What is the appropriate dosage and usage of Cymbalta (duloxetine) 30 mg?

Duloxetine (Cymbalta) 30 mg Dosage and Usage Guidelines

The appropriate starting dose of duloxetine 30 mg is typically used for 1-2 weeks before increasing to the target therapeutic dose of 60 mg daily for most conditions. 1

Dosing Recommendations by Condition

Diabetic Peripheral Neuropathic Pain

• Standard dose: 60 mg once daily 1
• Starting approach: Begin with 30 mg once daily for 1 week to improve tolerability before increasing to 60 mg once daily 1
• Maximum dose: 60 mg daily (higher doses show no additional benefit) 1
• Efficacy: Moderate quality evidence shows duloxetine 60 mg is effective for diabetic neuropathic pain with a number needed to treat of 5 2

Major Depressive Disorder

• Starting dose: 40 mg/day (given as 20 mg twice daily) to 60 mg/day (once daily or 30 mg twice daily) 1
• Adjustment period: May start at 30 mg once daily for 1 week before increasing to 60 mg 1
• Maximum dose: 60 mg daily (120 mg shows no additional benefit) 1

Generalized Anxiety Disorder

• Adults under 65: 60 mg once daily, starting with 30 mg once daily for 1 week 1
• Geriatric patients: 30 mg once daily for 2 weeks before considering increase to 60 mg 1
• Pediatric patients (7-17 years): 30 mg once daily for 2 weeks before considering increase to 60 mg 1

Fibromyalgia

• Recommended dose: 60 mg once daily 1
• Starting approach: 30 mg once daily for 1 week before increasing to 60 mg 1
• Efficacy: Effective for fibromyalgia with number needed to treat of 8 2

Chronic Musculoskeletal Pain

• Recommended dose: 60 mg once daily 1
• Starting approach: 30 mg once daily for 1 week before increasing to 60 mg 1

Administration Guidelines

• Take orally with or without food 1
• Swallow capsules whole; do not chew, crush, or open the capsule 1
• If a dose is missed, take it as soon as remembered; if close to next dose, skip the missed dose 1
• Do not take two doses at the same time 1

Special Populations

Renal Impairment

• Consider lower starting dose and gradual increase for patients with renal impairment 1
• Particularly important for diabetic patients who often have concurrent renal disease 1

Hepatic Impairment

• Avoid use in patients with liver disease 3

Elderly Patients

• Start at lower doses (30 mg daily) and titrate more slowly 3, 1
• Increase to target dose after 2 weeks if tolerated 1

Common Side Effects

• Nausea (most common reason for discontinuation) 4, 5
• Dry mouth, headache, constipation, dizziness, and fatigue 4
• Discontinuation-emergent adverse events occur in up to one-third of patients 4
• Most adverse effects are minor, but approximately 16% of patients discontinue due to side effects 2

Monitoring and Evaluation

• Evaluate initial response at 1-2 weeks 3
• Comprehensive evaluation at 4-6 weeks to determine full effect 3
• Patients should continue treatment for at least 4-6 weeks to experience full benefit 3

Clinical Pearls

• The 30 mg dose is primarily used as a starting dose to improve tolerability before increasing to the therapeutic dose of 60 mg 1
• For most conditions, there is no evidence that doses higher than 60 mg provide additional benefit 1
• Higher doses (>60 mg) are associated with increased adverse effects 1, 2
• Duloxetine has a balanced effect on both serotonin and norepinephrine reuptake, making it effective for both pain and mood disorders 5

Remember that while 30 mg is an appropriate starting dose for most conditions, the target therapeutic dose of 60 mg daily is typically needed for full clinical effect.