First thing to note, Unfortunately smoking does affects the amount of duloxetine in your system and blood stream meaning that you will loose between 40 - 50% of the duloxetine dose you take. It is not uncommon for people to have their duloxetine prescription increased if they smoke. Unfortunately it is not uncommon if you miss a dose to be experiencing these problems if your on a high dose, my patients even at a dose of 30mg do experience brain zaps, nausea and vomiting even with just one day missed. This is why duloxetine should be withdrawn extremely slowly and only under professional help. I always recommend being on duloxetine for a solid 12 months at the right dose for you before you even consider reducing or think about coming off the drug, kind regards
It is the same drug as Cymbalta. It is an SNRI and I think there are a few people on the forum that use this for neuropathic pain. Most of these medications work for neuropathic MS pain in the same way the work for the pain of diabetic neuropathy. They alter the conduction thresholds of ion channels in the nervous systems. The same is true of several anti-seizure medications like Tegretol and Gabapentin.
Bob