Tapering Duloxetine from 120 mg to 60 mg
Gradually reduce the duloxetine dose over a minimum of 2 weeks before reaching the target dose of 60 mg daily to minimize discontinuation-emergent adverse events. 1, 2, 3
Recommended Tapering Approach
Standard Taper Schedule
- Week 1: Reduce from 120 mg to 90 mg daily 3
- Week 2: Reduce from 90 mg to 60 mg daily 3
- This 2-week gradual reduction is the minimum recommended duration to avoid withdrawal symptoms 1, 2, 3
Alternative Extended Taper (if patient has history of withdrawal symptoms)
- Consider a slower taper over 3-4 weeks with smaller dose decrements (e.g., 120 mg → 100 mg → 80 mg → 60 mg) 4, 3
- Use small increments at intervals that allow adequate observation, usually at least a week at each dose level 4
Expected Discontinuation Symptoms
Common Withdrawal Effects
The most frequently reported discontinuation-emergent adverse events when reducing duloxetine include:
- Dizziness (12.4% of patients) - most common symptom 3
- Nausea (5.9%) 3
- Headache (5.3%) 3
- Paresthesia (2.9%) 3
- Irritability (2.4%) 3
- Nightmares (2.0%) 3
Symptom Resolution Timeline
- Most discontinuation symptoms are mild to moderate in severity 3
- 65% of symptoms resolve within 7 days 3
- Overall, 45.1% of discontinuation-emergent adverse events had resolved by study end 3
Important Clinical Considerations
Dose-Related Risk
- Higher doses (120 mg/day) are associated with a greater proportion of patients experiencing discontinuation symptoms compared to lower doses 3
- This makes gradual tapering particularly important when reducing from 120 mg 3
Monitoring During Taper
- Assess for discontinuation-emergent adverse events at each follow-up visit 1
- Monitor blood pressure, as duloxetine can cause modest hypertension that may change during dose reduction 1
- Evaluate therapeutic response using standardized pain or depression scales to ensure the lower dose maintains efficacy 1
Clinical Pitfalls to Avoid
Do not abruptly discontinue or rapidly reduce the dose, as this significantly increases the risk of withdrawal symptoms (44.3% with abrupt discontinuation vs. 22.9% with placebo in clinical trials) 3
Avoid tapering faster than 2 weeks, as this is the minimum recommended duration to reduce discontinuation syndrome risk 1, 2, 3
Be aware that 60 mg daily is the standard therapeutic dose for most indications including diabetic peripheral neuropathic pain, with no evidence that 120 mg confers additional significant benefit 5, so the dose reduction should maintain efficacy while reducing adverse effect burden 5