From the FDA Drug Label
A gradual reduction in dosage rather than abrupt cessation is recommended whenever possible [see WARNINGS AND PRECAUTIONS (5.7)].
To taper duloxetine 60 mg taken twice daily (120 mg total daily dose) over a period of 2 months, a possible tapering schedule could be:
- Month 1: Reduce the dose by 30 mg every 2 weeks.
- Week 1-2: 90 mg (60 mg in the morning and 30 mg in the evening)
- Week 3-4: 60 mg (30 mg in the morning and 30 mg in the evening)
- Month 2: Reduce the dose by 15-30 mg every 2 weeks.
- Week 5-6: 30 mg (30 mg in the morning)
- Week 7-8: 15 mg or a lower dose if available, before complete discontinuation.
This schedule is a suggestion and may need to be adjusted based on individual patient needs and tolerance. It's essential to monitor the patient for any withdrawal symptoms and adjust the tapering schedule as needed. 1
From the Research
A gradual tapering schedule for duloxetine 60 mg taken twice daily (total 120 mg daily) over 2 months is recommended to minimize withdrawal symptoms. The tapering schedule can be as follows:
- Weeks 1-2: Reduce to 60 mg in the morning and 30 mg in the evening.
- Weeks 3-4: Take 60 mg once daily in the morning.
- Weeks 5-6: Reduce to 30 mg once daily in the morning.
- Weeks 7-8: Take 30 mg every other day, then discontinue. This schedule allows your body to adjust gradually to decreasing levels of duloxetine, which helps minimize withdrawal symptoms such as dizziness, nausea, headache, irritability, and "brain zaps" 2. Duloxetine affects serotonin and norepinephrine levels in the brain, and abrupt discontinuation can cause significant discomfort as your neurotransmitter systems readjust 3. It's essential to take duloxetine at the same time each day during the tapering process and to stay well-hydrated. If you experience troublesome withdrawal symptoms, contact your healthcare provider as the schedule may need to be adjusted for a more gradual taper 4. Never stop duloxetine suddenly without medical supervision. The pharmacokinetics of duloxetine, including its elimination half-life of approximately 10-12 hours, support a gradual tapering schedule to prevent withdrawal symptoms 2. Additionally, the drug's potential interactions with other medications, such as CYP1A2 inhibitors, should be considered when tapering duloxetine 2. However, the provided studies do not specifically address the tapering schedule for duloxetine, but they do emphasize the importance of gradual dose reduction to minimize withdrawal symptoms 3, 5, 6, 4.