How to Wean Off 60mg of Cymbalta (Duloxetine)
Taper duloxetine gradually over at least 2-4 weeks by reducing the dose in small decrements, monitoring closely for withdrawal symptoms at each step, and never use alternate-day dosing as this significantly increases withdrawal risk. 1
Tapering Strategy
The recommended approach is to reduce duloxetine by small increments (typically 10-20% of the current dose) every 1-2 weeks, allowing adequate time at each dose level to assess for withdrawal symptoms before proceeding. 1
Specific Tapering Schedule from 60mg
- Start by reducing from 60mg to 30mg daily for 1-2 weeks, as this represents the available capsule strength and allows monitoring for withdrawal symptoms 1
- After tolerating 30mg for 1-2 weeks, consider further reduction to 20mg daily (if available) or opening capsules to create smaller doses, maintaining each reduction for at least 1-2 weeks 1
- The total taper duration should be at least 2-4 weeks minimum, though slower tapers over 4-8 weeks may be better tolerated, especially if you've been on duloxetine for many months or years 1
Critical Pitfall to Avoid
Never use alternate-day dosing (taking 60mg every other day) as a tapering strategy. Recent pharmacokinetic modeling demonstrates that alternate-day dosing causes severe fluctuations in receptor occupancy that dramatically increase withdrawal symptom risk, even at doses well below the therapeutic range 2. This approach, while sometimes recommended by clinicians, is not supported by evidence and will likely cause significant withdrawal effects 2.
Monitoring for Withdrawal Symptoms
Common duloxetine withdrawal symptoms include nausea, dizziness, headache, irritability, insomnia, sensory disturbances ("brain zaps"), anxiety, and fatigue. 3, 4
- Monitor yourself daily during the taper, particularly in the first 3-5 days after each dose reduction when withdrawal symptoms are most likely to emerge 1
- If withdrawal symptoms occur, return to the previous dose that was tolerated, stabilize for an additional 1-2 weeks, then attempt a smaller reduction (e.g., 5-10% instead of 20%) 1
When to Slow the Taper
If you experience significant withdrawal symptoms at any step:
- Return immediately to the last tolerated dose 1
- Stabilize at that dose for at least 1-2 additional weeks 1
- Make smaller dose reductions going forward (5-10% decrements rather than larger jumps) 1
Duration Considerations
The need for tapering is particularly important if you've been on duloxetine for longer than 3 weeks, as discontinuation symptoms are common after this duration 1. The longer you've been on the medication, the slower your taper should generally be.
Special Circumstances
If discontinuing due to adverse effects rather than treatment completion, a more rapid taper may be necessary but requires closer monitoring and medical supervision. 1 In such cases, the reason for discontinuation should guide the tapering schedule, balancing the urgency of stopping against withdrawal risk 1.
Work with your prescribing physician throughout this process, as they can provide appropriate dose formulations, monitor for complications, and adjust the taper schedule based on your individual response 1.