Recommended Dosage of Duloxetine (Cymbalta)
The recommended dose of duloxetine (Cymbalta) is 60 mg once daily for most indications, with specific conditions requiring dose adjustments based on patient factors and treatment response. 1
Dosing by Indication
Diabetic Peripheral Neuropathic Pain
- Standard dose: 60 mg once daily 2, 1
- No evidence that doses higher than 60 mg/day provide additional benefit 1
- For patients with tolerability concerns, may start at 30 mg once daily for 1 week before increasing to 60 mg 1
- Effective dose range in clinical trials: 60-120 mg/day 2
Major Depressive Disorder
- Standard dose: 60 mg once daily 1
- May start at 30 mg once daily for 1 week before increasing to 60 mg 3
- While 120 mg once daily was shown to be effective, there is no evidence that doses greater than 60 mg/day provide additional benefit 1, 4
Generalized Anxiety Disorder (GAD)
- Adults under 65: 60 mg once daily 1
- May start at 30 mg once daily for 1 week before increasing to 60 mg 1, 5
- Geriatric patients: Start at 30 mg once daily for 2 weeks before considering increase to 60 mg 1
- Pediatric patients (7-17 years): Start at 30 mg once daily for 2 weeks before considering increase to 60 mg 1
Fibromyalgia
- Standard dose: 60 mg once daily 1, 6
- Begin at 30 mg once daily for 1 week before increasing to 60 mg 1
- No evidence that doses greater than 60 mg/day provide additional benefit 1, 6
Chronic Musculoskeletal Pain
- Standard dose: 60 mg once daily 1, 6
- Begin at 30 mg once daily for 1 week before increasing to 60 mg 1
- No evidence that higher dosages provide additional benefit 1, 6
Special Population Considerations
Renal Impairment
- Since diabetes is frequently complicated by renal disease, consider lower starting dose and gradual increase for patients with renal impairment 1
- Avoid use in severe renal impairment (GFR <30 mL/minute) 1
Hepatic Impairment
- Avoid use in patients with chronic liver disease or cirrhosis 1
Elderly Patients
- Start at 30 mg once daily for 2 weeks before considering increase to 60 mg 1
- Titrate more slowly and monitor closely for side effects 7
Administration Guidelines
- May be administered without regard to food or time of day 5
- When discontinuing, gradually reduce dosage rather than abrupt cessation to minimize discontinuation symptoms 1
- Allow at least 14 days between discontinuation of an MAOI and initiation of duloxetine 1
- Allow at least 5 days after stopping duloxetine before starting an MAOI 1
Common Side Effects
- Nausea, dry mouth, headache, constipation, dizziness, and fatigue 5
- Most adverse events are mild to moderate in severity 5, 3
- Discontinuation-emergent adverse events (most commonly nausea and dizziness) may occur in up to one-third of patients 5
Monitoring Recommendations
- Evaluate response every 2-4 weeks during dose titration 7
- Assess for improvement in pain intensity, function, and quality of life 7
- Monitor for adverse effects and adjust dose accordingly 7
The 60 mg once-daily dosing of duloxetine has been established as effective across multiple indications while maintaining an acceptable side effect profile. Higher doses generally do not provide additional benefit but may increase the risk of adverse effects.