Duloxetine Tapering Protocol

When discontinuing duloxetine (Cymbalta), a gradual taper is strongly recommended over at least 2 weeks to minimize withdrawal symptoms. 1, 2

Recommended Tapering Schedule

Duloxetine should never be stopped abruptly except in cases of serious medical toxicity 2, 3
Begin with a 10% reduction of the previous dose every 2-4 weeks 2, 3
For patients on long-term duloxetine therapy (months to years), slower tapers of 10% per month may be more appropriate 3
Monitor for withdrawal symptoms after each dose reduction before proceeding to the next step 2

For 60mg daily dose:
- First reduction: 54mg daily (10% reduction) 2
- Second reduction: 48.6mg daily (10% of 54mg) 2
- Continue with 10% reductions of each new dose 2, 3
For higher doses (90-120mg):
- Initial reduction to 60mg daily 4
- Then follow the 10% reduction protocol as above 2, 3

Most common withdrawal symptoms include dizziness (12.4%), nausea (5.9%), headache (5.3%), paresthesia (2.9%), vomiting (2.4%), irritability (2.4%), and nightmares (2.0%) 2
The majority (65%) of withdrawal symptoms resolve within 7 days, but some may persist longer 2
Most patients rate their withdrawal symptoms as mild to moderate in severity 2

If withdrawal symptoms become severe, return to the previous well-tolerated dose and slow the taper further 2, 3
For increased sympathetic activity: α2-adrenergic agonists like clonidine may help reduce symptoms 1
For muscle aches and pain: acetaminophen or NSAIDs can provide symptomatic relief 1
For sleep disturbances: short-term use of non-benzodiazepine sleep aids may be beneficial 3

Higher doses (120mg/day shows higher incidence of withdrawal symptoms compared to lower doses) 2
Longer duration of treatment (patients on duloxetine for years may require much slower tapers) 3, 5
History of withdrawal symptoms with previous antidepressant discontinuation 6

Extended treatment with duloxetine beyond 8-9 weeks does not appear to increase the incidence or severity of withdrawal symptoms 2
Set clear expectations with patients about the tapering process and potential withdrawal symptoms 3
Recognize that withdrawal symptoms may be mistaken for relapse of depression 6
Duloxetine capsules cannot be split, so dose reductions may require switching to liquid formulation or alternate-day dosing for the smallest increments 5

Tapering too quickly (less than 2 weeks) significantly increases risk of withdrawal symptoms 2, 3
Setting arbitrary time limits for completing the taper rather than individualizing based on patient response 5
Mistaking withdrawal symptoms for recurrence of the underlying condition 6
Abandoning patients during the tapering process; ensure continued monitoring and support 1