How to taper off Cymbalta (duloxetine)?

How to Taper Off Cymbalta (Duloxetine)

The most effective approach to tapering Cymbalta is a gradual reduction of approximately 10% of the original dose per week, with slower tapers (10% per month or less) recommended for patients who have been on Cymbalta long-term. 1

General Tapering Principles

• Begin with a reduction of approximately 10% of the original dose per week as a reasonable starting point 1
• For long-term users, consider slower tapers of 10% per month or less to minimize withdrawal symptoms 1
• A gradual reduction in dose rather than abrupt cessation is strongly recommended to prevent discontinuation syndrome 2
• Withdrawal symptoms typically appear within days of dose reduction and may last 1-3 days per step 1

Specific Tapering Protocol

• For standard Cymbalta capsules, follow these steps:

  • First phase: Reduce by 10% of original dose weekly 1
  • Final stages: Consider alternating day dosing to achieve smaller dose reductions 1
  • Allow 1-2 weeks at each dose before further reduction to assess for withdrawal symptoms 1, 3

• For patients on higher doses (60-120mg):

  • Initial reductions can be larger (e.g., from 60mg to 40mg or 30mg) 1
  • As doses get lower, make smaller reductions (e.g., from 30mg to 20mg to 10mg) 1
  • Consider using a hyperbolic tapering approach for the final stages, making progressively smaller reductions as the dose decreases 3, 4

Managing Withdrawal Symptoms

• Common withdrawal symptoms include dizziness, headache, nausea, paresthesia, irritability, vomiting, insomnia, anxiety, and hyperhidrosis 2
• If withdrawal symptoms become severe, pause tapering and restart when the patient is ready 1
• Consider supportive medications to manage specific symptoms:
  • Short-term use of trazodone for anxiety or irritability 1
  • Sleep hygiene measures and possibly short-term sleep aids for insomnia 1
  • NSAIDs or acetaminophen for headaches and muscle aches 1

Special Considerations

• Successful tapering may require several weeks to months, especially after long-term use 1, 5
• Consider cognitive-behavioral therapy during tapering to increase rates of successful discontinuation 1
• Protracted withdrawal may occur months after discontinuation, with symptoms including dysphoria, irritability, and insomnia 1

Common Pitfalls to Avoid

• Avoid tapering too quickly, which significantly increases withdrawal risk 1, 3
• Do not mistake withdrawal symptoms for recurrence of the original condition 1
• Never discontinue Cymbalta abruptly, as this dramatically increases the risk of severe discontinuation syndrome 2, 5
• Even with seemingly small doses (e.g., 20mg), the final steps of tapering should be gradual, as evidence suggests that the relationship between dose and effect is not linear 3, 4

When to Seek Additional Help

• If symptoms of the original condition worsen significantly during tapering 1
• If withdrawal symptoms are intolerable despite slowing the taper 1, 2
• If resuming the previously prescribed dose does not alleviate intolerable withdrawal symptoms 2