Cymbalta (Duloxetine) Dosing Recommendations
The recommended dosing for Cymbalta (duloxetine) starts at 30 mg once daily for one week, then increases to 60 mg once daily for most indications, with a maximum dose of 120 mg daily depending on the condition being treated. 1
Dosing by Indication
Major Depressive Disorder
- Starting dose: 40-60 mg/day (given as 20 mg twice daily or 30 mg twice daily)
- Alternative starting approach: 30 mg once daily for 1 week, then increase to 60 mg once daily
- Maintenance dose: 60 mg once daily
- Maximum dose: 120 mg/day (though no additional benefit has been demonstrated beyond 60 mg/day) 1, 2
Generalized Anxiety Disorder
- Adults under 65 years:
- Geriatric patients:
- Starting dose: 30 mg once daily for 2 weeks
- Target dose: 60 mg once daily
- Maximum dose: 120 mg/day 1
- Pediatric patients (7-17 years):
- Starting dose: 30 mg once daily for 2 weeks
- Target dose: 30-60 mg once daily
- Maximum dose: 120 mg/day 1
Diabetic Peripheral Neuropathic Pain
- Standard dose: 60 mg once daily
- For patients with tolerability concerns: Lower starting dose with gradual increase
- Maximum dose: 60 mg once daily (no evidence of additional benefit at higher doses) 1, 4, 5
Fibromyalgia
- Starting dose: 30 mg once daily for 1 week
- Target dose: 60 mg once daily
- Maximum dose: 60 mg/day (no evidence of additional benefit at higher doses) 1, 4, 5
Chronic Musculoskeletal Pain
- Recommended dose: 60 mg once daily 4
Administration Guidelines
- Administer orally with or without food
- Swallow capsules whole; do not chew, crush, or open capsules
- If a dose is missed, take it as soon as remembered unless it's almost time for the next dose
- Do not take two doses at the same time 1
Dose Adjustments
Renal Impairment
- Consider lower starting dose and gradual increase for patients with renal impairment 6, 1
- Maximum time between doses should not exceed 12 hours 6
Hepatic Disease
- Contraindicated in patients with hepatic disease 6
Common Side Effects
- Sedation, dry mouth, constipation or diarrhea
- Anxiety, reduced appetite, nausea
- Headache, fatigue 7, 6
Important Considerations
- Therapeutic effects may take several days to weeks to develop
- Duloxetine is not effective as a PRN medication and requires consistent dosing
- Abrupt discontinuation can lead to withdrawal symptoms; taper over at least 1 week when discontinuing 6
- Discontinuation-emergent adverse events (most commonly nausea and dizziness) occur in up to one-third of patients 3
Drug Interactions
- Avoid concomitant use with MAOIs
- Use caution with other serotonergic drugs
- Avoid concomitant use with potent CYP1A2 inhibitors
- Use caution with drugs extensively metabolized by CYP2D6 1, 3
Duloxetine's dual mechanism of action on serotonin and norepinephrine makes it particularly effective for pain conditions while also addressing comorbid depression or anxiety, with 60 mg once daily being the optimal dose for most indications.