What is the starting dose of Cymbalta (duloxetine)?

Starting Dose of Duloxetine (Cymbalta)

The recommended starting dose of duloxetine (Cymbalta) is 30 mg once daily for 1 week before increasing to the target dose of 60 mg once daily. 1

Dosing Guidelines by Indication

Diabetic Peripheral Neuropathic Pain

• Start with 30 mg once daily for 1 week
• Increase to target dose of 60 mg once daily
• No evidence that doses higher than 60 mg provide additional benefit 1, 2
• For patients with tolerability concerns, the lower starting dose of 30 mg is particularly important

Major Depressive Disorder

• Start with 30 mg once daily for 1 week
• Increase to 60 mg once daily (or 30 mg twice daily)
• Maximum effective dose is typically 60 mg daily, though doses up to 120 mg have been studied 1

Generalized Anxiety Disorder

• Adults under 65: Start with 30 mg once daily for 1 week, then increase to 60 mg once daily
• Adults 65 and older: Start with 30 mg once daily for 2 weeks before considering an increase 1

Fibromyalgia

• Start with 30 mg once daily for 1 week
• Increase to 60 mg once daily
• No evidence that doses higher than 60 mg provide additional benefit 1

Administration Considerations

• Take with or without food
• Swallow capsules whole - do not chew, crush, or open capsules 1
• 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

Special Populations

Renal Impairment

Dose adjustment based on creatinine clearance 2:

• ≥60 mL/min: Standard dosing (30 mg to 60 mg daily)
• 30-59 mL/min: Consider lower doses
• <30 mL/min: Use with caution, consider lower doses

Elderly Patients

• Start with 30 mg once daily for 2 weeks
• More gradual titration is recommended
• Monitor closely for side effects 2, 1

Common Side Effects

• Nausea (most common reason for discontinuation)
• Dry mouth
• Headache
• Constipation
• Dizziness
• Fatigue 3, 4

Clinical Efficacy

Duloxetine has demonstrated efficacy in multiple conditions:

• Diabetic peripheral neuropathy: 60 mg daily shows significant pain reduction with NNT of 5 4
• Fibromyalgia: Effective at 60 mg daily with NNT of 8 4
• Major depression: Improvements typically seen after 1-2 weeks at 60 mg daily 5

Important Considerations

• Most side effects are mild to moderate but approximately 16% of patients discontinue due to side effects 4
• The lower starting dose of 30 mg daily helps improve tolerability
• Serious adverse events are rare 4
• Avoid in patients with severe hepatic impairment or creatinine clearance <30 mL/min 2

By starting with 30 mg daily for one week before increasing to the target dose of 60 mg daily, patients are more likely to tolerate the medication while still achieving therapeutic benefit across all approved indications.