What is the maximum dose of duloxetine (Cymbalta) delayed release?

From the Guidelines

The maximum dose of duloxetine delayed release is 120 mg per day, which should be split into two doses. This is based on the most recent and highest quality study available, which provides a comprehensive overview of medications for the treatment of neurologic manifestations of cardiac amyloidosis 1.

Key Points to Consider

• The recommended starting dose of duloxetine is 20-30 mg once daily, which can be increased weekly by the same dosage to a goal of 60 mg/d, with a maximum dose of 120 mg/d split twice a day.
• Duloxetine is used for the treatment of neuropathic pain, and the dose may need to be adjusted based on the patient's response and tolerance.
• Patients with hepatic failure should be cautioned when using duloxetine, and the dose may need to be adjusted to minimize the risk of adverse effects.
• The medication should be taken whole and not crushed or chewed, as this would disrupt the delayed-release mechanism.

Important Considerations

• Doses above 120 mg daily have not been evaluated for safety and are not recommended.
• When discontinuing duloxetine, the dose should be gradually tapered to minimize withdrawal symptoms.
• Patients with renal or hepatic impairment may require lower maximum doses, and the dose should be adjusted based on the patient's individual needs and response to the medication.

From the Research

Duloxetine Delayed Release Max Dose

• The maximum approved dose for duloxetine is 120 mg/day, administered as 60 mg twice daily or 120 mg once daily 2.
• Studies have shown that duloxetine is effective in the treatment of generalized anxiety disorder (GAD) and major depressive disorder (MDD) at doses ranging from 40 to 120 mg/day 3, 4.
• The recommended dosage of duloxetine is 40-80 mg daily, depending on the indication, preferably split into two doses per day 5.
• Dose escalation of duloxetine from 60 mg/day to 120 mg/day has been shown to be safe and tolerable, with most adverse events being mild and transient 6.

Adverse Events and Safety

• Common adverse events associated with duloxetine include nausea, dry mouth, headache, constipation, dizziness, and fatigue 3, 4, 6.
• Duloxetine is generally well-tolerated, but may cause serious side effects, such as increased blood pressure and suicidal thoughts 2, 5.
• Patients with a creatinine clearance of <30 mL/min and patients with hepatic impairment should avoid duloxetine 5.

Pharmacokinetics and Drug Interactions

• Duloxetine is eliminated primarily in the urine after extensive hepatic metabolism by multiple oxidative pathways, methylation, and conjugation 2.
• Duloxetine should not be used in combination with CYP 1A2 inhibitors or nonselective, irreversible monoamine oxidase inhibitors 2.