1 IntroductionDuloxetine is a serotonin-norepinephrine reuptake inhibitor (SNRI) used to treat major depressive disorder, generalized anxiety disorder, fibromyalgia, and diabetic peripheral neuropathy [1]. The pharmacological action of duloxetine includes the inhibition of serotonin and norepinephrine reuptake at the synaptic cleft, thereby modulating pain and mood pathways [2]. While duloxetine is generally well-tolerated, there have been reports of adverse effects, including nausea, dry mouth, dizziness, and, less commonly, hematological abnormalities [3,4].Thrombocytopenia, defined as a platelet count below 150 x10^3/uL, is a rare yet serious adverse effect that has been sporadically linked to duloxetine use [1]. The exact mechanism remains unclear, but hypotheses include serotonin depletion in platelets and immune-mediated platelet destruction [3,5]. Given the role of serotonin in platelet aggregation, interference with this system can compromise platelet function and survival [5].Despite its wide clinical application, duloxetine-induced thrombocytopenia is under-recognized. Awareness of this rare complication is critical for timely diagnosis and management, especially in complex cases involving polypharmacy and comorbidities. Here, we present a detailed case report of a patient who developed thrombocytopenia shortly after duloxetine initiation, with normalization following its withdrawal.
