Discontinuation of Duloxetine

Tapering Recommendations

• The American Academy of Physicians recommends a gradual taper of duloxetine 60mg over 4-6 weeks to minimize withdrawal symptoms, with dose reductions of 10% or less per week for most patients 1
• For patients with a history of severe withdrawal symptoms or anxiety disorders, a more gradual taper is recommended, with reductions of 10% or less per week over 12 weeks 1

Withdrawal Symptoms

• Monitor for protracted withdrawal which can include dysphoria, irritability, insomnia, and anhedonia, with most common withdrawal symptoms resolving within 7 days (65% of cases) 1

Management of Withdrawal Symptoms

• For anxiety/irritability, consider short-term trazodone for sleep disturbances, and for gastrointestinal symptoms, consider loperamide for diarrhea 1
• For dizziness/headache, consider over-the-counter analgesics, and avoid benzodiazepines due to their own risks 2

Special Considerations

• Patients with hepatic impairment may require even more gradual tapering due to altered drug metabolism 3
• Advise patients to contact their healthcare provider if they experience severe dizziness, suicidal thoughts, severe mood changes, or symptoms that don't improve within 1-2 weeks 1

Follow-up and Patient Education

• Schedule follow-up within 1-2 weeks of initiating taper, provide clear instructions about when to contact healthcare provider, and reassure patients that withdrawal symptoms are temporary and not dangerous 1