Duloxetine (Cymbalta) Should Not Be Cut in Half
Duloxetine 20mg capsules should not be cut, split, crushed, or chewed as this can compromise the delayed-release formulation and potentially lead to increased side effects.
Why Duloxetine Cannot Be Split
Duloxetine (Cymbalta) is formulated as an enteric-coated, delayed-release capsule designed to protect the medication from stomach acid and ensure proper absorption in the intestines. The specific formulation characteristics include:
- The medication is contained within enteric-coated pellets inside the capsule
- This coating prevents premature breakdown in the stomach
- Cutting or crushing destroys this protective mechanism
Potential Consequences of Cutting Duloxetine
If the delayed-release mechanism is compromised by cutting the capsule:
- Increased risk of gastrointestinal side effects (nausea, vomiting, abdominal discomfort)
- Possible altered absorption affecting efficacy
- Potential for increased discontinuation symptoms if dosing becomes inconsistent
Proper Dosing Considerations
For patients requiring dose adjustments:
- Duloxetine is available in multiple strengths (20mg, 30mg, 60mg capsules)
- Lower doses should be achieved by using the appropriate capsule strength
- For patients with renal impairment or hepatic dysfunction, dose adjustments should be made using the appropriate capsule strength 1
Alternative Approaches
If a lower dose is needed:
- Use the lowest available capsule strength (20mg)
- Consider taking the medication with food to improve tolerability 2
- For patients initiating treatment, starting at 30mg once daily in the morning for one week before increasing to 60mg may improve tolerability 2
Special Considerations
For Neuropathic Pain
- Duloxetine is FDA-approved for diabetic neuropathic pain at doses of 60mg daily 1, 3
- For elderly patients or those with increased sensitivity, starting at the lowest available dose (20mg) and titrating slowly is recommended 1, 3
For Anxiety Disorders
- Duloxetine has demonstrated efficacy for generalized anxiety disorder at doses of 60-120mg daily 4
- The medication should be taken as a whole capsule at the prescribed dose
Important Safety Information
- Duloxetine has a half-life of approximately 12 hours 5, 6
- Abrupt discontinuation can lead to withdrawal symptoms
- Patients with hepatic impairment or severe renal impairment should avoid duloxetine 5
- Concomitant use with CYP1A2 inhibitors (like fluvoxamine) should be avoided as they can significantly increase duloxetine exposure 6
Remember that proper medication administration is crucial for both safety and efficacy. If the current dose is not appropriate, consult with your healthcare provider about switching to a more suitable dosage form rather than attempting to modify the capsule.