Cross-Tapering from Sertraline (Zoloft) 100mg to Duloxetine (Cymbalta)
The best way to cross-taper from Zoloft 100mg to Cymbalta is to start with Cymbalta 30mg once daily for one week while gradually reducing Zoloft, then increase to Cymbalta 60mg once daily as you continue tapering off Zoloft completely over 2-4 weeks. 1
Equivalent Dosing
- Sertraline (Zoloft) 100mg is approximately equivalent to Duloxetine (Cymbalta) 60mg daily 2
Cross-Tapering Protocol
Week 1:
- Start Cymbalta 30mg once daily
- Reduce Zoloft to 75mg daily
Week 2:
- Increase Cymbalta to 60mg once daily
- Reduce Zoloft to 50mg daily
Week 3:
- Continue Cymbalta 60mg once daily
- Reduce Zoloft to 25mg daily
Week 4:
- Continue Cymbalta 60mg once daily
- Discontinue Zoloft completely
Important Considerations
Withdrawal Management
- Sertraline has been associated with discontinuation syndrome, characterized by dizziness, fatigue, headaches, nausea, sensory disturbances, anxiety, and irritability 1
- Tapering over 2-4 weeks rather than abrupt discontinuation significantly reduces the risk of withdrawal symptoms 3
- If withdrawal symptoms emerge during the taper, slow the taper rate by extending the time between dose reductions
Monitoring for Adverse Effects
- Monitor for serotonin syndrome during the cross-taper period, especially in the first 24-48 hours after dosage changes 1
- Symptoms include agitation, tremor, hyperthermia, autonomic instability, and mental status changes
- Duloxetine's most common adverse effect is nausea, which is reduced by starting at 30mg once daily for the first week 1
Special Precautions
- Avoid this cross-taper in patients with:
- Uncontrolled narrow-angle glaucoma
- Severe hepatic impairment
- Concurrent use of MAOIs
- QT prolongation risk factors
Follow-up Recommendations
- Schedule follow-up within 1-2 weeks of initiating the cross-taper
- Assess for:
- Withdrawal symptoms from Zoloft
- Adverse effects from Cymbalta
- Changes in mood, anxiety, or suicidal ideation
Common Pitfalls to Avoid
- Tapering too quickly - This increases risk of withdrawal symptoms and may compromise treatment efficacy
- Not starting with a lower dose of Cymbalta - Starting with 30mg reduces nausea and other initial side effects 1
- Overlooking drug interactions - Both medications affect serotonin levels, requiring careful monitoring during transition
- Inadequate follow-up - Close monitoring is essential during the cross-taper period
If withdrawal symptoms become severe or intolerable during the taper, consider slowing the taper rate by making smaller reductions (e.g., 12.5mg decrements of Zoloft) or extending the time between dose reductions to 2 weeks 3.