From the FDA Drug Label
A gradual reduction in dosage rather than abrupt cessation is recommended whenever possible [see WARNINGS AND PRECAUTIONS (5.7)].
The recommended tapering schedule for discontinuing Cymbalta (duloxetine) 60 mg is not explicitly stated in the drug label. However, it is recommended to gradually reduce the dosage rather than stopping abruptly.
- Gradual reduction: Reduce the dosage gradually, but the exact schedule is not specified.
- Abrupt cessation: Avoid stopping the medication abruptly, as it may lead to adverse reactions such as dizziness, headache, nausea, and anxiety. 1
From the Research
The recommended tapering schedule for discontinuing Cymbalta (duloxetine) 60 mg is to gradually reduce the dose over several months, with a hyperbolic tapering approach, to minimize withdrawal symptoms and reduce the risk of relapse. This approach is supported by recent studies, such as 2, which suggest that slower tapering of antidepressants and antipsychotics is associated with a lower risk of relapse and withdrawal symptoms. A typical approach would be to decrease the dose by a small amount (e.g., 10-25% of the current dose) every 3-6 months, with the goal of reaching a dose that is much lower than the therapeutic minimum before stopping completely. For example, a patient taking 60 mg of Cymbalta daily could be tapered to 30 mg daily for several months, then to 20 mg daily, and finally to 10 mg daily or lower before stopping.
Some key points to consider when tapering off Cymbalta include:
- Monitor for discontinuation symptoms such as dizziness, nausea, headache, irritability, insomnia, sensory disturbances (like "brain zaps"), and anxiety
- Never stop Cymbalta abruptly, as this can lead to severe discontinuation syndrome
- Consult with a healthcare provider before changing the medication regimen, as they may recommend a personalized tapering schedule based on the patient's specific situation and response
- Be aware that some patients may require an even more gradual taper, especially those who have been on the medication for a long time
It's also important to note that the tapering schedule may need to be adjusted based on the patient's individual response, and that some patients may need to be tapered more slowly or at a lower dose to minimize withdrawal symptoms. As suggested by 3, a hyperbolic tapering approach, which reduces the dose by a fixed percentage at each step, may be more effective in minimizing withdrawal symptoms than a linear tapering approach. Additionally, studies such as 4 and 5 provide further evidence for the importance of gradual tapering in minimizing withdrawal symptoms and reducing the risk of relapse.