Duloxetine and Aripiprazole Treatment Guidelines

Introduction to Duloxetine Dosing

The American College of Cardiology recommends starting duloxetine at 30 mg once daily for one week to minimize nausea, then increasing to the standard therapeutic dose of 60 mg once daily 1
The initial dose of duloxetine is 30 mg once daily for 7 days to reduce the risk of nausea, which is the most common side effect 1
The target dose of duloxetine is 60 mg once daily after the first week, which is the standard therapeutic dose for depression and anxiety 2, 1
The maximum dose of duloxetine can be increased to 120 mg daily if clinically indicated and the patient tolerates the 60 mg dose 2, 1

Elderly or frail patients should use a slower escalation schedule with a lower initial dose, such as 20 mg 1
Patients with renal insufficiency may require dosage adjustment 2
Patients with hepatic failure should use duloxetine with caution 2

Blood pressure and pulse should be monitored regularly, as duloxetine can cause increases in both parameters 1
Common side effects of duloxetine include nausea, dry mouth, headache, constipation, dizziness, fatigue, diaphoresis, and insomnia 2, 1

Aripiprazole can be used as an augmentation to clozapine, and may reduce clozapine dose requirements, treatment side effects, and residual symptoms 3
Aripiprazole augmentation can be considered for persistent positive or negative symptoms on clozapine 4
For negative symptoms specifically, aripiprazole augmentation is a suitable option in patients not already on a D2 partial agonist 4

Aripiprazole should be started at a low dose, such as 2.5-5 mg daily, and titrated slowly based on clinical indication and patient tolerability 1
The risk of serotonin syndrome should be monitored, particularly when using duloxetine with other serotonergic agents 2
The anticholinergic burden should be assessed, particularly when using aripiprazole for schizophrenia with cognitive symptoms, and anticholinergic medications should be minimized 4