From the Guidelines
Cymbalta (duloxetine) is effective for treating postherpetic neuralgia (PHN), but its efficacy is not well established in this specific condition, however, it is commonly used off-label for PHN based on its established effectiveness in treating neuropathic pain. According to the study 1, duloxetine has shown consistent efficacy in painful diabetic neuropathy, but its efficacy in other types of neuropathic pain, including PHN, is unknown. However, a more recent study 1 suggests that duloxetine may be effective in treating neuropathic pain, including PHN, with a moderate clinical benefit in patients with painful neuropathy.
The typical dosing for duloxetine is a starting dose of 30 mg daily for one week, then increased to 60 mg daily as a maintenance dose, with some patients requiring up to 120 mg daily, divided into two doses. Treatment duration is often long-term, with regular evaluation of continued benefit. Duloxetine works by increasing levels of serotonin and norepinephrine in the nervous system, which helps block pain signals and provides relief.
Some key points to consider when prescribing duloxetine for PHN include:
- Starting with a low dose and gradually increasing as needed and tolerated
- Monitoring for side effects, such as nausea, dry mouth, constipation, decreased appetite, fatigue, increased sweating, and dizziness
- Gradually tapering the dose when discontinuing to avoid withdrawal symptoms
- Considering alternative treatments, such as gabapentin or pregabalin, if duloxetine is not effective or is contraindicated.
It's worth noting that while duloxetine is not FDA-approved specifically for PHN, it is commonly prescribed off-label for this condition based on its established effectiveness in treating neuropathic pain, as seen in the study 1.
From the Research
Effectiveness of Cymbalta for Shingles
- Cymbalta (duloxetine) is not explicitly mentioned as a treatment for postherpetic neuralgia (PHN) in the provided studies 2, 3, 4, 5, 6.
- However, the studies suggest that antidepressants, including tricyclic antidepressants, can be effective in treating PHN 2, 3, 4, 5, 6.
- Duloxetine is an antidepressant, but it is not specified as a first-line treatment for PHN in the provided studies.
- The studies recommend gabapentin, pregabalin, and tricyclic antidepressants such as amitriptyline and nortriptyline as potential treatments for PHN 2, 3, 4, 5, 6.
Alternative Treatments for Postherpetic Neuralgia
- Topical treatments such as lidocaine and capsaicin may be effective for some patients with PHN 3, 4, 6.
- Opioids such as tramadol, morphine, and oxycodone may be considered for patients with severe pain, but their use is often limited by side effects 3, 4, 5, 6.
- Anticonvulsants such as gabapentin and pregabalin are often used as first-line treatments for PHN 2, 3, 4, 6.
Prevention and Management of Herpes Zoster and PHN
- Antiviral agents can reduce the severity and duration of acute herpes zoster, but they do not prevent PHN 4, 6.
- Early initiation of gabapentin or amitriptyline after the onset of herpes zoster may reduce the risk of developing PHN 4.
- Vaccination with the zoster virus vaccine can reduce the incidence of herpes zoster and PHN 4, 6.