What is the starting dose of Cymbalta (duloxetine)?

Starting Dose of Duloxetine (Cymbalta)

The recommended starting dose of duloxetine for most adults is 30 mg once daily for one week before increasing to the target dose of 60 mg once daily. 1

Dosing by Indication

• For Major Depressive Disorder (MDD):

  • Start with 30 mg once daily for 1 week to allow patients to adjust to the medication 1
  • Increase to 60 mg once daily (target dose) after the first week 1
  • Alternative starting regimen: 20 mg twice daily, increasing to 30 mg twice daily 1

• For Generalized Anxiety Disorder (GAD):

  • Adults under 65: Start with 30 mg once daily for 1 week, then increase to 60 mg once daily 1
  • Geriatric patients (≥65 years): Start with 30 mg once daily for 2 weeks before considering an increase to 60 mg daily 1
  • Pediatric patients (7-17 years): Start with 30 mg once daily for 2 weeks before considering an increase 1

• For Diabetic Peripheral Neuropathic Pain:

  • Standard dose is 60 mg once daily 1
  • For patients with tolerability concerns, a lower starting dose may be considered 1
  • For patients with renal impairment, consider a lower starting dose with gradual increase 1

• For Fibromyalgia:

  • Begin with 30 mg once daily for 1 week 1
  • Increase to target dose of 60 mg once daily 1

Administration Guidelines

• Administer duloxetine orally with or without food 1
• Swallow capsules whole; do not chew, crush, or open the capsules 1
• Taking duloxetine with food can improve initial tolerability, particularly when starting at 60 mg once daily 2

Tolerability Considerations

• Starting at 30 mg once daily for one week significantly improves initial tolerability compared to starting directly at 60 mg daily without food 2
• Common initial side effects include nausea, dry mouth, headache, constipation, dizziness, and fatigue 3
• Patients who take duloxetine with food experience fewer discontinuations due to adverse events 2

Monitoring

• Assess for adverse effects at each follow-up visit, particularly those related to higher doses 4
• Monitor blood pressure as duloxetine can cause modest hypertension 4
• Evaluate therapeutic response using standardized pain or depression scales 5

Dose Optimization

• While doses up to 120 mg/day have been studied, there is no evidence that doses greater than 60 mg/day confer additional benefits for most indications 1
• Higher doses are associated with increased adverse effects 3
• For chemotherapy-induced peripheral neuropathy, the SNRI duloxetine has shown efficacy at 30 mg daily for the first week followed by 60 mg daily 6