Cymbalta (Duloxetine) Does Not Need to Be Stopped Prior to CABG
Cymbalta (duloxetine) is not mentioned in any CABG perioperative guidelines and does not require discontinuation before surgery. The medications that require specific timing for discontinuation before CABG are antiplatelet agents and anticoagulants, not SNRIs like duloxetine.
Medications That DO Require Discontinuation Before CABG
The following agents have specific timing requirements that should not be confused with duloxetine management:
Antiplatelet Agents (P2Y12 Inhibitors)
- Clopidogrel and ticagrelor: Discontinue at least 5 days before elective CABG 1
- Prasugrel: Discontinue at least 7 days before elective CABG 1
- Aspirin: Continue perioperatively (100-325 mg daily) 1
Anticoagulants
- Enoxaparin: Discontinue 12-24 hours before CABG and transition to unfractionated heparin 1, 2
- Fondaparinux: Discontinue 24 hours before CABG and transition to unfractionated heparin 1
- Bivalirudin: Discontinue 3 hours before CABG and transition to unfractionated heparin 1
- Unfractionated heparin: Continue until surgery 1, 3
GP IIb/IIIa Inhibitors
- Eptifibatide or tirofiban: Discontinue 2-4 hours before surgery 1
- Abciximab: Discontinue at least 12 hours before surgery 1
Management of Duloxetine Perioperatively
- Continue duloxetine through the perioperative period unless there are specific contraindications unrelated to the surgery itself 4
- If discontinuation is necessary for other clinical reasons, taper gradually rather than stopping abruptly to avoid withdrawal symptoms (dizziness, headache, nausea, paresthesia, irritability) 4
- The FDA label recommends gradual dose reduction when discontinuing duloxetine, but provides no specific timing requirements for surgical procedures 4