How to taper and stop Cymbalta (duloxetine)?

How to Taper and Stop Cymbalta (Duloxetine)

Cymbalta should be tapered gradually over several weeks to months with dose reductions of approximately 10% of the most recent dose at intervals of at least several days to minimize withdrawal symptoms. 1

Understanding Duloxetine Withdrawal

Abrupt discontinuation of Cymbalta can lead to significant withdrawal symptoms including:

• Anxiety, irritability, and mood changes 1
• Dizziness and "electric shock-like sensations" 1
• Sleep disturbances and fatigue 1
• Headache, sweating, and gastrointestinal symptoms (vomiting, nausea, diarrhea) 1

Recommended Tapering Protocol

Initial Approach

• Begin with a reduction of approximately 10% of the original dose per week as a reasonable starting point 2
• For patients on Cymbalta long-term, slower tapers (10% per month or less) may be more appropriate and better tolerated 2
• Tapering plans should be individualized based on current dose, duration of treatment, and patient response 2

Practical Implementation

• For standard capsules (20mg, 30mg, 60mg), consider these steps:
  • If on 60mg daily, reduce to 30mg daily for 2 weeks, then 20mg daily for 2 weeks 1
  • For lower doses, consider alternating day dosing in the final stages of tapering 2
  • Do not open, crush, or chew capsules as this affects how the medication works 1

Advanced Tapering Considerations

• For patients experiencing significant withdrawal symptoms, even slower tapering may be necessary 3
• Recent evidence suggests hyperbolic tapering (making smaller reductions as the dose gets lower) may be more effective than linear tapering 3, 4
• Final doses before complete cessation may need to be very small to prevent a large decrease in neurotransmitter effects when stopped 4, 5

Managing Withdrawal Symptoms

• Withdrawal symptoms typically appear within days of dose reduction and may last 1-3 days per step 2
• Consider supportive medications to manage specific symptoms:
  • For anxiety or irritability: Short-term use of medications like trazodone 2
  • For sleep disturbances: Sleep hygiene measures; possibly short-term sleep aids 2
  • For gastrointestinal symptoms: Appropriate symptomatic treatments 2

Special Considerations

• Pause tapering and restart when the patient is ready if withdrawal symptoms become severe 2
• Successful tapering may require several weeks to months, especially after long-term use 2, 6
• Consider cognitive-behavioral therapies during tapering, which increase rates of successful discontinuation 2
• Discuss with patients that withdrawal symptoms are not necessarily a sign that they need to continue the medication long-term 2

Common Pitfalls to Avoid

• Avoid tapering too quickly, which increases withdrawal risk 2, 3
• Do not mistake withdrawal symptoms for recurrence of the original condition 2, 3
• Never stop Cymbalta abruptly as this significantly increases withdrawal risk 1
• Be aware that protracted withdrawal may occur months after discontinuation, with symptoms including dysphoria, irritability, and insomnia 2

When to Seek Additional Help

• If severe withdrawal symptoms occur despite slow tapering 1
• If symptoms of the original condition worsen significantly during tapering 2
• If new concerning symptoms develop during the tapering process 1