From the Guidelines
Cymbalta (duloxetine) is typically started at 30 mg once daily for one week before increasing to the target dose of 60 mg once daily. This gradual titration helps minimize initial side effects like nausea and dizziness, as noted in the study by 1. For depression and generalized anxiety disorder, the recommended dose is 60 mg once daily, though some patients may respond to the lower 30 mg dose. For diabetic peripheral neuropathic pain and fibromyalgia, doses range from 60-120 mg daily, as seen in the study by 1. For chronic musculoskeletal pain, 60 mg daily is standard.
- Key considerations for dosing include:
- Starting with a low dose and gradually increasing to minimize side effects
- Adjusting the dose based on the patient's response and tolerance
- Considering lower doses for patients with liver or kidney impairment, as mentioned in the study by 1
- Administration guidelines include:
- Taking the medication at the same time each day
- Taking the medication with or without food
- Swallowing the capsule whole without crushing or chewing
- It is essential to note that patients should not abruptly stop taking Cymbalta, as this can cause withdrawal symptoms; instead, the dosage should be gradually reduced when discontinuing, as advised in the study by 1. Cymbalta works by increasing serotonin and norepinephrine levels in the brain, which helps regulate mood, pain perception, and anxiety.
From the FDA Drug Label
2.2 Dosage for Treatment of Major Depressive Disorder in Adults The recommended starting dosage in adults with MDD is 40 mg/day (given as 20 mg twice daily) to 60 mg/day (given either once daily or as 30 mg twice daily) 2.3 Dosage for Treatment of Generalized Anxiety Disorder Recommended Dosage in Adults Less than 65 Years of Age For most adults less than 65 years of age with GAD, initiate duloxetine delayed-release capsules 60 mg once daily 2.4 Dosage for Treatment of Diabetic Peripheral Neuropathic Pain in Adults Administer 60 mg once daily in adults with diabetic peripheral neuropathic pain. 2.5 Dosage for Treatment of Fibromyalgia The recommended duloxetine delayed-release capsules dosage is 60 mg once daily in adults with fibromyalgia. 2.6 Dosage for Treatment of Chronic Musculoskeletal Pain in Adults The recommended duloxetine delayed-release capsules dosage is 60 mg once daily in adults with chronic musculoskeletal pain.
The recommended dose of Duloxetine (Cymbalta) varies by condition:
- Major Depressive Disorder: 40-60 mg/day
- Generalized Anxiety Disorder: 60 mg once daily
- Diabetic Peripheral Neuropathic Pain: 60 mg once daily
- Fibromyalgia: 60 mg once daily
- Chronic Musculoskeletal Pain: 60 mg once daily 2
From the Research
Recommended Dose of Duloxetine
The recommended dose of Duloxetine (Cymbalta) varies depending on the condition being treated.
- For the management of diabetic peripheral neuropathic pain, fibromyalgia, and chronic musculoskeletal pain due to chronic osteoarthritis pain and low back pain, the recommended dose is 60 mg once-daily dosing 3.
- For the treatment of generalized anxiety disorder (GAD), the recommended dose is 60-120 mg once daily 4.
- For the treatment of major depressive disorder (MDD), the recommended dose is 60 mg once daily, with some studies suggesting that higher doses (up to 120 mg/day) may be effective for some patients 5, 6.
- For the treatment of painful neuropathy, chronic pain, or fibromyalgia, the recommended dose is 60 mg daily, with some studies suggesting that higher doses (up to 120 mg/day) may be effective for some patients 7.
Dose Escalation
Dose escalation of duloxetine from 60 mg/day to 120 mg/day has been studied, and results suggest that it is safe and tolerable 6.
- The majority of adverse events were mild and transient and occurred in the first week of duloxetine dosing (at 60 mg once daily).
- Long-term treatment at a stabilized duloxetine dose was associated with a relatively low incidence of treatment-emergent adverse events and treatment discontinuation due to adverse events.
Safety and Tolerability
Duloxetine has been shown to be generally well tolerated, with most adverse events being of mild to moderate severity 3, 4, 5, 7, 6.
- Common adverse events include nausea, dry mouth, headache, constipation, dizziness, and fatigue.
- Serious adverse events are rare, but may include suicidal thoughts or behaviors, and serotonin syndrome.