From the Guidelines
Duloxetine 60 mg twice daily is not a standard or recommended dose for most conditions, and the maximum FDA-approved dose is generally 120 mg daily, which can be divided as 60 mg twice daily only for specific conditions like diabetic peripheral neuropathic pain or when clinically necessary. The standard therapeutic dose of duloxetine is typically 60 mg once daily, with some conditions requiring 30 mg daily initially 1. Some studies suggest that duloxetine has efficacy in the treatment of pain associated with diabetic peripheral neuropathy (DPN) at doses of 60 and 120 mg/day 1. However, taking 120 mg daily may increase the risk of side effects such as nausea, dizziness, dry mouth, constipation, insomnia, and increased blood pressure without providing additional therapeutic benefit for many patients. If a higher dose is being considered, it should be implemented gradually under close medical supervision, and only after a lower dose has proven insufficient 1. Patients should never adjust their duloxetine dose without consulting their healthcare provider, as both dose increases and abrupt discontinuation can cause significant adverse effects. In the context of osteoarthritis, duloxetine is suggested for use in treating patients with OA, with a goal dose of 60 mg/d, and patients should be educated that duloxetine is to be taken daily and discontinued only after consultation with their prescribing provider 1. It's also important to note that duloxetine does not seem to produce clinically important electrocardiographic or blood pressure changes, and a recent review concluded that aminotransferase monitoring is unnecessary 1. Overall, the use of duloxetine should be individualized and based on the specific condition being treated, with careful consideration of the potential benefits and risks.
From the Research
Duloxetine Dosage and Efficacy
- The recommended dosage of duloxetine is 40-80 mg daily, depending on the indication, preferably split into two doses per day 2.
- Duloxetine is a more potent 5-HT and NE reuptake inhibitor with a more balanced profile of binding at about 10:1 for 5HT and NE transporter binding 3.
- Clinical trials have demonstrated rates of response and remission in patients with major depression that are comparable to other marketed antidepressants 3.
Comparison with Other SNRIs
- Duloxetine has a 10-fold selectivity for 5-HT, whereas milnacipran blocks 5-HT and norepinephrine reuptake with equal affinity, and venlafaxine has a 30-fold selectivity for 5-HT 4.
- Duloxetine and milnacipran appear better tolerated and essentially devoid of cardiovascular toxicity, compared to venlafaxine 4.
- The most frequent adverse event with SNRIs is nausea, and duloxetine is associated with serious and potentially fatal hepatotoxity 5.
Specific Dosage of 60 mg BID
- There is no specific mention of a 60 mg BID dosage in the provided studies, but the recommended dosage range is 40-80 mg daily, which could include a 60 mg BID regimen 2.
- The efficacy and safety of duloxetine at a dosage of 60 mg BID would likely be similar to other dosages within the recommended range, but this would depend on individual patient factors and should be determined by a healthcare professional 3, 2.