Starting Cymbalta Again After Stopping

There are many factors to consider.

Question

I was on Cymbalta for multiple years. I took a trip 2 weeks ago and forgot it. I decided to see what would happen if I went cold turkey from the two low doses per day. I seem fine. My wife, tonight said I was more argumentative and somewhat more forgetful. After almost 3 weeks without Cymbalta, should I restart?

Asked by Bob On Nov 20, 2018

Answered by
Medical Content Reviewed By PharmacistAnswers Staff

On Nov 20, 2018
Antidepressant Title

Answer

After not taking Cymbalta (Duloxetine) for three weeks, we can be fairly confident that the actual drug is no longer in your system in any appreciate amount. 

However, even though the drug isn't in your system anymore, there is a good chance you may still be experiencing withdrawal symptoms.

The concern with potential withdrawal symptoms has more to do with the structural changes in the brain from your antidepressant therapy, which takes time to adjust after medication changes.

Withdrawal symptoms from antidepressants, like Cymbalta, can last weeks, even after the drug is completely eliminated from your body. Withdrawal symptoms are more likely if you stop the medication abruptly.

In terms of restarting your therapy, there is no single agreed upon method.

Some individuals respond well to restarting the dose they were previously taking, while others may experience side effects. Your best resource will be your doctor as they can recommend the most appropriate dosing schedule for your particular situation. 

Section Summary
Cymbalta can cause withdrawal symptoms if stopped abruptly. It is recommended to be tapered. If you are considering restarting therapy, be sure to speak to your doctor for proper dosing instructions.

Cymbalta In Your System

Studies show that the elimination half-life of Cymbalta (the time it takes for 50% of a drug to be eliminated from the body) ranges from 9.2 to 19.1 hours (average 12.5 hours).

In general, it takes around 5 to 6 half-lives for most drugs to be considered completely eliminated from your system.

In regard to Cymbalta, this translates to the drug being completely eliminated in 2 to 5 days. This may be prolonged in those with kidney or liver disease.

Section Summary
For most individuals, Cymbalta will be completely eliminated from your system in 2 to 5 days.

Cymbalta Withdrawal

A more pertinent consideration when talking about the stopping antidepressants is the withdrawal that can be experienced.

Antidepressant withdrawal isn't completely understood, but is thought to be due to altered brain chemistry from your antidepressant therapy.

One study describes it as follows:

Presumably, the discontinuation syndrome [from antidepressants] results from neurophysiologic readjustment in the central nervous system to compensate for the pharmacologic activity of the SSRI.

Withdrawal symptoms and duration vary greatly by individual. Potential symptoms include:

  • Abnormal dreams
  • Headache
  • Mood changes
  • Insomnia
  • Dizziness
  • Nausea/vomiting
  • Numbness
  • Irritability
  • Fatigue
  • Diarrhea
  • Anxiety
  • Increased sweating
  • Increased heart rate
  • Confusion


Abrupt discontinuation of Cymbalta puts you more at risk for these symptoms.

Therefore, gradual tapering is recommended during discontinuation to decrease potential withdrawal symptoms. This allows time for our brains to slowly adjust to your decreasing doses of medication.

Tapering protocols will vary by individual. With drugs like Cymbalta, one source recommends decreasing slowly, reducing your dose by 25% every four to six weeks.

Section Summary
A gradual taper of Cymbalta is recommended to reduce the risk of withdrawal symptoms, which are thought to be a result of changing brain chemistry. Tapering protocol recommendations vary.

Starting Again

In terms of starting Cymbalta (Duloxetine) again, you should discuss this with your doctor.

There is no single recommendation regarding restarting your medication.

In general, it would be recommended start at a dose lower than your previous maintenance dose, and slowly taper to a target maintenance dose (which is around 60 mg/day).

Nevertheless, some people may be perfectly fine resuming therapy at their previously effective and well tolerated dose.

Your doctor will be your best resource on how to begin therapy again and it is certainly a case-by-case basis.

Section Summary
Speak with your doctor regarding how to safely restart Cymbalta. Some may be able to return to their previous dose, while others may need to start low and taper up slowly.

About Cymbalta

Cymbalta (Duloxetine) is an antidepressant, belonging to the Serotonin-Norepinephrine Reuptake Inhibitor class.

SNRI medications work by inhibiting the reuptake of both serotonin and norepinephrine and are often referred to as a 'dual' inhibitors.

Cymbalta has been shown to be effective in treating symptoms of depression as well as painful neuropathy due to the effects on norepinephrine.

Like most antidepressants, Cymbalta can take 4 to 12 weeks to reach full effect and should be taken consistently.

Cymbalta is generally dosed once to twice daily and can be administered without regard to meals.

About the Pharmacist

Dr. Brian Staiger Pharm.D

Dr. Brian Staiger is a licensed pharmacist in New York State and the founder of PharmacistAnswers.com. He graduated from the University At Buffalo with a Doctor of Pharmacy degree in 2010. He has been featured in numerous publications including the Huffington Post as well as a variety of health and pharmacy-related blogs. Please feel free to reach out to him directly if you have any inquiries or want to connect! He's answered thousands of medication and pharmacy-related questions and he's ready to answer yours! Brian.Staiger@PharmacistAnswers.com Office: 716-389-3076

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