Duloxetine (Cymbalta) Can Be Taken in the Evening
Yes, Cymbalta 60 mg can be safely moved from morning to evening dosing. The medication can be taken either in the morning or evening based on patient preference and tolerability of side effects.
Rationale for Evening Dosing
Duloxetine (Cymbalta) has a pharmacokinetic profile that supports flexible dosing:
- The FDA drug label indicates duloxetine "may be administered without regard to food or time of day" 1
- Duloxetine has an elimination half-life of approximately 12 hours (range 8-17 hours), which allows for once-daily dosing 1
- The medication reaches steady-state plasma concentrations typically after 3 days of dosing 1
Considerations When Switching to Evening Dosing
Potential Benefits
- May help manage side effects like drowsiness/sedation
- Improved adherence if patient prefers evening dosing
- May help with sleep if insomnia is not a concern
Potential Drawbacks
- The FDA label notes "a 3 hour delay in absorption and a one-third increase in apparent clearance of duloxetine after an evening dose as compared to a morning dose" 1
- Some patients may experience insomnia as a side effect, which could be worsened by evening dosing
Monitoring After Timing Change
When changing the timing of duloxetine administration:
- Monitor for changes in efficacy or side effect profile
- Allow 1-2 weeks for adjustment to the new schedule
- If sleep disturbances occur, consider returning to morning dosing
Common Side Effects to Monitor
- Nausea (most common reason for discontinuation)
- Dry mouth
- Headache
- Constipation
- Dizziness
- Fatigue
- Somnolence
Important Precautions
- No dose adjustment is needed when changing the time of administration
- The medication can be taken with or without food
- Maintain the same 24-hour interval between doses during the transition
Special Populations
For elderly patients, the maximum recommended dose is 60 mg once daily, with careful consideration of starting at a lower dose of 30 mg once daily for 1-2 weeks before increasing to 60 mg 2.
In summary, changing Cymbalta 60 mg from morning to evening dosing is acceptable and can be done based on patient preference. The efficacy should remain similar, though there may be slight pharmacokinetic differences that are not clinically significant for most patients.