Cymbalta for neuropathy dosage
For nerve pain, anxiety, and more
Cymbalta (duloxetine) is a brand-name prescription medication. The Food and Drug Administration (FDA) has approved it to treat the following conditions in adults:
- generalized anxiety disorder
- major depressive disorder (also known as clinical depression)
- fibromyalgia
- chronic musculoskeletal pain
- pain caused by diabetic neuropathy (nerve damage)
Cymbalta is FDA-approved to treat the following conditions in children:
- generalized anxiety disorder in children ages 7 years and older
- fibromyalgia in children ages 13 years and older
Cymbalta comes as an oral capsule. It’s an antidepressant medication that belongs to a class of drugs called serotonin-norepinephrine reuptake inhibitors (SNRIs).
For information on the dosage of Cymbalta, including its form, strengths, and how to take the drug, keep reading. For a comprehensive look at Cymbalta, see this article.
This article describes typical dosages for Cymbalta provided by the drug’s manufacturer.
When taking Cymbalta, always follow the dosage prescribed by your doctor.
Below are Cymbalta dosages that are commonly used for the conditions the drug is prescribed to treat.
Cymbalta form
Cymbalta comes as oral capsules.
Cymbalta strengths
Cymbalta capsules are available in three strengths: 20 milligrams (mg), 30 mg, and 60 mg.
Typical dosages
Typically, your doctor will start you on a low dosage. Then, they’ll adjust it over time to reach the amount that’s right for you. Your doctor will ultimately prescribe the smallest dosage that provides the desired effect.
The following information describes dosages that are commonly used or recommended. However, be sure to take the dosage your doctor prescribes for you. Your doctor will determine the best dosage to fit your needs.
Dosage for chronic musculoskeletal pain
Chronic musculoskeletal pain is long-term pain in the muscles, bones, joints, tendons, ligaments, or nerves.
Examples of this type of pain include back pain and arthritis pain.
The recommended dosage of Cymbalta for chronic musculoskeletal pain in adults is 60 mg once per day.
The typical starting dosage of Cymbalta is 30 mg once per day for the first week. If your condition responds well to the medication, your doctor will likely increase your dosage to 60 mg once per day.
The maximum recommended dosage for this condition is 60 mg per day.
Dosage for fibromyalgia
Cymbalta is approved to treat fibromyalgia in adults. The dosage of Cymbalta for this condition is the same as the dosage for chronic musculoskeletal pain. See the “Dosage for chronic musculoskeletal pain” section above.
Dosage for diabetic nerve pain
The recommended Cymbalta dosage for diabetic neuropathy in adults is 60 mg once per day. Doses higher than 60 mg are not recommended for diabetic neuropathy.
Dosage for anxiety
The recommended dosage of Cymbalta for generalized anxiety disorder depends on your age.
For adults younger than age 65 years, the recommended dosage is 60 mg once per day. Most people can start with this dosage. In some cases, your doctor may prescribe a starting dosage of 30 mg once per day for the first week. Then, they’ll increase your dosage to 60 mg once per day.
For adults ages 65 years and older, the recommended starting dosage is 30 mg once per day for 2 weeks. If you don’t have bothersome side effects, your doctor may increase your dosage to 60 mg once per day.
In adults of any age, the maximum Cymbalta dosage for anxiety is 120 mg per day. However, in clinical studies, doses higher than 60 mg weren’t found to be more effective than 60-mg doses.
For children, see the “Dosage for children” section below.
Dosage for depression
The recommended Cymbalta starting dosage for depression is 40 mg to 60 mg per day.
For the 40-mg dosage, you’ll likely take 20 mg twice per day. For the 60-mg dosage, you’ll likely take 30 mg twice per day or 60 mg once per day.
Most people can start with this dosage. However, in some cases, your doctor may decide to start having you take 30 mg once per day for a week before increasing your dosage.
If needed, your doctor may increase your dosage to a maximum of 120 mg per day to treat depression. However, in clinical studies, doses higher than 60 mg weren’t found to be more effective than 60-mg doses.
Dosage for older adults
In most cases, the dosage of Cymbalta prescribed for older adults is the same as that for adults younger than age 65 years.
However, for generalized anxiety disorder, adults ages 65 years and older should start treatment with a lower dosage than younger adults. For more information, see the “Dosage for anxiety” section above.
Dosage for children
Cymbalta is used to treat fibromyalgia and generalized anxiety disorder in children. The pediatric dose for these conditions is typically lower than the adult dose.
For fibromyalgia in children ages 13 years and older, the recommended starting dosage is 30 mg once per day.
If your child doesn’t have bothersome side effects, their doctor may increase their dosage to 60 mg once per day if needed.
For generalized anxiety disorder in children ages 7 years and older, the recommended starting dosage is 30 mg once per day for 2 weeks. If your child doesn’t have bothersome side effects, their doctor may increase their dosage to 60 mg once per day if needed. The recommended Cymbalta dosage range for children is 30 mg to a maximum of 60 mg once per day.
Long-term use
Cymbalta is meant to be used as a long-term treatment. If you and your doctor determine that Cymbalta is safe and effective for you, you’ll likely take it long term.
Exactly how long you’ll take Cymbalta for depends on the condition it’s treating and how well that condition responds to the medication.
Here are answers to some frequently asked questions about Cymbalta’s dosage.
Is Cymbalta prescribed in 90-mg and 120-mg doses?
Yes, Cymbalta can be prescribed in 90-milligram (mg) and 120-mg doses.
These doses may be used for depression or anxiety. However, they’re not common because clinical studies haven’t shown them to be more effective than the 60-mg dose.
Cymbalta isn’t prescribed in 90-mg or 120-mg doses for any other conditions.
For more information about the dosage of Cymbalta that’s right for you, talk with your doctor or pharmacist.
When would my doctor recommend the maximum dosage of Cymbalta?
Your doctor may increase your Cymbalta dosage to 120 mg per day for depression or anxiety if lower dosages haven’t worked for you. If the maximum dosage doesn’t work for you, your doctor will likely switch you to a different treatment.
The highest dosage of Cymbalta for depression or anxiety is 120 mg per day. However, this dosage isn’t typically prescribed.
For treating fibromyalgia, chronic musculoskeletal pain, and diabetic nerve pain, dosages above 60 mg per day are not recommended. In clinical studies, the 60-mg doses didn’t show any additional benefit for these conditions.
Higher doses of Cymbalta are also associated with more side effects.
If you have questions about the maximum dosage of Cymbalta, talk with your doctor or pharmacist.
What’s considered a low dose of Cymbalta?
A low dose of Cymbalta is 30 mg. A dosage of 30 mg once per day is often prescribed when starting treatment with Cymbalta. Taking a low starting dose can help your body get used to the medication and may help you avoid side effects.
A 30-mg dose is typically prescribed in children. If needed, your child’s doctor may increase their dose.
A low dose may also be used if you take certain other medications. If you take other medications, talk with your doctor before starting treatment with Cymbalta.
If you miss a dose of Cymbalta, take your missed dose as soon as possible. Then, continue with your usual dosing schedule. However, if it’s almost time for your next dose, skip the missed dose and take your next dose as scheduled.
You should not take two doses at once to make up for a missed dose.
This may increase your risk of side effects.
To help make sure that you don’t miss a dose, try using a medication reminder. This can include setting an alarm or using a timer. You could also download a reminder app on your phone.
The dosage of Cymbalta that your doctor prescribes will depend on several factors. These include:
- the condition you’re taking Cymbalta to treat and its severity
- other medical conditions you may have
- other medications you take
- your age
Dosage adjustments
Your doctor may adjust your treatment by increasing or lowering your Cymbalta dosage depending on:
- how your condition responds to Cymbalta
- side effects you may have with Cymbalta
You should not adjust your dosage of Cymbalta on your own. Your doctor will help determine what dosage is right for you.
You should take Cymbalta as instructed by your doctor. Cymbalta comes as an oral capsule. You may take your dose with or without food.
If you take Cymbalta once per day, you can take it at any time. However, try to take it around the same time every day.
If you take Cymbalta twice per day, you should take it in the morning and evening. However, try to take your doses around the same time every day.
Cymbalta has the potential to be misused. Misuse refers to using a drug differently than how it was prescribed. This can include taking Cymbalta more often, in a different way, or in a higher dosage than prescribed.
Cymbalta has a potential risk of misuse because it affects brain chemicals that influence mood, behavior, and feelings of reward. Although misuse with Cymbalta is rare, it can occur.
Misusing a drug can cause side effects and lead to overdose. It can also lead to drug dependence and addiction. With drug dependence, your body becomes reliant on a drug to function normally. As a result, you may have withdrawal symptoms when you stop taking it. With drug addiction, you find it difficult to stop misusing a drug, even though it may be causing harm.
Cymbalta isn’t known to be addictive. However, it can cause dependence and withdrawal symptoms if you suddenly stop taking it. For this reason, your Cymbalta dosage should be tapered down gradually when you stop taking it. For more information, see the “Cymbalta and withdrawal and dependence” section below.
If you have concerns about how to take Cymbalta safely, talk with your doctor. They can help you manage your risk of misusing the drug.
If you use more Cymbalta than your doctor prescribes, you may develop serious side effects.
It’s important that you don’t use more Cymbalta than your doctor advises.
Symptoms of an overdose
Symptoms of a Cymbalta overdose can include:
- sleepiness
- vomiting
- fast heartbeat
- dizziness
- fainting
- sweating
- flushed skin
- body tremors
- muscle stiffness
- loss of coordination
- diarrhea
- agitation
- hallucinations (seeing or hearing things that aren’t real)
- seizures
- coma
If you take more than the recommended amount of Cymbalta
Call your doctor right away if you believe you’ve taken too much Cymbalta.
Another option is to call the American Association of Poison Control Centers at 800-222-1222 or use its online tool. If you have severe symptoms, immediately call 911 (or your local emergency number) or go to the nearest emergency room.
Cymbalta can cause physical dependence.* With physical dependence, your body becomes reliant on a drug to function normally. As a result, you may have withdrawal symptoms if you suddenly stop taking it.
Examples of Cymbalta withdrawal symptoms may include:
- pins and needles or electric shock-like sensations
- headache
- tinnitus (ringing or buzzing in your ears)
- feeling uneasy, irritable, or agitated
- mood shifts
- trouble sleeping
- anxiety
- confusion
To help prevent withdrawal symptoms, you should not stop taking Cymbalta suddenly. If you and your doctor agree that you should stop treatment, your doctor will explain how to reduce your dosage gradually over time.
This is called a drug taper. It allows your body to gradually readjust to not having the medication. The length of time this can take varies from person to person.
* Note that dependence is not the same as addiction. See “Cymbalta and misuse” above to learn more about this.
The dosages in this article are typical dosages provided by the drug manufacturer. If your doctor recommends Cymbalta for you, they’ll prescribe the dosage that’s right for you. Always follow the dosage that your doctor prescribes for you.
As with any drug, never change your dosage of Cymbalta without your doctor’s recommendation. If you have questions about the dosage of Cymbalta that’s right for you, talk with your doctor.
Besides learning about dosage, you may want other information about Cymbalta. These additional articles might be helpful to you:
- More about Cymbalta. For information about other aspects of Cymbalta, refer to this article.
- Side effects. To learn about the side effects of Cymbalta, see this article. You can also look at the Cymbalta prescribing information.
- Drug comparison. To find out how Cymbalta compares with other drugs, refer to these sections on Lexapro and Effexor XR.
- Interactions. For more information about Cymbalta’s interactions, see this article.
- Details on your condition. For details on your condition, see our:
- list of fibromyalgia articles and this article on Cymbalta for fibromyalgia
- diabetes hub
- mental health hub
- lists of depression articles and anxiety articles
Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional.
You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.
For nerve pain, anxiety, and more
Cymbalta (duloxetine) is a brand-name prescription medication. The Food and Drug Administration (FDA) has approved it to treat the following conditions in adults:
- generalized anxiety disorder
- major depressive disorder (also known as clinical depression)
- fibromyalgia
- chronic musculoskeletal pain
- pain caused by diabetic neuropathy (nerve damage)
Cymbalta is FDA-approved to treat the following conditions in children:
- generalized anxiety disorder in children ages 7 years and older
- fibromyalgia in children ages 13 years and older
Cymbalta comes as an oral capsule.
It’s an antidepressant medication that belongs to a class of drugs called serotonin-norepinephrine reuptake inhibitors (SNRIs).
For information on the dosage of Cymbalta, including its form, strengths, and how to take the drug, keep reading. For a comprehensive look at Cymbalta, see this article.
This article describes typical dosages for Cymbalta provided by the drug’s manufacturer. When taking Cymbalta, always follow the dosage prescribed by your doctor.
Below are Cymbalta dosages that are commonly used for the conditions the drug is prescribed to treat.
Cymbalta form
Cymbalta comes as oral capsules.
Cymbalta strengths
Cymbalta capsules are available in three strengths: 20 milligrams (mg), 30 mg, and 60 mg.
Typical dosages
Typically, your doctor will start you on a low dosage. Then, they’ll adjust it over time to reach the amount that’s right for you. Your doctor will ultimately prescribe the smallest dosage that provides the desired effect.
The following information describes dosages that are commonly used or recommended. However, be sure to take the dosage your doctor prescribes for you. Your doctor will determine the best dosage to fit your needs.
Dosage for chronic musculoskeletal pain
Chronic musculoskeletal pain is long-term pain in the muscles, bones, joints, tendons, ligaments, or nerves. Examples of this type of pain include back pain and arthritis pain.
The recommended dosage of Cymbalta for chronic musculoskeletal pain in adults is 60 mg once per day.
The typical starting dosage of Cymbalta is 30 mg once per day for the first week. If your condition responds well to the medication, your doctor will likely increase your dosage to 60 mg once per day.
The maximum recommended dosage for this condition is 60 mg per day.
Dosage for fibromyalgia
Cymbalta is approved to treat fibromyalgia in adults. The dosage of Cymbalta for this condition is the same as the dosage for chronic musculoskeletal pain.
See the “Dosage for chronic musculoskeletal pain” section above.
Dosage for diabetic nerve pain
The recommended Cymbalta dosage for diabetic neuropathy in adults is 60 mg once per day. Doses higher than 60 mg are not recommended for diabetic neuropathy.
Dosage for anxiety
The recommended dosage of Cymbalta for generalized anxiety disorder depends on your age.
For adults younger than age 65 years, the recommended dosage is 60 mg once per day. Most people can start with this dosage. In some cases, your doctor may prescribe a starting dosage of 30 mg once per day for the first week. Then, they’ll increase your dosage to 60 mg once per day.
For adults ages 65 years and older, the recommended starting dosage is 30 mg once per day for 2 weeks. If you don’t have bothersome side effects, your doctor may increase your dosage to 60 mg once per day.
In adults of any age, the maximum Cymbalta dosage for anxiety is 120 mg per day.
However, in clinical studies, doses higher than 60 mg weren’t found to be more effective than 60-mg doses.
For children, see the “Dosage for children” section below.
Dosage for depression
The recommended Cymbalta starting dosage for depression is 40 mg to 60 mg per day.
For the 40-mg dosage, you’ll likely take 20 mg twice per day. For the 60-mg dosage, you’ll likely take 30 mg twice per day or 60 mg once per day.
Most people can start with this dosage. However, in some cases, your doctor may decide to start having you take 30 mg once per day for a week before increasing your dosage.
If needed, your doctor may increase your dosage to a maximum of 120 mg per day to treat depression. However, in clinical studies, doses higher than 60 mg weren’t found to be more effective than 60-mg doses.
Dosage for older adults
In most cases, the dosage of Cymbalta prescribed for older adults is the same as that for adults younger than age 65 years.
However, for generalized anxiety disorder, adults ages 65 years and older should start treatment with a lower dosage than younger adults. For more information, see the “Dosage for anxiety” section above.
Dosage for children
Cymbalta is used to treat fibromyalgia and generalized anxiety disorder in children. The pediatric dose for these conditions is typically lower than the adult dose.
For fibromyalgia in children ages 13 years and older, the recommended starting dosage is 30 mg once per day. If your child doesn’t have bothersome side effects, their doctor may increase their dosage to 60 mg once per day if needed.
For generalized anxiety disorder in children ages 7 years and older, the recommended starting dosage is 30 mg once per day for 2 weeks. If your child doesn’t have bothersome side effects, their doctor may increase their dosage to 60 mg once per day if needed. The recommended Cymbalta dosage range for children is 30 mg to a maximum of 60 mg once per day.
Long-term use
Cymbalta is meant to be used as a long-term treatment. If you and your doctor determine that Cymbalta is safe and effective for you, you’ll likely take it long term.
Exactly how long you’ll take Cymbalta for depends on the condition it’s treating and how well that condition responds to the medication.
Here are answers to some frequently asked questions about Cymbalta’s dosage.
Is Cymbalta prescribed in 90-mg and 120-mg doses?
Yes, Cymbalta can be prescribed in 90-milligram (mg) and 120-mg doses. These doses may be used for depression or anxiety. However, they’re not common because clinical studies haven’t shown them to be more effective than the 60-mg dose.
Cymbalta isn’t prescribed in 90-mg or 120-mg doses for any other conditions.
For more information about the dosage of Cymbalta that’s right for you, talk with your doctor or pharmacist.
When would my doctor recommend the maximum dosage of Cymbalta?
Your doctor may increase your Cymbalta dosage to 120 mg per day for depression or anxiety if lower dosages haven’t worked for you.
If the maximum dosage doesn’t work for you, your doctor will likely switch you to a different treatment.
The highest dosage of Cymbalta for depression or anxiety is 120 mg per day. However, this dosage isn’t typically prescribed.
For treating fibromyalgia, chronic musculoskeletal pain, and diabetic nerve pain, dosages above 60 mg per day are not recommended. In clinical studies, the 60-mg doses didn’t show any additional benefit for these conditions. Higher doses of Cymbalta are also associated with more side effects.
If you have questions about the maximum dosage of Cymbalta, talk with your doctor or pharmacist.
What’s considered a low dose of Cymbalta?
A low dose of Cymbalta is 30 mg. A dosage of 30 mg once per day is often prescribed when starting treatment with Cymbalta. Taking a low starting dose can help your body get used to the medication and may help you avoid side effects.
A 30-mg dose is typically prescribed in children. If needed, your child’s doctor may increase their dose.
A low dose may also be used if you take certain other medications. If you take other medications, talk with your doctor before starting treatment with Cymbalta.
If you miss a dose of Cymbalta, take your missed dose as soon as possible. Then, continue with your usual dosing schedule. However, if it’s almost time for your next dose, skip the missed dose and take your next dose as scheduled.
You should not take two doses at once to make up for a missed dose. This may increase your risk of side effects.
To help make sure that you don’t miss a dose, try using a medication reminder. This can include setting an alarm or using a timer. You could also download a reminder app on your phone.
The dosage of Cymbalta that your doctor prescribes will depend on several factors. These include:
- the condition you’re taking Cymbalta to treat and its severity
- other medical conditions you may have
- other medications you take
- your age
Dosage adjustments
Your doctor may adjust your treatment by increasing or lowering your Cymbalta dosage depending on:
- how your condition responds to Cymbalta
- side effects you may have with Cymbalta
You should not adjust your dosage of Cymbalta on your own.
Your doctor will help determine what dosage is right for you.
You should take Cymbalta as instructed by your doctor. Cymbalta comes as an oral capsule. You may take your dose with or without food.
If you take Cymbalta once per day, you can take it at any time. However, try to take it around the same time every day.
If you take Cymbalta twice per day, you should take it in the morning and evening. However, try to take your doses around the same time every day.
Cymbalta has the potential to be misused. Misuse refers to using a drug differently than how it was prescribed. This can include taking Cymbalta more often, in a different way, or in a higher dosage than prescribed.
Cymbalta has a potential risk of misuse because it affects brain chemicals that influence mood, behavior, and feelings of reward. Although misuse with Cymbalta is rare, it can occur.
Misusing a drug can cause side effects and lead to overdose. It can also lead to drug dependence and addiction.
With drug dependence, your body becomes reliant on a drug to function normally. As a result, you may have withdrawal symptoms when you stop taking it. With drug addiction, you find it difficult to stop misusing a drug, even though it may be causing harm.
Cymbalta isn’t known to be addictive. However, it can cause dependence and withdrawal symptoms if you suddenly stop taking it. For this reason, your Cymbalta dosage should be tapered down gradually when you stop taking it. For more information, see the “Cymbalta and withdrawal and dependence” section below.
If you have concerns about how to take Cymbalta safely, talk with your doctor. They can help you manage your risk of misusing the drug.
If you use more Cymbalta than your doctor prescribes, you may develop serious side effects.
It’s important that you don’t use more Cymbalta than your doctor advises.
Symptoms of an overdose
Symptoms of a Cymbalta overdose can include:
- sleepiness
- vomiting
- fast heartbeat
- dizziness
- fainting
- sweating
- flushed skin
- body tremors
- muscle stiffness
- loss of coordination
- diarrhea
- agitation
- hallucinations (seeing or hearing things that aren’t real)
- seizures
- coma
If you take more than the recommended amount of Cymbalta
Call your doctor right away if you believe you’ve taken too much Cymbalta.
Another option is to call the American Association of Poison Control Centers at 800-222-1222 or use its online tool. If you have severe symptoms, immediately call 911 (or your local emergency number) or go to the nearest emergency room.
Cymbalta can cause physical dependence.* With physical dependence, your body becomes reliant on a drug to function normally. As a result, you may have withdrawal symptoms if you suddenly stop taking it.
Examples of Cymbalta withdrawal symptoms may include:
- pins and needles or electric shock-like sensations
- headache
- tinnitus (ringing or buzzing in your ears)
- feeling uneasy, irritable, or agitated
- mood shifts
- trouble sleeping
- anxiety
- confusion
To help prevent withdrawal symptoms, you should not stop taking Cymbalta suddenly. If you and your doctor agree that you should stop treatment, your doctor will explain how to reduce your dosage gradually over time.
This is called a drug taper. It allows your body to gradually readjust to not having the medication. The length of time this can take varies from person to person.
* Note that dependence is not the same as addiction. See “Cymbalta and misuse” above to learn more about this.
The dosages in this article are typical dosages provided by the drug manufacturer. If your doctor recommends Cymbalta for you, they’ll prescribe the dosage that’s right for you. Always follow the dosage that your doctor prescribes for you.
As with any drug, never change your dosage of Cymbalta without your doctor’s recommendation. If you have questions about the dosage of Cymbalta that’s right for you, talk with your doctor.
Besides learning about dosage, you may want other information about Cymbalta. These additional articles might be helpful to you:
- More about Cymbalta. For information about other aspects of Cymbalta, refer to this article.
- Side effects. To learn about the side effects of Cymbalta, see this article. You can also look at the Cymbalta prescribing information.
- Drug comparison. To find out how Cymbalta compares with other drugs, refer to these sections on Lexapro and Effexor XR.
- Interactions. For more information about Cymbalta’s interactions, see this article.
- Details on your condition. For details on your condition, see our:
- list of fibromyalgia articles and this article on Cymbalta for fibromyalgia
- diabetes hub
- mental health hub
- lists of depression articles and anxiety articles
Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional.
You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.
Duloxetine for the treatment of painful neuropathy, chronic pain or fibromyalgia
Review question
Does duloxetine work to treat pain generated by nerves when damaged by disease or pain caused by fibromyalgia?
Relevance
Duloxetine is a medicine used to treat depression and urinary incontinence (urinary leakage), and may also be useful for certain types of pain. Pain can occur spontaneously when there is damage to the nerves that carry pain information to the brain (neuropathic pain).
When nerve damage occurs outside of the spinal cord, it is called peripheral neuropathy. Another type of pain, nociceptive pain, occurs when nerves sense damage to another tissue (such as a prick in the skin). Some types of pain of unknown origin occur without visible nerve or tissue damage. This type of pain occurs, for example, with fibromyalgia. The purpose of this review was to evaluate the benefits and harms of duloxetine for the treatment of neuropathic pain and chronic pain of all types. nine0005
Study profile
We reviewed all published scientific literature and found 18 trials with a total of 6407 participants that were of sufficient quality to include in this review. Eight clinical trials examined the effect of duloxetine in painful diabetic neuropathy and six in pain associated with fibromyalgia. Three trials looked at painful physical symptoms associated with depression, and one small study looked at duloxetine for stroke pain or spinal cord disease (central pain).
nine0005
Main findings and quality of evidence
The usual dose of duloxetine is 60 mg. There was moderate-quality evidence that duloxetine at this dose reduced pain in painful diabetic peripheral neuropathy and fibromyalgia. In diabetic peripheral neuropathic pain, 50% or slightly more had an improvement on duloxetine 60 mg per day more than one and a half times more often than in the placebo group. In other words, five people with diabetic peripheral neuropathy must receive duloxetine in order for one of them to achieve an effect of 50% or more. The effect on fibromyalgia was similar, but the number of patients needed to be treated for improvement of 50% or more was eight. Based on only one study, it is not possible to determine whether the 20 mg dose is effective, and the 120 mg dose was no more effective than 60 mg. nine0005
We calculated that there were sufficient trials for diabetic neuropathy to draw these conclusions and no further trials are required.
For fibromyalgia and the painful symptoms associated with depression, more trials are needed to make strong claims about the effectiveness of duloxetine.
Most people who take duloxetine will have at least one side effect. They are mostly minor and the most common are feeling unwell, insomnia or drowsiness, headache, dry mouth, constipation or dizziness. About one in six people will stop taking duloxetine due to side effects. Serious problems associated with duloxetine are very rare. nine0005
Although duloxetine is useful in the treatment of neuropathic pain and fibromyalgia, there is little evidence from clinical trials comparing duloxetine with other antidepressants as to which is better.
We conclude that duloxetine can be used to treat pain associated with diabetic neuropathy and possibly fibromyalgia.
The information contained in this review is current up to November 2013, when the most recent literature search was made.
Translation notes:
Translation notes: Translation: Alexandrova Elvira Grigorievna.
Editing: Gamirova Rimma Gabdulbarovna, Ziganshina Lilia Evgenievna. Russian translation project coordination: Kazan Federal University. For questions related to this transfer, please contact us at: [email protected]
Medical therapy | Clinic of Urogynecology and Neurourology
Drug therapy for chronic pelvic pain syndrome has certain characteristics, depending on the type of pelvic pain (neuropathic, myofascial), but certain general principles are followed when prescribing drugs. nine0005
Topicals: Topicals have the advantage of local action without systemic toxicity. Capsaicin cream, which contains chili pepper extract, is sometimes used to treat neuropathic pain. This cream affects the so-called. vanilloid receptors on the nerve endings of the C-fibers, which are responsible for the transmission of pain. The most common side effect is burning, which decreases with consistent use.
Lidocaine can be used topically. It comes in two forms, cream and patch.
There are also combined topical agents such as a cream of gabapentin, amitriptyline, lidocaine, and ketoprofen. nine0005
Antidepressants: tricyclic antidepressants and serotonin reuptake inhibitors are used to treat pudendal neuropathy. Numerous clinical studies demonstrate the safety and efficacy of TCAs. Amitriptyline was the first tricyclic antidepressant used to treat neuropathy and is still included in all European guidelines for the treatment of chronic pelvic pain syndrome. Amitriptyline also has a high incidence of anticholinergic side effects. It may lead to delirium in the elderly and should be avoided in this population. Desipramine and nortriptyline, which have the least anticholinergic activity, are equally effective substitutes. The analgesic properties of TCAs occur independently of their antidepressant properties. nine0005
Some of the TCAs have proarrhythmic side effects. Therefore, it is necessary to perform a baseline ECG with repetition after reaching the therapeutic dose.
The greatest risk for the development of arrhythmia occurs at the maximum therapeutic dose. Other risk factors include congestive heart failure, coronary artery disease, and bundle branch block. TCAs should also be avoided in people with angle-closure glaucoma, benign prostatic hyperplasia, and bipolar disorders. nine0005
Specific serotonin reuptake inhibitors (SSRIs) are less effective in treating pudendal neuropathy, although some have shown some clinical benefit. Some of the typical SSRIs are: sertraline, paroxetine, fluoxetine.
Serotonin and norepinephrine reuptake inhibitors include drugs such as Cymbalta (duloxetine), venlafaxine are widely used to treat symptoms of pudendal neuralgia. Serotonin and norepinephrine reuptake inhibitors appear to have a better effect on pudendal neuropathy. Cymbalta is currently approved by the FDA for the treatment of neuropathic pain. Side effects may include high blood pressure and/or hypertension, irritability, insomnia, nausea, vomiting, and constipation.
nine0005
Anticonvulsants: Anticonvulsants are considered second line therapy. Carbamazepine (Tegretol), phenytoin (Dilantin), gabapentin (Tebantin), lamotrigine (Lamictal), and pregabalin (Lyrica) are all used to treat neuropathic pain. The ones most widely used for pudendal neuralgia are Lyrica and Tebantine.
Lyrica is currently used to treat pudendal neuropathy. This drug is FDA approved for the treatment of neuropathic pain. There are some studies showing that the combination of Lyric and Cymbalt is more effective for treating pudendal neuropathy than using either one. nine0005
Carbamazepine: Carbamazepine is considered first-line therapy for trigeminal neuralgia. Clinical trials show its effectiveness for treating diabetic neuropathy, but results are mixed for postherpetic neuralgia.
The most common side effects of carbamazepine are dizziness and upset stomach. These are dose-dependent symptoms and can be minimized by starting treatment with low doses.
Gabapentin: Gabapentin is more effective than placebo in the treatment of diabetic neuropathy and postherpetic neuralgia. The most common side effects associated with gabapentin are asthenia, headache, dizziness and drowsiness. Surprisingly, gabapentin has been reported to cause polyneuropathy. nine0005
Lamotrigine has been shown to reduce pain associated with trigeminal neuralgia. However, there is no difference from placebo when used to treat other types of neuropathic pain. Of the side effects, rashes on the skin, including Stevens-Johnson syndrome, are of greatest concern. To avoid this, treatment should be started at low doses and slowly titrated to a therapeutic dose.
Analgesics : Abroad, opiates and other narcotic analgesics are actively used to treat chronic pelvic pain. In Russia, this is impossible due to the peculiarities of legislation and law enforcement. nine0005
Benzodiazepines : Patients with myofascial pelvic floor pain syndromes due to pudendal neuralgia may benefit from diazepam (Relanium), lorazepam, or clonazepam, which act as muscle relaxants.
Their mechanism of action is not fully known, but they act on the neurotransmitter gamma-aminobutyric acid (GABA), a substance that reduces neural activity in the center of descending pain modulation.
Zolpidem is not a classic benzodiazepine, however it is a hypnotic with some of the same pharmacological characteristics as benzodiazepines. Many patients with pudendal neuropathy who have trouble sleeping can use Zolpidem to fall asleep. nine0005
Flexeril (cyclobenzaprine) is a muscle relaxant that may be useful in the treatment of myofascial pain syndromes. Baclofen is used in the Russian Federation, however, when an effective dosage (50-75 mg / day) is reached, pronounced side effects often occur.
Vaginal or rectal suppositories: Diazepam or belladonna extract suppositories are used to relieve pelvic floor muscle spasm in chronic pelvic pain syndrome.
Botulinum toxin (Xeomin) : Botulinum toxin injections to relieve spasm of the pelvic floor muscles are very effective for the treatment of myofascial pain syndromes.
