What is a recommended taper schedule for a patient taking Cymbalta (duloxetine) 30mg?

Tapering Cymbalta (Duloxetine) 30mg

For a patient on Cymbalta 30mg, reduce to 20mg daily for 2 weeks, then to 10mg daily for 2 weeks, followed by 10mg every other day for 1 week before complete discontinuation. 1

Recommended Tapering Protocol

The tapering schedule should follow a hyperbolic reduction pattern, which means each reduction represents a similar percentage decrease from the current dose rather than the original dose. 2 This approach minimizes withdrawal symptoms by reducing the drug's biological effect at receptors in a more linear fashion. 2

Specific Dosing Schedule

• Weeks 1-2: Reduce from 30mg to 20mg daily (approximately 33% reduction) 1
• Weeks 3-4: Reduce from 20mg to 10mg daily (50% reduction from current dose) 1
• Week 5: Take 10mg every other day 1
• Week 6: Take 10mg every third day before complete discontinuation 1

This schedule represents a 4-6 week taper for the 30mg dose. 1 The hyperbolic approach ensures that the final reductions are smaller in absolute dose, which is critical since even small dose changes at the end of a taper can cause disproportionately large biological effects. 2

Managing Withdrawal Symptoms

When to Slow the Taper

• If severe withdrawal symptoms occur (anxiety, irritability, insomnia, dizziness, paresthesias, nausea), immediately slow the taper rate or temporarily return to the previous dose. 1
• For patients experiencing significant withdrawal symptoms, extend the taper to 10% reductions per month rather than the standard schedule. 1

Adjunctive Medications

• Clonidine (α2-agonist): Can attenuate withdrawal symptoms, though start with small doses due to risk of orthostasis or hypotension. 1
• Trazodone: Short-term use (25-50mg at bedtime) may help with insomnia during the taper. 1
• Gabapentin: Can help with anxiety and irritability symptoms (start 100-300mg at bedtime or three times daily). 1

Monitoring Requirements

• Weekly follow-ups during the taper period are recommended to assess for withdrawal symptoms and adjust the schedule as needed. 1
• Monitor blood pressure regularly if the patient has cardiac risk factors, as duloxetine can affect blood pressure. 1
• Screen for emergence of depressive symptoms, as withdrawal can unmask underlying depression. 1

Critical Pitfalls to Avoid

• Never abruptly discontinue duloxetine, as this significantly increases the risk of severe withdrawal symptoms. 3
• Do not reduce by fixed amounts (e.g., 10mg every week) throughout the taper, as this creates disproportionately large reductions at lower doses. 2
• Do not abandon the patient if the initial taper attempt is unsuccessful; maintain the therapeutic relationship and consider a slower taper rate. 4
• The first dose reduction is the most critical—it must be well-tolerated to predict success with the remainder of the taper. 3

Special Considerations

• For patients who have been on duloxetine for more than 1 year, consider extending the taper to 10% reductions per month (which would mean approximately 2-3 months for a 30mg taper). 1
• Some patients may require an even slower taper with reductions as small as 5% of the current dose per month if they are particularly sensitive to withdrawal. 2
• The goal is durability of the taper, not speed—pauses in the taper are acceptable and often necessary when withdrawal symptoms emerge. 4