From the Guidelines
Duloxetine withdrawal symptoms can include dizziness, nausea, headache, paresthesia, irritability, anxiety, insomnia, fatigue, and electric shock-like sensations, and to minimize these effects, duloxetine should never be stopped abruptly, but instead, the dose should be gradually tapered over at least 2 to 4 weeks under medical supervision. These symptoms typically begin within 1-3 days after reducing or stopping the medication and can last for several weeks 1. More severe symptoms may include vomiting, diarrhea, nightmares, and mood changes. A typical tapering schedule might reduce the dose by 20-30mg every 2 weeks, but this should be personalized by your healthcare provider 1. Withdrawal occurs because your brain has adapted to the medication's effects on serotonin and norepinephrine levels, and needs time to readjust when the medication is reduced. Some key points to consider when discontinuing duloxetine include:
- Gradual tapering of the dose to minimize withdrawal symptoms
- Close monitoring by a healthcare provider to adjust the tapering schedule as needed
- Being aware of the potential for severe withdrawal symptoms, such as vomiting, diarrhea, nightmares, and mood changes
- Recognizing that withdrawal symptoms can be protracted and disabling, and may be attributed to relapse to depression rather than withdrawal from the medication itself 1. If you experience severe withdrawal symptoms, contact your healthcare provider immediately as they may need to adjust your tapering schedule or provide supportive treatments to manage symptoms.
From the FDA Drug Label
Discontinuation symptoms have been systematically evaluated in patients taking duloxetine delayed-release capsules Following abrupt or tapered discontinuation in adult placebo-controlled clinical trials, the following symptoms occurred at 1% or greater and at a significantly higher rate in duloxetine delayed-release capsules-treated patients compared to those discontinuing from placebo: dizziness, headache, nausea, diarrhea, paresthesia, irritability, vomiting, insomnia, anxiety, hyperhidrosis, and fatigue During marketing of other SSRIs and SNRIs (serotonin and norepinephrine reuptake inhibitors), there have been spontaneous reports of adverse events occurring upon discontinuation of these drugs, particularly when abrupt, including the following: dysphoric mood, irritability, agitation, dizziness, sensory disturbances (e.g., paresthesias such as electric shock sensations), anxiety, confusion, headache, lethargy, emotional lability, insomnia, hypomania, tinnitus, and seizures. The withdrawal symptoms from duloxetine include:
- Dizziness
- Headache
- Nausea
- Diarrhea
- Paresthesia
- Irritability
- Vomiting
- Insomnia
- Anxiety
- Hyperhidrosis
- Fatigue
- Dysphoric mood
- Agitation
- Sensory disturbances (e.g. paresthesias such as electric shock sensations)
- Confusion
- Lethargy
- Emotional lability
- Hypomania
- Tinnitus
- Seizures 2
From the Research
Withdrawal Symptoms from Duloxetine
The withdrawal symptoms from duloxetine are characterized by several studies, including 3, which reports that discontinuation-emergent adverse events (DEAEs) were common following abrupt discontinuation of duloxetine treatment. Some of the key withdrawal symptoms include:
- Dizziness (12.4%)
- Nausea (5.9%)
- Headache (5.3%)
- Paresthesia (2.9%)
- Vomiting (2.4%)
- Irritability (2.4%)
- Nightmares (2.0%)
Severity and Duration of Withdrawal Symptoms
According to 3, most patients rated the severity of their symptoms as mild or moderate, and the majority of symptoms resolved within 7 days. The study also found that a higher proportion of patients reporting DEAEs were seen with 120 mg/day duloxetine compared with lower doses.
Comparison with Other Antidepressants
Study 4 compared the incidence and duration of antidepressant-induced nausea among patients treated with duloxetine, paroxetine, and fluoxetine. The results showed that the incidence of treatment-emergent nausea with duloxetine did not differ significantly from paroxetine or fluoxetine. However, the study found that nausea was more common with duloxetine during treatment initiation, but resolved rapidly with continued treatment.
Clinical Implications
The studies suggest that clinicians should be aware of the potential withdrawal symptoms associated with duloxetine and consider gradual dose reduction when discontinuing treatment. As noted in 3, it is recommended that clinicians gradually reduce the dose no less than 2 weeks before discontinuation of duloxetine treatment.