What is the recommended tapering schedule for discontinuing duloxetine (Cymbalta) 120mg?

Duloxetine 120mg Tapering Protocol

The recommended approach for tapering duloxetine 120mg is to reduce the dose by approximately 10% per week, with slower tapers (10% per month) for patients on long-term therapy, to minimize withdrawal symptoms. 1

Standard Tapering Schedule for Duloxetine 120mg

• Begin with a reduction of approximately 10% of the original dose per week as a reasonable starting point, with slower tapers (10% per month or less) for patients who have been on duloxetine long-term 1
• For duloxetine 120mg, a typical tapering schedule might look like:
  • Week 1-2: Reduce from 120mg to 90mg daily 1, 2
  • Week 3-4: Reduce from 90mg to 60mg daily 1, 2
  • Week 5-6: Reduce from 60mg to 30mg daily 1, 3
  • Week 7-8: Reduce from 30mg to 20mg daily 1, 4
  • Week 9-10: Alternate 20mg and 0mg daily 1
  • Week 11: Discontinue 1

Managing Withdrawal Symptoms

• 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%) 3
• If severe withdrawal symptoms occur, pause tapering and return to the previous well-tolerated dose before attempting a slower taper 1
• Most withdrawal symptoms are mild to moderate in severity and typically resolve within 7 days 3
• Consider supportive medications to manage specific symptoms, such as short-term use of trazodone for anxiety or irritability 1

Important Considerations

• Higher doses of duloxetine (120mg/day) are associated with more frequent discontinuation-emergent adverse events compared to lower doses 3
• Avoid tapering too quickly, as this significantly increases withdrawal risk 1
• Do not mistake withdrawal symptoms for recurrence of the original condition (depression, pain, etc.) 1
• Extended treatment with duloxetine beyond 8-9 weeks does not appear to be associated with increased incidence or severity of discontinuation symptoms 3
• Recent research suggests that hyperbolic tapering (making reductions smaller as the dose gets lower) may be more effective than linear tapering for minimizing withdrawal symptoms 4, 5

Special Situations

• For patients who experience intolerable withdrawal symptoms, consider an even slower taper with reductions of only 10% per month 1, 4
• In the final stages of tapering, alternating day dosing may be helpful 1
• Successful tapering may require several weeks to months, especially after long-term use 1
• Consider cognitive-behavioral therapies during tapering to increase rates of successful discontinuation 1

When to Seek Additional Help

• If symptoms of the original condition worsen significantly during tapering 1
• If withdrawal symptoms become severe or intolerable despite slow tapering 1, 3
• If protracted withdrawal occurs months after discontinuation, with symptoms including dysphoria, irritability, and insomnia 1