The clinic nurse is seeing a client who is taking duloxetine hydrochloride. When updating the client’s medical history, for which condition mentioned by the client would the nurse notify the health care provider?

  1. recent worsening of insomnia
  2. unplanned weight loss of 6 pounds
  3. uncontrolled narrow-angle glaucoma
  4. removal of a benign skin cancer on the leg
Number 3 is correct.
Rationale: Uncontrolled narrow-angle glaucoma is a contraindication for duloxetine hydrochloride therapy, as it can further increase pressure in the eye. The nurse should notify the health care provider so that an alternative medication may be considered, along with treatment of glaucoma. Insomnia is a common side effect of duloxetine hydrochloride. The nurse can educate the client about nonpharmacologic methods to improve sleep. Decreased appetite and weight loss are side effects of the medication. If the weight loss is too fast or too much, the health care provider should be notified; otherwise, small fluctuations in weight over a long period of time should not be a concern. Removal of a skin cancer, while important, is not an anticipated side effect of duloxetine hydrochloride.