Can duloxetine be abruptly discontinued after a 14‑day course?

Can Duloxetine Be Abruptly Stopped After 14 Days?

No, duloxetine should not be abruptly discontinued even after only 14 days of treatment—gradual tapering over at least 2 weeks is recommended to minimize withdrawal symptoms. 1, 2

Evidence-Based Rationale

FDA Guidance on Discontinuation

The FDA drug label explicitly states that adverse reactions after discontinuation of duloxetine occur "after abrupt or tapered discontinuation" and include dizziness, headache, nausea, diarrhea, paresthesia, irritability, vomiting, insomnia, anxiety, hyperhidrosis, and fatigue. A gradual reduction in dosage rather than abrupt cessation is recommended whenever possible. 2

Duration-Specific Recommendations

• Duloxetine should be tapered when discontinuing to prevent withdrawal symptoms, especially after treatment longer than 3 weeks. 1
• However, the American Geriatrics Society recommends that duloxetine should not be discontinued abruptly, but rather tapered gradually over at least 2-4 weeks to prevent withdrawal symptoms such as adrenergic hyperactivity, dizziness, and anxiety—without specifying a minimum treatment duration before tapering becomes necessary. 1

Clinical Trial Data on Short-Term Discontinuation

Research evidence demonstrates that discontinuation symptoms occur even after relatively brief exposure:

• In pooled analysis of 6 short-term treatment trials where duloxetine was stopped abruptly, 44.3% of duloxetine-treated patients reported discontinuation-emergent adverse events (DEAEs) compared to 22.9% of placebo-treated patients. 3
• The most common symptoms following abrupt discontinuation were dizziness (12.4%), nausea (5.9%), headache (5.3%), paresthesia (2.9%), vomiting (2.4%), irritability (2.4%), and nightmares (2.0%). 3
• Among patients reporting DEAEs, the mean number of symptoms was 2.4, with most rated as mild to moderate severity. 3
• Importantly, 65% of discontinuation symptoms resolved within 7 days, and 45.1% had resolved by study end. 3

Practical Tapering Approach for 14-Day Exposure

Even after only 14 days of treatment, implement a gradual taper rather than abrupt cessation:

• If the patient is on 60 mg daily, reduce to 30 mg daily for 1 week, then discontinue. 1
• If the patient is on 30 mg daily, consider reducing to 20 mg daily for several days before complete discontinuation, or discontinue after 1 week at 30 mg with close monitoring. 1
• Monitor closely for withdrawal symptoms during and for 1-2 weeks after complete discontinuation. 1

Important Clinical Caveats

• The risk of discontinuation symptoms exists regardless of treatment duration—the FDA label does not specify a minimum treatment duration below which abrupt discontinuation is safe. 2
• Discontinuation symptoms following duloxetine are similar to those seen with other SSRIs and SNRIs, representing a class effect rather than a duration-dependent phenomenon. 3, 4
• When discontinuing duloxetine due to adverse effects, a more rapid taper may be necessary but requires closer monitoring. 1
• The recommendation to taper "no less than 2 weeks before discontinuation" applies broadly and is not contingent on treatment duration exceeding a specific threshold. 3