Ideal Duloxetine Taper Schedule from 60mg Daily
For a patient taking 60mg duloxetine daily, taper gradually over 3-4 weeks using the following schedule: 60mg → 30mg (for 1-2 weeks) → discontinue, with the option to extend the taper or use smaller decrements if withdrawal symptoms emerge. 1
Standard Tapering Protocol
The recommended approach for discontinuing duloxetine after more than 3 weeks of treatment involves:
- Week 1-2: Reduce from 60mg once daily to 30mg once daily 1, 2
- Week 3-4: Continue 30mg once daily, then discontinue 1, 2
- Minimum taper duration: At least 2-4 weeks 1, 2
This schedule leverages the fact that 30mg capsules are commercially available and represent the standard starting dose, making this a practical two-step taper 1, 2.
Extended Taper for High-Risk Patients
For patients with a history of withdrawal symptoms or who develop symptoms during the standard taper, use a slower 3-4 week schedule with smaller decrements: 1
While duloxetine capsules don't come in intermediate doses between 30mg and 60mg, you can achieve smaller decrements by:
- Alternating doses: Switch to 60mg and 30mg on alternating days (effective dose ~45mg) for 1-2 weeks before dropping to 30mg daily 1
- Extended time at 30mg: Remain at 30mg for 2-3 weeks instead of 1-2 weeks before final discontinuation 1
- Slower final taper: Consider alternating 30mg with no dose (every other day) for the final week 1
The American Geriatrics Society specifically recommends using intervals of at least one week at each dose level, allowing adequate observation for withdrawal symptoms 1, 3.
Monitoring During Taper
Watch closely for discontinuation-emergent symptoms, particularly: 4
- Nausea and dizziness (most common withdrawal symptoms) 4
- Mood changes, irritability, or anxiety worsening 1
- Headache, fatigue, or sleep disturbances 4
- Paresthesias or "brain zaps" (though less commonly reported with duloxetine than other SNRIs)
If significant withdrawal symptoms emerge at any point, return to the previous dose, stabilize for 1-2 weeks, then resume tapering more slowly 1, 3.
Special Considerations
When discontinuing due to adverse effects rather than treatment completion, a more rapid taper may be necessary but requires closer monitoring 3. In such cases, the minimum 2-week taper should still be attempted unless the adverse effect is severe enough to warrant immediate discontinuation 3.
Consider whether another medication needs to be substituted, particularly if duloxetine was being used for depression, anxiety, or chronic pain, as abrupt loss of therapeutic effect can compound withdrawal symptoms 3.
Common Pitfall to Avoid
Do not attempt to open capsules and divide the contents, as duloxetine has enteric coating to reduce gastrointestinal side effects, and disrupting this coating can cause increased nausea and reduced absorption 2. The capsule formulation limits tapering options to the available strengths (20mg, 30mg, 60mg).