From the FDA Drug Label
2.2 Dosage for Treatment of Major Depressive Disorder in Adults The recommended starting dosage in adults with MDD is 40 mg/day (given as 20 mg twice daily) to 60 mg/day (given either once daily or as 30 mg twice daily) For some patients, it may be desirable to start at 30 mg once daily for 1 week, to allow patients to adjust to duloxetine delayed-release capsules before increasing to 60 mg once daily.
The starting dose of Cymbalta (duloxetine) while tapering off of Lexapro 20mg is 30 mg to 60 mg/day. It may be desirable to start at 30 mg once daily for 1 week to allow patients to adjust to duloxetine delayed-release capsules before increasing to 60 mg once daily 1.
From the Research
When transitioning from Lexapro 20mg to Cymbalta, the typical starting dose of Cymbalta is 30mg once daily for the first week, and for the tapering of Lexapro, a hyperbolic tapering approach should be considered to minimize withdrawal symptoms, as suggested by the most recent and highest quality study 2.
Key Considerations
- The tapering of Lexapro should be done gradually, and a hyperbolic tapering approach may be more effective in reducing withdrawal symptoms, as it reduces the biological effect of the medication at receptors by fixed amounts 2.
- The starting dose of Cymbalta is typically 30mg once daily for the first week, which helps minimize side effects while the body adjusts to the new medication.
- After one week, if tolerated well, the dose of Cymbalta can be increased to the therapeutic dose of 60mg daily.
- The cross-tapering approach, where Lexapro is gradually reduced while starting Cymbalta, helps prevent discontinuation symptoms from Lexapro while allowing Cymbalta to begin working.
- Hydration, rest, and reporting any unusual symptoms to the doctor during this transition period are essential for safety.
Tapering Schedule
- A common schedule for tapering Lexapro could involve reducing the dose by smaller amounts over a longer period, such as reducing Lexapro to 15mg for 2-4 weeks, then 10mg for 2-4 weeks, then 5mg for 2-4 weeks before stopping completely, but a hyperbolic tapering approach may be more effective 2.
- The gradual transition is important because both medications affect serotonin levels, and changing too quickly can lead to serotonin syndrome or withdrawal effects.
Medication Considerations
- Cymbalta (duloxetine) has been shown to be effective in treating major depressive disorder, and its efficacy and acceptability have been compared to other antidepressants in several studies 3, 4, 5, 6.
- However, the most recent and highest quality study suggests that a hyperbolic tapering approach may be more effective in reducing withdrawal symptoms when tapering off SSRIs like Lexapro 2.