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Duloxetine Tapering

This entry was posted in Antidepressant on by .
Medically Reviewed Fact Checked

Last Updated on August 4, 2022 by Carol Gillette

Alternative to Meds Editorial Team
Medically Reviewed by Dr Samuel Lee MD

Antidepressant medications present their own hellish challenges when it comes to tapering and withdrawal. Our expertise has given rise to effective, comfortable duloxetine tapering protocols.

We use holistic and scientific modalities to determine the cause(s) of symptoms such as depression. Then we create a custom-tailored program to provide the opportunity for successful duloxetine tapering without the return of original symptoms.

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Why Duloxetine Tapering Program Is Recommended

Duloxetine tapering programs may be the best recommendation when persons have become dependent on this SNRI antidepressant and want to stop taking it safely. Duloxetine (sold under various brand names including Drizalma Sprinkle©, Cymbalta©, pervades the CNS in serious ways that are not completely understood. An additional factor of concern is that duloxetine capsules contain many small beads, and the capsule is not able to be simply cut in half or quarters, as a tablet might be. Therefore, when stopping duloxetine, having a way to cut the dose precisely is important.1,2

Duloxetine Tapering Guidelines include:
  • Except in the case of serotonin syndrome, gradual duloxetine cessation is recommended.10
  • If your prescriber switches you to another SNRI ensure you stay on the new med for long enough to become acclimated to the new medication before starting to taper.11
  • For duloxetine, your prescriber may advise the bead count method:  Since each capsule won’t necessarily have the same number of beads, open up 3 capsules, one at a time. Count the number of beads and take an average number of beads as a base to start with.
  • With your prescriber, figure out what a 10% reduction in milligrams would be for you.
  • This may entail using different dosage capsules for the math.
  • For ease, you may want to put the correct number of beads in empty gel caps for the one or 2-week period needed, for each reduction.
  • A dark airtight pill bottle should be used to store the remaining beads until you are ready to use them.
  • Individual sensitivity will help decide whether a 10% or greater or lesser percentage is right for you. Talk with your prescriber about the percentage of reduction that is best.
  • The half-life of any drug is a good predictor of when withdrawals may emerge. For duloxetine, the half-life is estimated at 10-12 hours, and this can vary from person to person.9
  • Be prepared to make changes as the taper progresses according to personal tolerance levels, which may change over the course of reductions during the duloxetine taper.
  • Take it slow. Let the reactions settle out and get adequate rest before attempting another dose reduction. This may mean anywhere from 1-4 weeks or even longer, especially near the end of the taper.
  • Nutrition plays a powerful role in healing after drug use has left its mark.12
  • Exercise is key in staying physically and mentally fit, especially during and after a taper.13
  • CBT is highly recommended as part of the healing process after drug tapering.14

FDA guidelines are sparse, leaving most prescribing physicians at a real loss when it comes to detailed protocols or steps to use for duloxetine tapering. This is because neither the art nor science of how to get off duloxetine or other SNRIs is what physicians are taught at medical school. This glaring absence in training means that working with a pharmacist along with a physician may be required to negotiate the problem.

duloxetine withdrawal symptomsWhat we have seen at Alternative to Meds Center is most persons trying to quit duloxetine gradually, with support, can successfully complete the process with improved health in 2 months inpatient. A person can run into problems if trying to quit duloxetine too quickly or all at once. Even a slow taper needs nutrition, sleep, neurotoxin removal, and other important factors that can avoid discomfort and promote natural mental health.

Like a car with no brakes traveling down a winding mountain road, this missing expertise concerning duloxetine cessation puts many people at risk each day. At Alternative to Meds Center, our inpatient duloxetine tapering programs can help with getting off duloxetine safely, gently, and comfortably, without a return of original symptoms.

Duloxetine Tapering Prior to Pregnancy

There may be a concern for prospective parents to consider. Duloxetine is thought to be possibly linked to some birth defects. Some research, such as that sponsored by Eli Lilly report no increased risk of birth defects,4 while other research referred to on the FDA drug label of 2017 warns of fetal/neonatal adverse reactions such as seizure, tremors, hypoglycemia, constant crying, and many other adverse effects in infants whose mothers were taking duloxetine. There have been no actual clinical trials on pregnant women taking duloxetine as to do so would be outside the ethical lines that govern testing procedures.5 Even though these researchers are noncommittal on the subject, a woman may want to consider the health of the infant as a possible motivation for duloxetine tapering before becoming pregnant.

Finding Competent Help for Duloxetine Tapering

duloxetine side effectsSome controversy exists as to whether antidepressants work any better than placebo.3

Regardless, a person who has become dependent on antidepressant medications, and is experiencing unmanageable side effects may decide to begin trying to quit duloxetine. Side effects like insomnia and the resulting sleep deprivation may make life and work quite difficult for anyone. For many reasons, one may decide it’s time for getting off duloxetine.8

But now the reality hits. The doctor who prescribed the medication may not know how to proceed. A significant challenge arises in finding qualified and competent help (beyond best guesswork) concerning stopping duloxetine.2,6 Doctors are typically not trained on administering medication tapering, and though they generally are trying their best, that often means little more than guesswork.

To simplify the process, a patient may be advised to open the capsule and count beads, as mentioned above, or in some cases, could be switched to another type of medication, to make it easier to control the dosage reduction.

There can be problems with switching over from one drug to another, which may further complicate getting off duloxetine smoothly. Another option exists called “cross-tapering.” Cross-tapering is an option at Alternative to Meds Center, and can sometimes be used to smooth out the transition from one drug to another, where the second drug is hoped to cause less intense side effects, may have a longer half-life, and may ease the process. These types of actions are best done within a treatment center where access to a compounding pharmacy is available to provide the best options, in coordination with their experienced healthcare staff, and the person receives constant monitoring. Delayed-release medications are not considered suitable for self-administered tapering due to their sometimes unpredictable outcomes.

Self-Administered Duloxetine Tapering vs Monitored Inpatient Tapering Treatment

For some, the person who has become disorganized in their life, with each day an uphill struggle of tasks that involve both self-care and care of family members or struggling with a work situation, these sorts of real-life factors almost guarantee that the schedule will not be followed exactly, and this can introduce even more complexity.

Other complications can arise, especially when a person is doing duloxetine tapering because it is a delayed-release medication. The physician may need to write a prescription for a liquid form of the drug and may give directions for measuring it exactly to achieve a 20% or 40% reduction, or whatever has been suggested. To complicate what sounded straightforward and simple in the doctor’s office, some responses to reductions in dosage might not occur right away but may set in after a couple of days or even longer. There can be many variations and “tweaks” that may need to be alertly responded to during the course of duloxetine tapering to try and keep pace with emerging side effects and reactions.

One is seeking to achieve a reduction with the goal of reducing or stopping duloxetine without running into unmanageable withdrawal effects. Brain zaps are a common duloxetine withdrawal symptom, along with insomnia, nausea, and a possible host of other common withdrawal symptoms. Should these become too intense this scenario might bring trying to quit duloxetine to a disastrous crashing halt.

If the person who is attempting the duloxetine tapering is already feeling unwell, already experiencing harsh side effects and unpredictable mood swings, lapses in memory, and other troubles, it may be too burdensome to expect a person in such a weakened condition to be their own duloxetine tapering administrator. It does not have to be this difficult.

Duloxetine Withdrawal at Alternative to Meds Center

duloxetine tapering sedona arizonaIf you or your loved one has been considering getting off duloxetine, perhaps you are not confident about how exactly to proceed. You may also be looking for holistic options to improve mental health naturally that you want to explore. If so, we invite you to find out more about how our program works. Please feel free to contact us directly. We are here to help. We can give you more information on the many treatment protocols (i.e., metabolic testing, neurotoxin removal, rebuilding the neurochemistry, integrative psychiatry, organic nutrition and supplementation, and much more) that are designed to soften the whole duloxetine tapering process and provide a compassionate, warm, and welcoming space in which to experience a true resurgence of health. Find out why we feel our duloxetine tapering program is the best in the world, but more importantly, how it has been designed to create a revitalizing experience, focused on helping our clients regain natural mental health and vitality.

1. FDA Duloxetine label [cited 2022 July 12]

2. Ruhe HG, Horikx A, van Avendonk MJP, Groeneweg BF, Mulder H, Woutersen-Koch H. Het afbouwen van SSRI’s en SNRI’s [Discontinuation of SSRIs and SNRIs]. Ned Tijdschr Geneeskd. 2020 Feb 17;164:D4004. Dutch. PMID: 32186829. [cited 2022 July 12]

3. Stegenga J “The Evidence in Favour of Antidepressants is Flawed” Aeon Newsletter [published online 2019 Mar] [cited 2022 July 12]

4. Hoog, Cheng, Elpers & Dowsett, “Duloxetine and Pregnancy Outcomes-Safety Surveillance Findings” International Journal of Medical Sciences [cited 2022 July 12]

5. FDA label Duloxetine, Section 8.1, “Pregnancy” [cited 2022 July 12]

6. Stockmann T, Odegbaro D, Timimi S, Moncrieff J. SSRI and SNRI withdrawal symptoms reported on an internet forum. Int J Risk Saf Med. 2018;29(3-4):175-180. doi: 10.3233/JRS-180018. PMID: 29758951. [cited 2022 July 12]

7. Fava GA, Benasi G, Lucente M, Offidani E, Cosci F, Guidi J. Withdrawal Symptoms after Serotonin-Noradrenaline Reuptake Inhibitor Discontinuation: Systematic Review. Psychother Psychosom. 2018;87(4):195-203. doi: 10.1159/000491524. Epub 2018 Jul 17. PMID: 30016772. [cited 2022 July 12]

8. Carter NJ, McCormack PL. Duloxetine: a review of its use in the treatment of generalized anxiety disorder. CNS Drugs. 2009;23(6):523-41. doi: 10.2165/00023210-200923060-00006. PMID: 19480470. [cited 2022 July 12]

9. Lantz RJ, Gillespie TA, Rash TJ, Kuo F, Skinner M, Kuan HY, Knadler MP. Metabolism, excretion, and pharmacokinetics of duloxetine in healthy human subjects. Drug Metab Dispos. 2003 Sep;31(9):1142-50. doi: 10.1124/dmd.31.9.1142. PMID: 12920170. [cited 2022 July 12]

10. Gelener P, Gorgulu U, Kutlu G, Ucler S, Inan LE. Serotonin syndrome due to duloxetine. Clin Neuropharmacol. 2011 May-Jun;34(3):127-8. doi: 10.1097/WNF.0b013e31821b3aa0. PMID: 21586918. [cited 2022 July 12]

11. Keks N, Hope J, Keogh S. Switching and stopping antidepressants. Aust Prescr. 2016 Jun;39(3):76-83. doi: 10.18773/austprescr.2016.039. Epub 2016 Jun 1. PMID: 27346915; PMCID: PMC4919171. [cited 2022 July 12]

12. Zell M, Grundmann O. An orthomolecular approach to the prevention and treatment of psychiatric disorders. Adv Mind Body Med. 2012 Fall;26(2):14-28. PMID: 23341413. [cited 2022 July 12]

13. Mikkelsen K, Stojanovska L, Polenakovic M, Bosevski M, Apostolopoulos V. Exercise and mental health. Maturitas. 2017 Dec;106:48-56. doi: 10.1016/j.maturitas.2017.09.003. Epub 2017 Sep 7. PMID: 29150166. [cited 2022 July 12]

14. Gautam M, Tripathi A, Deshmukh D, Gaur M. Cognitive Behavioral Therapy for Depression. Indian J Psychiatry. 2020 Jan;62(Suppl 2):S223-S229. doi: 10.4103/psychiatry.IndianJPsychiatry_772_19. Epub 2020 Jan 17. PMID: 32055065; PMCID: PMC7001356. [cited 2022 July 12]

Originally Published Nov 1, 2019 by Lyle Murphy

This content has been reviewed and approved by a licensed physician.

Dr. Samuel Lee

Dr. Samuel Lee is a board-certified psychiatrist, specializing in a spiritually-based mental health discipline and integrative approaches. He graduated with an MD at Loma Linda University School of Medicine and did a residency in psychiatry at Cedars-Sinai Medical Center and University of Washington School of Medicine in Seattle. He has also been an inpatient adult psychiatrist at Kaweah Delta Mental Health Hospital and the primary attending geriatric psychiatrist at the Auerbach Inpatient Psychiatric Jewish Home Hospital. In addition, he served as the general adult outpatient psychiatrist at Kaiser Permanente.  He is board-certified in psychiatry and neurology and has a B.A. Magna Cum Laude in Religion from Pacific Union College. His specialty is in natural healing techniques that promote the body’s innate ability to heal itself.

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Duloxetine Tapering
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Nothing on this Website is intended to be taken as medical advice. The information provided on the website is intended to encourage, not replace, direct patient-health professional relationships. Always consult with your doctor before altering your medications. Adding nutritional supplements may alter the effect of medication. Any medication changes should be done only after proper evaluation and under medical supervision.

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