A bottle of generic delayed-release Duloxetine (Cymbalta) 30 mg

From what we hear from readers of our syndicated newspaper column and visitors to this website, most patients are not warned about how to stop duloxetine (Cymbalta). Perhaps the prescriber assumes that they will need to take this antidepressant for the rest of their lives. Or perhaps there is a reluctance to mention anything negative about a new prescription. Whatever the motivation, a lot of people are not adequately warned that they must never stop duloxetine suddenly.

The Many “Indications” for Duloxetine:

The FDA originally gave Cymbalta the green light for treating major depression in 2004. The drug has also received FDA approval for nerve pain (neuropathy) triggered by diabetes. In addition, the FDA has granted duloxetine approval to treat anxiety, the discomfort of fibromyalgia and the musculoskeletal pain brought on by arthritis or lower back injury. It works by affecting the neurotransmitters serotonin and norepinephrine.

On the surface, duloxetine seems like an ideal drug. It will ease your pain and relieve any related depression. Not surprisingly, Cymbalta became very successful. Today, the generic duloxetine formulation is prescribed quite frequently.

Duloxetine Side Effects:

There is a long list of significant side effects associated with Cymbalta. You can find them at this link.

Powerful Stories from Readers:

Kent in Oregon has the worst of both worlds: Side Effects and Withdrawal Symptoms:

“I am a 50 year old college honors grad, U.S. Marine and a retired homicide detective. I began taking Cymbalta to combat the effects of stress and depression associated with my constant exposure to the worst society has to offer.

“I have been taking it for about 15 years and now have symptoms I would trade for those that put me on Cymbalta in the first place. Each time the Veteran’s Healthcare Administration has failed to send my refills in the mail, it takes just 48 hours for the most terrible withdrawal symptoms to reappear.

“I experience horrible shakiness, uncontrollable, inappropriate and sudden bursts of tears, irritability and snappy moodiness, appetite problems and more. The worst of all my withdrawal symptoms, however, are the electrical shorts or zapping sensations in my brain. It literally feels like it shoots across my head and makes my brain bounce and eyeballs wobble. I find that it progressively worsens day after day while I wait for VHA to do their job and send the next bottle of capsules.

“There are symptoms that I get from taking the capsules as well, including erectile dysfunction, appetite changes, severe dry mouth, and MAJOR tinnitus [ringing in the ears]. The worst two are massive anxiety and sweating anytime I am in public or have even the slightest thought of things that are stressful for me.

“As a cop, I always thought anxiety was something people made up and used to escape work, or some other unpleasant task. Now I know it’s very real and has completely destroyed my public life. Standing in ANY store checkout line is a guaranteed shirt-soaking, sweat-filled-eyeballs experience for me.

“At one time, I was an over-achiever and a rising star in my profession with national awards and recognition, but now I live alone, have lost my family, friends, my personal belongings and even my home. I’m now stuck on a drug my brain cannot live without in a system with no reasonable means for discontinuation whatsoever.”

Sweating is a recognized side effect of duloxetine, along with hot flashes.

Martha in Texas shared a similar experience:

“I’ve been on Cymbalta since 2010 for fibromyalgia. Stupid me! I’m the one who asked my doctor to put me on it, since I saw it advertised on TV. The commercial said that it helps with pain!

“I was tired of the hot flashes and my ears ringing! And feeling like I was a robot! I had a lot of ‘brain farts’ where my mind would stop with a blank and couldn’t get my words out. I decided it was time to get off of Cymbalta.

“Getting off Cymbalta is horrific! Like so many others, I too am experiencing light-headedness, dizziness, and brain zaps. I describe it…when my eyes move my hearing zings while my brain zaps. I’m so tired and can sleep 12 hours at a time. I just don’t feel like myself.

All of this is affecting my job performance. I really need help, and I don’t care what it takes. Somehow or other, I’m getting off this awful drug!”

How to Stop Duloxetine (Cymbalta):

First, and we cannot emphasize this enough, NEVER stop duloxetine on your own. This requires very careful medical supervision. The prescriber must be informed of any plans to stop this drug. That said, the official prescribing information does not provide health professionals or patients much detailed guidance on how to stop duloxetine (Cymbalta).

Official Prescribing Information:

The FDA requires the following wording in the package insert. This is the officially sanctioned information hammered out between the drug manufacturer and the Food and Drug Administration. See what you think:

“Discontinuation symptoms have been systematically evaluated in patients taking CYMBALTA. 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 CYMBALTA-treated patients compared to those discontinuing from placebo: dizziness, headache, nausea, diarrhea, paresthesia, irritability, vomiting, insomnia, anxiety, hyperhidrosis [excess sweating], 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 [bad] 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. Although these events are generally self-limiting, some have been reported to be severe.

“Patients should be monitored for these symptoms when discontinuing treatment with CYMBALTA. A gradual reduction in the dose rather than abrupt cessation is recommended whenever possible. If intolerable symptoms occur following a decrease in the dose or upon discontinuation of treatment, then resuming the previously prescribed dose may be considered. Subsequently, the physician may continue decreasing the dose but at a more gradual rate [see Dosage and Administration (2.7)].

2.7 Discontinuing CYMBALTA:

“Adverse reactions after discontinuation of CYMBALTA, after abrupt or tapered discontinuation, include: dizziness, headache, nausea, diarrhea, paresthesia, irritability, vomiting, insomnia, anxiety, hyperhidrosis, and fatigue. A gradual reduction in dosage rather than abrupt cessation is recommended whenever possible [see Warnings and Precautions (5.7)].”

FDA’s Guidance on How to Stop Duloxetine (Cymbalta)?

So, what do you make of the official prescribing information? Do you feel as if you might be caught on the cusp of a Catch 22 situation? The FDA and the company acknowledge that “intolerable symptoms” may occur upon “discontinuation of treatment” or even a “decrease in dose.” The solution: resume the previously prescribed dose. Then “continue decreasing the dose but at a more gradual rate.”

We did not find any actual guidance on how to stop duloxetine (Cymbalta) gradually. For one physician that might mean over a week. For another health professional, “gradual” might be interpreted as a month. But the company and the FDA seem to be very careful not to provide clear and concise recommendations. That means that physicians are pretty much on their own and that leaves patients vulnerable to all sorts of complications.

a bottle of Cymbalta 20 mg

Withdrawal Stories from Patients:

Cindy in Dickson, Tennessee went through hell:

“I have been on Cymbalta for about 2 years. I recently ran out and didn’t have the money to refill my prescription. It’s been 6 days. My body hurts, I feel like I’m sweating from inside, upset stomach, whooshing in my head and brain zaps.

“Yesterday, which would have been day 5, I could barely move. I was very sick to my stomach and throwing up. I was going to refill it today cause I had 1 refill left but it expired on 5/19 so I couldn’t refill it.”

Angela in Palo Alto, California, had a similar experience:

“I’ve been on Cymbalta for the past 6 years for depression. My new insurance would not pay for my meds without a prior auth. I’ve been waiting for a month for my Dr. to handle the paperwork.

I’ve been so sick. Headaches, sweating, thoughts of killing myself, hostility, crying, not sleeping, feeling of everyone around me is gonna die, can’t think clearly, the runs, chest hurting, wheezing, and so much more! I finally got my thoughts right for me to look up Rx discount today. I’ll be getting my meds tomorrow. Thank God!

JoAnne in New Market, Ontario, adds:

“I came off Cymbalta two weeks ago. Oh My God! I don’t mind pain, but this is sick.
I have nausea, runs, stomach pain and headache.

“Well at least I don’t have thoughts of suicide. One minute I am cold and the next hot and feverish. Some times light hurts my eyes. I have gas, burping and farting.

“Then I have moments of wanting to just break down and cry for no reason at all. Chills. I am having a bad moment now. I just want to go to bed and stay there until it all passes and God I hope this passes soon. Shortness of breath. Please tell me it will end soon.”

There is no way to predict how long withdrawal symptoms will persist for any given individual. Some people tell us that after several weeks of unbearable symptoms, things gradually begin to smooth out. Others tell us it takes months. That is why it is essential never to do this on your own or suddenly.

Nancy in Florida was taking a different antidepressant: citalopram (Celexa). Here is what she reports:

“I was on citalopram for many years. More than one doctor tried to tell me that there were no side effects if you quit. More than one time I tried to go off but would have major crying spells and irritability.

“I finally got off of it by taking 2/3 of a pill for one month, then 1/2 of a pill for 1 month, then 1/3 of a pill for 1 month, then 1/4 of a pill for 1 month. Then I went to 1/4 of a pill every other day for a month, then every third day, etc. It was an incredibly slow process but did not cause any problems.”

Kassandra in Arizona had physician support:

“I am currently on duloxetine for my extreme nerve pain related to sciatica. When I asked my doctor about the reported difficulty of stopping duloxetine, she said that she would put me on a different drug while I reduced the duloxetine, and that it would reduce the side effects. She also said that it can take months to get off it completely, and should not be rushed.”

How to stop duloxetine (Cymbalta) from “Hopeful” in Indiana:

“Getting off of Cymbalta was the hardest physical thing I’ve ever done in my life. Many doctors don’t realize how difficult it is or that you have to taper – mine did not.

“I found A LOT of help online — my withdrawals were so difficult, I’m not sure I would have survived if I had not found all the online resources and other people’s stories of how difficult getting off of it was and the techniques they used.

“What I did, safely and carefully, was actually open the capsules and count the beads in order to taper down. (Cold turkey is horrible and was simply not do-able for me!) This counting of the ‘beads’ was detailed in many places online.

“I went down VERY slowly and this greatly minimized the horrors of cold turkey. I think I took 3 solid months to go off of it completely. I took a LONG time to phase off this drug. Even then, I had bad side effects and my brain didn’t ‘heal’ completely for 9 months. I had bad memory problems, extreme difficulty with logical thinking, exhaustion, physical aches, and more. BUT I DID get better finally; it was just a very long, painful journey.

“Now I continue to experiment and research and have had successes with natural alternatives to a prescription antidepressant. I understand deeply how much antidepressants are needed for some people, but after my terrible experience with going off of Cymbalta, I hope to not use one again. (And the fact that the manufacturer doesn’t make a tapering dose/pack is unbelievable given the bad results of cold turkey.) I have much sympathy for you and urge you to search online regarding how to best go off Cymbalta. I wish you well. Hang in there – it can be done!”

We are grateful for “Hopeful” in Indiana for her guidance. Many visitors to our website have successfully tapered off duloxetine by removing a few pellets from the capsule each day. Some have gone so far as to remove only one a day for awhile until the body adjusts. Because duloxetine comes in a capsule with tiny pellets or beads containing the active drug, it is actually possible to lower the dose very gradually over a period of many months. If symptoms show up, a slight increase in the dose may suppress the discomfort.

An Alternate Approach from a Physician:

We were contacted by a board-certified family physician who specializes in pain and addiction. He reports that:

“The best way to stop this drug is to put the patient on fluoxetine (Prozac) for one to two weeks. You then stop the Prozac. Prozac is so long lasting that it gradually decreases blood levels slowly enough so that the discontinuation syndrome doesn’t happen.

“This is simple and inexpensive. It is important, as you say in your article, that people do not stop this medication [duloxetine] on their own. However, it is not necessary to go through the ‘Chinese water torture’ by such a prolonged and unnecessary tapering regimen.

“Since most physicians do not know this simple trick, it is up to the patient to ask their physician to use the simple method.”

Once again, we recommend this be supervised by a physician who is knowledgeable and sympathetic. Some people may be successful with the prolonged tapering regimen described by “Hopeful.” Others may find the fluoxetine substitution for duloxetine a helpful strategy under close medical supervision. Because each person responds differently, we hope that the health professional who assists in this process is patient and understanding.

Here are some links to other articles to consider:

Stopping Duloxetine (Cymbalta) Suddenly Flipped her Out

Stopping Cymbalta Suddenly Triggered Emotional Roller Coaster Ride

Stopping Cymbalta Suddenly Led to Disaster

Reader Enraged by Advice about Stopping Cymbalta

Share your own duloxetine (Cymbalta) story in the comment section below:

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  1. Roberta M
    Canada
    Reply

    I have been on 60 mg Of Cymbalta for about 2 years for diabetic neuropathy. I am so sleepy and listless and brain-fogged all the time, and I wonder how much the Cymbalta really helps the neuropathy pain. I would like to drop down to 30 mg but the thought of the withdrawal symptoms scare the hell out of me. I’ll ask my doctor.

  2. Diane S. S.
    Sydney, Australia
    Reply

    I’ve been taking Duloxetine for nearly 6 years. I started because I was suffering depression due to emotional stress and pain. I suffer with a lot of unexplained pain and thought it was a bonus that Duloxetine is used to treat fibromyalgia as well.

    Last year I had minor surgery on my eyes and noticed that the drops I was using in my eyes effected my brain, and I was a bit gaga. During this time I forgot to take my Duloxetine for 2 days, and on the 3rd day I didn’t know if I’d taken it or not so I was too scared to take it in case I overdosed. I couldn’t think clearly. My brain felt ‘spaced out’ and silly. I reversed into a wall in a parking area and felt very insecure about driving. At this stage I didn’t realize what was happening to me so I asked my daughter to take me to Emergency thinking I was having a stroke or going mad!

    I started having brain zaps as I sat in the waiting room so I decided to look up Cymbalta on my phone while I was waiting. I read a bit about how hard it was to stop taking Cymbalta. Then realised that I really needed to take my meds and couldn’t wait to get home and take them. I got the all-clear from the doctors at the hospital. I wasn’t having a stroke or rapidly declining into dementia. Phew!

    I took my meds since then, and I’m generally ok. However, I have put on at least 30kg over the last few years, and I wake up with a headache most mornings (probably because the withdrawal symptoms are setting in already). And I sweat like crazy!!! 3 days ago I told my doctor that I wanted to come off Duloxetine. SLOWLY. He suggested taking the capsules to a compounding chemist and getting them to reduce them by 10mg each week. I wanted to take longer so the doctor suggested 10mg every two weeks.

    I am taking my capsules to a compounding chemist where they are reducing the dose by 10 mg for a whole month’s worth because it’s slightly easier for them. I wish I had checked out Google first because then I might have done it myself by taking out a few beads each week, or whatever. Instead it’s costing me $45 per month’s worth, or $80 for 2 month’s worth.
    I’m only up to day 2 at the moment. So far am crying a lot and crazy tired (not much different than usual) but otherwise fine. Hoping that taking 6 months to do this will work for me.

  3. Kitten
    wisconsin
    Reply

    I just want to thank everyone who shared their withdrawal symptoms. I am a veteran who has been without my med for about a week. I was having so much trouble with depression that I never knew if it was me or my meds. I have liver disease too so any symptoms make me anxious about my liver function but all the symptoms you have listed are what I am experiencing. So now I feel much better and, yes, I started to cry. Just the withdrawal. Thank you.

  4. Missy
    Indiana
    Reply

    I am taking duloxetine for the pain of facial palsy. I’ve been taking it for over a year. I’ve been on the highest dose 60mg, and at one time he had me try 60mg + 30mg, which did not work so put me back down to 60mg. I do not feel that it is doing me any good. I’m still in pain and actually I think it’s getting worse. My face feels like pins and needles especially around and on the ear and neck. Just recently I’ve been getting really bad headaches couple feeling like a migraine. Literally put me in bed out of work. I’m not taking Duloxetine for depression. Never been depressed in my life. Just started last week to try and wean myself off of it. I’ve researched online the best method and I feel taking the beads out is the best. Definitely cannot do “cold turkey”. All the different things I’ve read I have not read anyone taking it for pain. Please respond if you’re in the same boat as I am.

    • Janet
      Chicago, Western Burbs
      Reply

      I am on Cymbalta for extreme nerve pain around my upper chest especially the rib cage just under my breasts. The cause of this horrible pain was a thoracotomy operation with complications of an empyema and an abscess. First I was on a Fentanyl Patch and Nucynta in addition to gabapentin capsules at 900 mg. 3xday. The Cymbalta was added because I was in so much pain I would have taken Anything to ease it. I am still taking it. It will be two years in February of 2018.

      I am totally off the Fentanyl (opioid) and am in the process of weaning off Nucynta (opioid). My pain management doctor will not let me wean off anything else until the opioids are totally out of my system. When that happens I am going off Cymbalta because of the horrible stories I have heard about withdrawal from this drug. Since in the past I had been on Prozac for years and had no problems quitting cold turkey I think I am going to go on that while weaning off the Cymbalta. I will run this by my Pain Management Doctor who is very smart and very compassionate and see what he thinks. I can only say that it really helped with the terrible cut nerve pain I was experiencing and that made it worth it to me at any cost.

      As this incredible pain odyssey nears an end I am terrified of going off the last non-opioid pain killers that I am on (gabapentin and Cymbalta). I will keep you posted on the Cymbalta withdrawal as I am going through it. At any rate I think as I wean down as far as I am able maybe my mind will work as quickly as it used to. As it was, I was willing to suffer the brain confusion and feeling numb and dumb as long as the terrible pain was somewhat manageable. Chronic pain is a demanding Master.

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