From the Guidelines
Duloxetine (Cymbalta) is a prescription medication primarily used to treat depression, anxiety disorders, fibromyalgia, and certain types of chronic pain, including osteoarthritis and neuropathic pain, as evidenced by the most recent guideline from 2022 1.
Key Uses of Duloxetine
- Treatment of depression and anxiety disorders
- Management of fibromyalgia
- Treatment of certain types of chronic pain, including osteoarthritis and neuropathic pain
Dosage and Administration
- The typical starting dose for depression or anxiety is 30 mg once daily, often increased to 60 mg daily after one week
- For fibromyalgia or chronic pain, dosing usually starts at 30 mg and may increase to 60 mg daily, with some patients requiring up to 120 mg daily
- Duloxetine should be taken at the same time each day, with or without food
Side Effects and Interactions
- Common side effects include nausea, dry mouth, constipation, decreased appetite, fatigue, increased sweating, and dizziness
- Patients should not stop taking duloxetine abruptly as this can cause withdrawal symptoms; dosage should be gradually reduced under medical supervision
- Duloxetine may interact with other medications, particularly MAOIs, and should not be taken within 14 days of stopping an MAOI
Evidence-Based Recommendations
- The 2022 guideline recommends the use of duloxetine for the treatment of osteoarthritis pain, particularly in patients who have not responded to nonpharmacologic interventions or topical NSAIDs 1
- A systematic review from 2017 found that duloxetine was associated with small improvements in chronic low back pain, with a significant reduction in pain intensity and improvement in function 1
- The 2021 synopsis of the VA/DoD clinical practice guideline recommends the use of duloxetine for the treatment of hip and knee osteoarthritis, with a suggested starting dose of 30 mg/d and a goal dose of 60 mg/d 1
From the FDA Drug Label
Duloxetine delayed-release capsules are indicated for the treatment of: Major depressive disorder in adults Generalized anxiety disorder in adults and pediatric patients 7 years of age and older Diabetic peripheral neuropathic pain in adults Fibromyalgia in adults Chronic musculoskeletal pain in adults
The use of Duloxetine (Cymbalta) is for the treatment of:
- Major Depressive Disorder (MDD) in adults
- Generalized Anxiety Disorder (GAD) in adults and pediatric patients 7 years of age and older
- Diabetic Peripheral Neuropathic Pain (DPNP) in adults
- Fibromyalgia (FM) in adults
- Chronic Musculoskeletal Pain in adults 2
From the Research
Uses of Duloxetine (Cymbalta)
Duloxetine, also known by its brand name Cymbalta, is a medication with multiple uses, including:
- Treatment of major depressive disorder (MDD) 3
- Management of generalized anxiety disorder (GAD) 4, 5
- Treatment of neuropathic pain associated with diabetic peripheral neuropathy 6, 7
- Management of fibromyalgia 6, 5, 7
- Treatment of stress urinary incontinence 6, 5
Efficacy and Safety
Studies have shown that duloxetine is effective in treating various conditions, including:
- MDD: duloxetine at dosages ranging from 40 to 120 mg/day was effective in the short- and long-term treatment of MDD 3
- GAD: duloxetine 60-120 mg once daily was effective in the short-term treatment of patients with GAD 4
- Neuropathic pain: duloxetine at 60 mg daily is effective in treating painful diabetic peripheral neuropathy in the short-term 6, 7
- Fibromyalgia: duloxetine at 60 mg daily is also effective in fibromyalgia over 12 weeks and 28 weeks 6, 7
Common Adverse Events
Common adverse events associated with duloxetine include:
- Nausea
- Dry mouth
- Headache
- Constipation
- Dizziness
- Fatigue Most adverse events are minor, but 16% of participants stopped the drug due to adverse events 6, 7. Serious adverse events are rare.
Dosage and Administration
Duloxetine is typically administered at a dosage of 60 mg daily, although dosages ranging from 40 to 120 mg/day have been used in various studies 6, 4, 3, 7. The medication can be taken without regard to food or time of day.