Usual Starting Dose of Cymbalta (Duloxetine)
The usual starting dose of Cymbalta (duloxetine) is 30 mg once daily for 1 week, followed by an increase to the therapeutic dose of 60 mg once daily. 1
Starting Dose by Indication
Major Depressive Disorder
- Start with 30 mg once daily for 1 week
- Increase to 60 mg once daily (or 30 mg twice daily)
- Maximum dose: 120 mg daily (no additional benefit shown beyond 60 mg/day) 1
Generalized Anxiety Disorder
- Adults <65 years: Start with 30 mg once daily for 1 week
- Increase to 60 mg once daily
- Geriatric patients: Start with 30 mg once daily for 2 weeks before considering an increase 1
Diabetic Peripheral Neuropathic Pain
- Standard dose: 60 mg once daily
- For patients with tolerability concerns: Start with 30 mg once daily for 1 week
- No evidence that doses higher than 60 mg provide additional benefit 1, 2
Fibromyalgia
- Start with 30 mg once daily for 1 week
- Increase to 60 mg once daily
- No evidence of additional benefit beyond 60 mg/day 1
Chronic Gastrointestinal Pain
- Start with 30 mg once daily
- Titrate according to response to a maximum of 60 mg once daily 3
Administration Considerations
- Take with or without food (taking with food may improve initial tolerability) 1, 4
- Swallow capsules whole; do not chew, crush, or open 1
- For patients concerned about tolerability:
Special Populations
Elderly Patients
- Start with 30 mg once daily for 2 weeks before increasing 1
- Titrate more slowly than in younger adults 2
Renal Impairment
- For creatinine clearance <30 mL/min: Avoid use 5
- For moderate renal impairment: Consider lower starting dose 1
Hepatic Impairment
- Avoid use in patients with hepatic impairment 5
Common Side Effects to Monitor
- Nausea (most common reason for discontinuation) 5
- Dry mouth, headache, constipation, dizziness, fatigue 6
- Sedation (particularly in elderly patients) 2
- Most side effects are mild to moderate and occur in the first week of treatment 7
Titration and Follow-up
- Evaluate response after 2-4 weeks 2
- Full therapeutic trial requires 6-8 weeks for antidepressant effects 2
- For neuropathic pain, effects may be seen within 1-2 weeks 2
Important Considerations
- Avoid abrupt discontinuation; taper gradually to prevent withdrawal symptoms 2
- Monitor blood pressure, as duloxetine can cause mild increases 5
- Do not use concurrently with MAOIs or within 14 days of stopping an MAOI 1
Duloxetine's starting dose of 30 mg once daily for 1 week before increasing to 60 mg once daily provides the optimal balance between efficacy and tolerability across most indications, with the FDA-approved drug label specifically recommending this approach 1.