How to Safely Stop Cymbalta (Duloxetine)
Do not stop duloxetine abruptly—taper gradually over at least 2-4 weeks to minimize discontinuation syndrome, which can cause dizziness, nausea, headache, irritability, and other withdrawal symptoms. 1
Understanding Discontinuation Syndrome
Duloxetine discontinuation can produce significant withdrawal symptoms due to its relatively short half-life of approximately 12 hours 2. The FDA label explicitly warns against stopping duloxetine suddenly, as this may result in serious symptoms including 1:
- Neurological symptoms: Dizziness, electric shock-like sensations, headache, paresthesias
- Gastrointestinal symptoms: Nausea, vomiting, diarrhea
- Psychiatric symptoms: Anxiety, irritability, insomnia, agitation
- Physical symptoms: Sweating, fatigue
These symptoms can be severe enough to significantly impair function and quality of life if the medication is stopped too quickly 3.
Recommended Tapering Schedule
The standard approach is to taper duloxetine gradually over a minimum of 2-4 weeks 4, 3. Here's a practical algorithm:
For patients on 60 mg once daily:
- Week 1-2: Reduce to 30 mg once daily
- Week 3-4: Continue 30 mg once daily, then discontinue
- Monitor closely for withdrawal symptoms throughout 1
For patients on higher doses (90-120 mg daily):
- Week 1: Reduce by 30 mg (e.g., 120 mg → 90 mg)
- Week 2: Reduce by another 30 mg (e.g., 90 mg → 60 mg)
- Week 3: Reduce to 30 mg
- Week 4: Continue 30 mg, then discontinue
- Consider extending the taper if withdrawal symptoms emerge 5
For patients who are elderly, frail, or have had previous severe withdrawal reactions:
- Use a slower taper extending beyond 4 weeks (e.g., 6-8 weeks total)
- Reduce by smaller increments (e.g., 15-20 mg every 1-2 weeks)
- Monitor more frequently 6
Special Circumstances Requiring Modified Tapering
If discontinuing due to adverse effects: A more rapid taper may be necessary, but maintain closer monitoring for both the adverse effect prompting discontinuation and withdrawal symptoms 4.
If switching to another antidepressant: Your healthcare provider may employ a cross-taper strategy, starting the new medication while gradually reducing duloxetine to minimize both withdrawal symptoms and gaps in therapeutic coverage 6, 1.
If the patient has been on duloxetine for less than 3 weeks: A shorter taper (1-2 weeks) may be sufficient, as discontinuation syndrome is less likely with brief exposure 4.
Critical Monitoring During Discontinuation
Monitor patients weekly during the taper for 1:
- Withdrawal symptoms: Particularly dizziness, nausea, and mood changes
- Return of original symptoms: Depression, anxiety, or pain may re-emerge
- Suicidal ideation: Especially in patients with depression or anxiety disorders
- Blood pressure and heart rate: May normalize after discontinuation
Common Pitfalls to Avoid
Never stop duloxetine abruptly unless there is a life-threatening adverse reaction (e.g., severe skin reactions, hepatic failure, serotonin syndrome) 1. Even then, close medical supervision is essential.
Do not assume all patients tolerate the same taper schedule—some patients are highly sensitive to dose reductions and require slower, more gradual tapers extending 6-8 weeks or longer 4.
Do not confuse withdrawal symptoms with relapse of the underlying condition—withdrawal symptoms typically emerge within days of dose reduction and improve over 1-2 weeks, whereas relapse develops more gradually 3.
Avoid concurrent discontinuation of other serotonergic medications without medical supervision, as this compounds withdrawal risk 1.
Managing Withdrawal Symptoms If They Occur
If significant withdrawal symptoms develop during tapering 3:
- Temporarily return to the previous dose that was tolerated
- Wait 1-2 weeks for symptoms to resolve
- Resume tapering at a slower rate (smaller dose reductions or longer intervals between reductions)
- Consider symptomatic treatment for specific symptoms (e.g., antiemetics for nausea, though avoid serotonergic antiemetics like ondansetron)
When to Seek Immediate Medical Attention
Contact your healthcare provider immediately if you experience 1:
- Suicidal thoughts or behavior
- Severe agitation or panic attacks
- Severe dizziness or falls
- Persistent vomiting leading to dehydration
- New or worsening depression or anxiety that is intolerable