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. Meesha
    Kentucky
    Reply

    I have been on 60mg cymbals for 2 years. It made everything worse: thinking,rationalizing,choices,bad thought, stress, eating,energy gone,loving myself gone,loss of thoughts, very short term memory,brain zaps etc. Then switched to 30mg for 4 years. Nothing changed. Things are worse.

    I want off so badly. I ran out, and the second day was in a ball. My stomach hurt, sweats, freaking out diarrhea. Thought I could tough through it a week. Nope. I got it refilled. Ugh. I quit my job and lost my insurance, so doc will not call me any in. I’m seriously thinking of admitting myself to get off the drug but am scared they won’t take me. I’m so angry. How can any doc give this to anyone? All these stories: it’s like heroin withdrawal. From what I’ve read, this horrible drug should be taken off the mark.

    I have 2 young children. I am scared for them to see me like this. I’m a walking zombie. I work now with seniors, which I love while I’m there but getting there is the problem. I need off this medicine. I need my life back. I was stressed and depressed before but it’s way worse now.

  2. LaVonna
    tx
    Reply

    I’m using it for depression. I tried to get off gradually, and I became suicidal. I had to go back on it. What am I to do? There’s no weaning down for me. It’s not working, and I’m on 60 mgs. So how do I do this?

  3. Tory
    wisconsin
    Reply

    I was prescribed Cymbalta in October 2017, for fibromyalgia and arthritis pain. Due to my chronic allergies to meds, etc. I was only on 20mgs. Well, the pain went away almost immediately but soon enough I experienced side effects. My doctor and I decided I should stop taking it. Now, I seem to be going through all the classic symptoms of withdrawals so I phoned doctor. His nurse informed me I wasn’t on it long enough to be experiencing such symptoms. Ummm, seriously? I haven’t been able to work since.

  4. Ella
    Bristol, Virginia
    Reply

    I AM ON CYMBALTA FOR FIBRO. MY TEETH CLAMP TOGETHER CONSTANTLY. MY MOUTH AND LIPS ARE SORE. I HAVE TO GET OFF THIS HORRIFIC DRUG!

  5. Mila
    LOS angelesi
    Reply

    I have been on cymbalta for twenty years due to personal issues of divorce, betrayal, death of parents and wiped out financially by family. I . Wanted to come off cymbalta 80mg due to ineffectiveness and teary episodes. I was the worst experience of my life. UNder psychiatric advisement I tapered 80mg x 1 week with help of klonopin and trasadol. It was a nightmare . vymbaltaweek two decrease to 60 mg while increasing trasadol. Then then 40mg for a week then 20mg. The blogs helped me. I suffered from insomnia. Tinnitus, wishing I was dead,uncontrolled bursts of tears and anger, unable to complete sentences,fatigue ,impaired driving. I have another appt this week. Nothing works and it has been three months. Others experience has helped.

  6. Amy
    Reply

    Zaps gone in 2 days

    I took cognitex by life extension
    DL-phenylalanine
    DMAE

    Serious 2 days

    • Larissa
      Minnesota
      Reply

      I’m not sure what any of those aberrations mean. Can you please explain further?

    • Tory
      Reply

      I have just read about that in a fibro support group! Glad it’s helped!

  7. Bo
    Nebraska
    Reply

    The best way to stop this drug is never to start it. Sadly, no one ever told me this. It has taken me years to taper down to where I’m at today. And today has been a day of increased anxiety, chest pain, major GI disturbances, and insomnia at the same time as fatigue. My doctor did give me the great idea of going to a compounding pharmacy to get lower doses than the 20mg that they make. So I went down to 10mg for a month, and now I am at 5mg. I had to pay out of pocket for this compounded Rx but it has helped me not have to go down to steeply too quickly. Maybe your physician will do this for you too.

    • Kathleen
      Portland OR
      Reply

      This is a great idea. I may have to do it. It has taken me about a year to get to where I am. Started at 120 mg and just took my last 30 mg five days ago. This is the worst! I’m scheduled to have knee replacement surgery on the 24th of January and am hoping to get through the worst of the withdrawals by then!! I may have to try to get the mg.

  8. Terri
    Tennessee
    Reply

    I don’t want to be on this drug the rest of my life for depression. I have put on weight and cannot take it off!!! I don’t have insurance so it’s expensive. I have had help with the cost but I’m afraid that may not last. Sadly the reason anyone wants to come off a drug is not the issue. The issue is the lack if education the doctors give patients when prescribing drugs. We should know the options before we agree. We should not have to do all the research ourselves, which can be dangerous if we find incorrect information.

  9. p
    oregon
    Reply

    December 9, 2017. This is the worst drug I have ever taken. It gave me terrible night sweats, and when doc reduced the dose it was too quick, and now I have had even worse brain zaps, tinnitus, and headaches for a year now and no relief in sight. My regular doc says stupidly, “There are no side effects,” so I get no help from her or the doc that prescribed it in the first place.

    sad and sick.

    • Kathleen
      Oregon
      Reply

      I have also had my doctor say there are no side effects or withdrawals. WRONG!

  10. Julie
    Australia
    Reply

    Hi, just been prescribed Cymbalta, first day yesterday! Been on 150mg Lyrica for neuropathic pancreas pain (3 years) + Champix for smoking (3 weeks). Champix morning dose makes me nausea & headache for 4 hours, no matter whether you have breakfast or not. Then I took 1 x 30mg of Cymbalta, in bed all day with nausea & head spinning. Lyrica puts on weight so I was prescribed Cymbalta for weight, neuropathic pain, & depression, anxiety.

    Last night, I had 100mg Lyrica because I didn’t want my head whirling off the bed or feeling like it! This morning my head feels like I have been strung up by chopsticks in my ears, headache, whirly head. This comment is taking forever! I haven’t eaten since yesterday morning (2 x plain bread) so the weight will drop if I continue with Cymbalta! But I couldn’t drive, work etc. My dog needs a walk! One day equals crap.

    Reading your comments have helped me to access if this medication is for me. Having another addiction (Lyrica) to come off will be crap. I found company medications are worse to come off than illegal stuff. Past heroin & speed user (25 yrs) then methadone so I know about addictions and prefer not to go through that again esp at 55. Thank you ladies & gentlemen for your help. I sympathise.

  11. marcia
    Maryland
    Reply

    I have been on cymbalta twice first time coming off was major hell for me it took 4 months..Brain zaps were brutal. I went back on it due to fibromyalga pain ..big mistake. gonna ween myself off tomorrow by lowering my dosage from 90 to 60 for 2 weeks and then from 60 to 30 for 2 weeks and then seperate the capsule in half for 2 weeks.

    • Rachel
      Benton, AR
      Reply

      But what, then, do you do about the fibromyalgia/musculoskeletal pain? I have that, arthritis, and sciatica. I HATE Cymbalta, but it does help with pain. What do you do??

    • Helen
      Illinois
      Reply

      But then what do you do after separating the capsule for two weeks, go cold turkey?

  12. crazygiraffelady
    st louis mo
    Reply

    So, I said I would be back with an update. The pau d’arco tea definitely has helped with the withdrawal symptoms. I drink this nearly every morning. It is touted to be a natural antiinflammatory, and it helped with the bowel problem. I also take a magnesium supplement, which also helps the swelling.

    The only thing fibro that I can’t deal with naturally is when it is about to rain, which the medical world considers coincidence. So I went back to my doctor to get FMLA going again. When I told him I cold turkeyed that crap, he said “Oh, so you want me to bail you out with FMLA”!

    I let that go because I did convince him to get me back on hydrocodone for the bad days, instead of the nonfunctional tramadol. I’ve also been trying to go natural with food,avoiding fast food, prepared shelf food with preservatives, and sugary vending machine goodies. I’m SLOWLY seeing improvement, except for the occasional brain farts!

    I broke down crying when the third time of trying to say I was leaving to refill a prescription it came out renew a subscription. My boss thought I was joking until he saw I was genuinely upset. He gave me a hug. I knew there was a soft side to him!

  13. HC
    Oregon
    Reply

    I have successfully weaned off of Cymbalta without taking additional meds and I couldn’t be happier! I was taking 60 mg, then went to 30 mg. After three months or so, I started “counting pellets” for six weeks until I was down to zero. I had some brain zaps and dizziness, but nothing major. I had previously tried to go cold turkey, but that didn’t work at all. I would highly recommend the counting pellet method.

    • PJ
      North Dakota
      Reply

      Thanks HC for your post. On October 3,2017 I was prescribed 30 mg daily x 2 weeks. Then I was to increase to 60mg daily. After approximately 3 weeks of the 60mg I couldn’t handle the way it made me feel. I describe it as “vibrating.” I reduced it to 30mg and now am trying to “quit” that dose. I’m currently at day 3 of cold turkey. I’m dizzy, nauseated and just want to be left to my misery.
      I will do as you did. I’m going to break open by capsules and start reducing pellets. I’m so upset that I was prescribed this horrific medication. I’m even more upset at myself for being naive and not researching the medication prior to starting it. HUGE mistake. Wish me luck in this horrible journey.

      • Amy
        Reply

        Cold turkey

        Zaps gone in 2 days

        I took cognitex by life extension
        DL-phenylalanine
        DMAE

        Serious 2 days
        No prob

        • Mike
          FL
          Reply

          I was only on this horrible medicine for 24 days and stopped taking it 3 days ago. The withdrawals have been horrible. I’m going to tough it out. I was only on it such a short time. I was taking one 30 mg capsule a day. Did anyone else quit after such a short time? And if so, how long do the withdrawals last?

        • Pam
          MD
          Reply

          Amy, please explain how and what you took to wean so fast and easy. Would appreciate the info.

  14. Marchita
    Michigan
    Reply

    I have been on cymbalta 11days now. I want to just stop 30 mg. Do I have to wean after 11 days. I woke with a UTI this a.m. which I am prone to get. I feel like crap for a 11 days now and now this UTI that you can be prone to due to the med.

    • Audrey
      Sparta, Michigan
      Reply

      That’s awesome, Marchita , I’ve been on Cymbalta for many years. I would like to know why do people decide to quit this medicine? I’m also in Michigan, from Audrey

      • Amy
        Reply

        Indifference and no thoughts of consequences

        Cold turkey
        Zaps gone in 2 days

        I took cognitex by life extension
        DL-phenylalanine
        DMAE

        Serious 2 days

    • BONNIE
      NYC
      Reply

      MARCHITA, were you successful at the cold turkey route after 11 days? My sister wants to get off after 14 days on 30mgs, but is frightened to do it cold turkey after reading all of these comments..

      • Sherry
        Reply

        Facebook: Cymbalta Hurts Worse

    • Michael M. H.
      FL
      Reply

      Did you stop? I stopped 30 mg after 24 days of taking it, and I’m on day 3 of bad withdrawals and diarrhea.

What Do You Think?

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