org/drugs-supplements/duloxetine-oral-route/precautions/drg-20067247. Accessed August 22, 2017.
  11. American Pregnancy Association. Duloxetine During Pregnancy. Last updated 2017. http://americanpregnancy.org/medication/duloxetine-during-pregnancy/. Accessed August 22, 2017.
  1. Gabapentin. Last updated July 15, 2011. https://medlineplus.gov/druginfo/meds/a694007.html. Accessed August 22, 2017.
  2. Rudroju N, Bansal D, Talakokkula ST, Gudala K, Hota D, Bhansali, A, Ghai B. Comparative Efficacy and Safety of Six Antidepressants and Anticonvulsants in Painful Diabetic Neuropathy: A Network Meta-analysis. Pain Physician Journal 2013; 16:E705-E714. http://www.painphysicianjournal.com/current/pdf?article=MjAwNA%3D%3D&journal=78.
  3. MedlinePlus. Trazodone. Last updated May 15, 2017. https://medlineplus.gov/druginfo/meds/a681038.html. Accessed August 22, 2017.
  4. MedlinePlus. Amitriptyline. Last updated July 15, 2017. https://medlineplus.gov/druginfo/meds/a682388.html. Accessed August 22, 2017.
  5. Cochrane. Duloxetine versus other antidepressive agents for depression. Published October 17, 2012. http://www.cochrane.org/CD006533/DEPRESSN_duloxetine-versus-other-antidepressive-agents-for-depression. Accessed August 22, 2017.
  6. MedlinePlus. Citalopram. November 15, 2014. https://medlineplus.gov/druginfo/meds/a699001.html. Accessed August 22, 2017.
  7. MedlinePlus. Fluoxetine. Last updated November 15, 2014. https://medlineplus.gov/druginfo/meds/a689006.html. Accessed August 22, 2017.
  8. Eckert L, Lançon C. Duloxetine compared with fluoxetine and venlafaxine: use of meta-regression analysis for indirect comparisons. BMC Psychiatry. 2006;6:30. doi:10.1186/1471-244X-6-30.
  9. Mayo Clinic. Duloxetine (Oral Route): Before Using. Last updated March 01, 2017. http://www.mayoclinic.org/drugs-supplements/duloxetine-oral-route/before-using/drg-20067247. Accessed August 22, 2017.
  10. Talking Sense. Duloxetine. Last updated 2017. http://www.talkingsense.org/how-we-can-help/medication-for-mental-health/duloxetine/. Accessed August 22, 2017.
  11. Toxicology Data Network. Duloxetine. Last updated October 19, 2015. https://toxnet.nlm.nih.gov/cgi-bin/sis/search/a?dbs+hsdb:@[email protected]+7368. Accessed August 22, 2017.

Comments

No comments

New Articles

Experts notesMedicine
Open source health care resources.
June 25, 201901,709

These changes mirror and support organizational changes in the health care industry. Whether...

Experts notesMedicine
Openhealth — Open source software in health care.
June 25, 201901,381

Around the world, health care software is moving from hospital-centered departmental systems, to...