From the Guidelines
The recommended dosing for Cymbalta (duloxetine) is 30 mg once daily, which can be increased to 60 mg once daily after 1 week, with a maximum dosage of 60 mg twice daily 1.
Key Considerations
- The starting dosage is 30 mg once daily, which allows for assessment of tolerance before increasing the dose.
- The dose can be increased to 60 mg once daily after 1 week, and this is often the standard maintenance dose for various conditions.
- For certain conditions, such as neuropathic pain, the recommended dose is 60 mg once daily.
Important Administration Instructions
- Cymbalta should be taken at the same time each day, with or without food.
- The capsule should be swallowed whole without crushing or chewing.
Special Populations
- Dose adjustments may be needed for patients with renal impairment, as duloxetine is primarily eliminated by the kidneys.
- Gradual tapering of the medication is recommended when discontinuing to avoid withdrawal symptoms.
Common Side Effects
- Nausea, dry mouth, constipation, decreased appetite, fatigue, sleepiness, and increased sweating are common side effects of Cymbalta.
Mechanism of Action
- Cymbalta works by increasing the levels of serotonin and norepinephrine in the brain, which helps regulate mood, pain signals, and anxiety, as supported by the pharmacological management recommendations 1.
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.
The recommended dosing for Cymbalta (duloxetine) varies by condition:
- Major Depressive Disorder (MDD): 40-60 mg/day
- Generalized Anxiety Disorder (GAD): 60 mg once daily
- Diabetic Peripheral Neuropathic Pain: 60 mg once daily
- Fibromyalgia: 60 mg once daily 2
From the Research
Cymbalta Dosing
- The recommended dosing for Cymbalta (duloxetine) varies depending on the condition being treated.
- For generalized anxiety disorder (GAD), the recommended dose is 60-120 mg once daily 3.
- In patients with GAD, duloxetine 60-120 mg once daily was effective in improving anxiety and functional impairment, and was generally well tolerated 3, 4.
- For major depressive disorder (MDD), duloxetine at dosages ranging from 40 to 120 mg/day was effective in the short- and long-term treatment 5.
- A comparison of initial duloxetine dosing strategies in patients with MDD found that starting at 30 mg once daily for 1 week with or without food, or starting at the therapeutic dose of 60 mg once daily with food, can improve the initial tolerability of the medication 6.
Dosing Considerations
- Duloxetine may be administered without regard to food or time of day 3.
- The pharmacokinetics of duloxetine in healthy volunteers were dose proportional over the range of 40-120 mg once daily 3.
- Steady state was typically reached by day 3 of administration, and the mean elimination half-life of duloxetine is approximately 12 hours 3.
- Concomitant use of duloxetine and potent CYP1A2 inhibitors should be avoided, and duloxetine should be used with caution in patients receiving drugs that are extensively metabolized by CYP2D6 3.