From the Research
To taper off 60mg of Cymbalta (duloxetine) while starting Lamictal (lamotrigine), I recommend a hyperbolic tapering approach, which appears to be the most promising strategy for psychiatric drug discontinuation, as suggested by the most recent study 1. This approach involves gradually reducing the dose of Cymbalta over time, allowing the body to adjust to the decrease in medication. The following steps can be taken:
- Begin by reducing Cymbalta to 30mg daily for 2 weeks,
- then to 20mg daily for 2 weeks,
- followed by 20mg every other day for 2 weeks before stopping completely. Meanwhile, start Lamictal at 25mg daily for 2 weeks,
- then increase to 50mg daily for 2 weeks,
- 100mg daily for 2 weeks,
- and finally to the target dose (typically 200mg daily) as directed by your doctor. This slow tapering of Cymbalta is important to minimize discontinuation symptoms like dizziness, nausea, headaches, and mood changes. The gradual introduction of Lamictal reduces the risk of serious skin reactions like Stevens-Johnson syndrome. It is also important to note that the use of tapering strips, as described in studies 2 and 3, may be a useful tool in facilitating the tapering process, as they allow for personalized titration of discontinuation to the intensity of withdrawal. However, the quality of clinical practice guidelines on tapering and discontinuing antidepressants is overall low, as noted in study 4, highlighting the need for better guidance and more research on optimal strategies for facilitating successful tapers. In any case, it is crucial to drink plenty of water, maintain regular sleep patterns, and immediately report any rash, severe headache, or worsening mood symptoms to your doctor. Never stop Cymbalta abruptly as this can cause significant withdrawal effects. Your doctor may need to adjust this schedule based on your specific response to the medications.