Olfactory Disturbances with Duloxetine
Yes, duloxetine can cause persistent abnormal smell perception, including the perception of cigarette smoke, though this is a rare adverse effect documented in the medical literature.
Evidence for Olfactory Side Effects
The most relevant evidence comes from a documented case report of dysosmia (distorted smell perception) directly attributed to duloxetine 1. In this case, a 68-year-old woman developed perception of a "rotten egg smell" after 4 weeks of duloxetine treatment, which was confirmed through objective olfactory testing using the T&T olfactometer threshold test 1. Critically, her symptoms completely resolved after discontinuing duloxetine while continuing all other medications, establishing a clear causal relationship 1.
Clinical Characteristics
- Onset timing: The documented case showed symptom onset after approximately 4 weeks of treatment, though individual variation is expected 1
- Associated symptoms: The olfactory disturbance was accompanied by dysgeusia (taste disturbance) and nausea in the reported case 1
- Reversibility: Complete symptom resolution occurred after duloxetine discontinuation, indicating the effect is not permanent 1
Mechanism and Context
While dysosmia and dysgeusia are not listed among the common adverse effects of duloxetine (which typically include nausea, dry mouth, dizziness, headache, constipation, and fatigue), they represent documented rare complications 2, 3, 1. The perception of cigarette smoke specifically would fall under the category of phantosmia (smelling odors that aren't present) or parosmia (distorted smell perception), both subtypes of dysosmia 1.
Clinical Management Recommendations
- Discontinuation approach: If the olfactory disturbance is significantly impacting quality of life, taper duloxetine rather than abruptly stopping, especially if treatment has exceeded 3 weeks 2
- Tapering schedule: Reduce the dose gradually over 1-2 weeks minimum to prevent withdrawal symptoms while monitoring for symptom improvement 2
- Monitoring expectations: Based on the documented case, symptom improvement should begin within days to weeks after discontinuation 1
Important Caveats
This adverse effect is exceptionally rare, representing the first documented case in the literature as of 2017 1. However, the clear temporal relationship, objective confirmation through testing, and complete resolution upon discontinuation establish duloxetine as a potential cause of persistent abnormal smell perception 1. If other causes of olfactory disturbance (such as sinus disease, neurological conditions, or COVID-19) have been excluded, duloxetine should be considered as a potential culprit 1.