Is it better to take duloxetine (Cymbalta) in the morning or at night?

From the Guidelines

It is recommended to take duloxetine (Cymbalta) in the morning, as this allows for better management of potential side effects such as nausea, dizziness, or fatigue, which are commonly experienced during the initial treatment phase 1. When considering the optimal timing for taking duloxetine, it's essential to weigh the potential benefits and drawbacks of morning versus evening dosing.

• Morning dosing may be preferable for individuals who experience insomnia or increased energy levels as a result of taking duloxetine, as it can help minimize disruptions to sleep patterns.
• On the other hand, if duloxetine causes drowsiness, taking it at night before bedtime may be more suitable. The prescribed dose of duloxetine is typically 30mg or 60mg once daily, and it's crucial to maintain consistency in timing to ensure stable blood levels of the medication 1. Some individuals may experience side effects such as nausea, dizziness, or fatigue when first starting duloxetine, which can influence their preferred dosing schedule. If side effects are bothersome, it's essential to consult a healthcare provider before making any changes to the dosing schedule. The medication's mechanism of action, which involves increasing serotonin and norepinephrine levels in the brain, can affect energy and sleep patterns differently in different people, explaining why timing preferences vary among patients 1.

From the FDA Drug Label

There is 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. The best time to take duloxetine (Cymbalta) is in the morning, as there is a delay in absorption and an increase in clearance when taken in the evening 2.

• Morning dosing may be preferred due to the pharmacokinetic profile of duloxetine.
• The difference in absorption and clearance between morning and evening doses may affect the efficacy and safety of the medication.

From the Research

Administration Timing

• Duloxetine may be administered without regard to food or time of day 3
• The pharmacokinetics of duloxetine in healthy volunteers were dose proportional over the range of 40-120 mg once daily, and steady state was typically reached by day 3 of administration 3

Efficacy and Safety

• Duloxetine has demonstrated efficacy for the treatment of major depressive disorder (MDD) at a dose of 60 mg/day (given once daily) 4
• Rapid dose escalation of duloxetine (60 mg/day --> 90 mg/day --> 120 mg/day) is safe and tolerable 4
• Duloxetine is effective in the treatment of generalized anxiety disorder (GAD) as well as other indications 3
• Duloxetine is a potent and selective inhibitor of serotonin and noradrenaline transporters, and a weak inhibitor of dopamine transporters 3

Dosage and Tolerability

• The majority of adverse events were mild and transient and occurred in the first week of duloxetine dosing (at 60 mg once daily) 4
• Long-term treatment at a stabilized duloxetine dose was associated with a relatively low incidence of treatment-emergent adverse events and treatment discontinuation due to adverse events 4
• Duloxetine was well tolerated and significantly more effective than citalopram and sertraline for the treatment of anxiety symptoms in poststroke depression patients 5