Maximum dose of cymbalta for neuropathy
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.
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).
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.
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.
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]
Cymbalta vs Effexor: Differences, Similarities & What's Best for You - Drug Vs. Friend
Home >> Drug Vs. Friend >> Cymbalta vs Effexor: Differences, Similarities and Which is Best for You
Drug Vs. Friend
Drug Overview and Key Differences | Conditions of treatment | Efficiency | Insurance coverage and cost comparison | Side effects | Drug Interactions | Warnings | Frequently Asked Questions
Cymbalta (duloxetine) and Effexor (venlafaxine) are brand name drugs used to treat mental illnesses such as depression and anxiety. They are commonly prescribed as antidepressants to relieve symptoms of major depressive disorder. Symptoms of major depressive disorder may include persistent sadness and a severe loss of interest in daily activities.
Cymbalta and Effexor belong to a class of drugs called serotonin and norepinephrine reuptake inhibitors (SNRIs). They work by increasing the availability of serotonin and norepinephrine in the brain. These chemicals, or neurotransmitters, are believed to play a role in causing mental disorders.
For the purposes of this comparison, the name Effexor may also refer to Effexor XR, the only Effexor brand currently available on the market.
What are the main differences between Cymbalta and Effexor?
Cymbalta
Cymbalta is the brand name for duloxetine. It is available as delayed-release oral capsules in 20mg, 30mg, or 60mg strengths. It is usually taken by mouth as one capsule once a day depending on the condition being treated. The maximum daily dose is 120 mg, although there is no evidence that doses greater than 60 mg provide a significant increase in benefit.
Cymbalta has a half-life of about 12 hours. It is metabolized and excreted through the liver and kidneys. It should be avoided in severe liver or kidney disease.
Effexor
Effexor is the brand name for venlafaxine. However, the brand name Effexor is only available as Effexor XR or venlafaxine extended release tablets. The immediate release effexor has been discontinued because it needs to be injected multiple times throughout the day and causes more nausea than the extended release version.
Effexor XR is available in 37.5 mg, 75 mg and 150 mg oral capsules. The dosage may vary depending on the condition being treated. However, Effexor XR is usually taken once a day with a target daily dose of 75 mg and a maximum daily dose of 225 mg.
Like Cymbalta, Effexor is metabolized in the liver and has a half-life of up to 11 hours. It can be used for liver or kidney problems at lower doses.
Conditions Treated by Cymbalta and Effexor
CymbaltaTR is FDA approved for the treatment of Major Depressive Disorder (MDD) and Generalized Disorder.
It can also be used to treat fibromyalgia and diabetic neuropathy pain, as well as general muscle, tendon, ligament and bone pain. Cymbalta may occasionally be used off-label for other anxiety disorders.
Effexor XR is FDA approved for the treatment of major depressive disorder (MDD), generalized anxiety disorder (GAD), social anxiety disorder (SAD), and panic disorder (PD). It is also sometimes used off-label to treat obsessive-compulsive disorder (OCD), premenstrual dysphoric disorder (PMDD), and pain.
| Condition | Cymbalta |
Are Cymbalta or Effexor more effective?
The effectiveness of Cymbalta or Effexor depends on the condition being treated. Very few studies have directly compared Cymbalta and Effexor. However, compared to placebo, Cymbalta and Effexor are more effective for conditions such as major depression.
One study combined several clinical trials and found venlafaxine to be a better short-term treatment option for major depression than duloxetine.
Venlafaxine, the active ingredient in effexor, may also be preferred for those who do not respond well to initial treatment with selective serotonin reuptake inhibitors (SSRIs) or tricyclic antidepressants (TCAs). However, the study found that there were no significant differences in response and response rates between duloxetine and venlafaxine.
Another systematic review compared venlafaxine with duloxetine and other antidepressants such as paroxetine, fluoxetine and fluvoxamine. Compared to other options, venlafaxine was found to be one of the more effective antidepressants. However, both venlafaxine and duloxetine have been ranked among the least tolerated antidepressants in terms of side effects.
Consult with a mental health professional to determine the best treatment option for you.
Cover and cost comparison Cymbalta and Effexor
Cymbalta is a brand-name prescription drug used for depression. The generic duloxetine is usually covered by Medicare and insurance plans.
With a 30-day supply, the average retail price can exceed $470. With the SingleCare Cymbalta coupon, the generic version starts at $15 at participating pharmacies.
Effexor XR tablets are available by prescription. Generic Effexor XR tablets are often covered by Medicare and insurance plans. At an average price of around $145, the Effexor XR is cheaper than the Cymbalta. However, using SingleCare's Effexor XR Coupon can lower the cost even further. Ask a pharmacist for a generic and get it for about $15.
| Cymbalta | Effexor | yes | yes | |||
| Usually covered by Medicare Part D? | yes | yes | ||||
| Quantity | 30 tablets | 30 tablets | ||||
| Typical surcharge of Medicare | 0–89 US dollars | 0–1 dollar USA | Cost Singlecare | US dollars 15+ dollars US Cymbalta vs. Effexor The most common side effects of Cymbalta include nausea, headache, dry mouth, drowsiness or drowsiness, constipation and fatigue. Cymbalta may also cause diarrhea, decreased appetite, increased sweating, and abdominal pain, among other side effects. The most common side effects of Effexor are nausea, headache, dry mouth, weakness and drowsiness. Effexor can also cause insomnia, constipation, dizziness, diarrhea, and decreased appetite. Both Cymbalta and Effexor can also cause a decrease in sexual desire (libido). However, Effexor has been shown to cause more sexual dysfunction problems than Cymbalta. The table below lists other common side effects of Cymbalta and Effexor.
This may not be a complete list of side effects that may occur. Drug Interactions between Cymbalta and EffexorCymbalta and Effexor should not be used with monoamine oxidase inhibitors (MAOIs) such as selegiline and phenelzine. Cymbalta or Effexor should not be used within 14 days of stopping an MAOI. Otherwise, the risk of serotonin syndrome, a serious condition that may require emergency medical attention, increases. There may also be a risk of serotonin syndrome when taking Cymbalta or Effexor together with another serotonergic drug. Serotonergic drugs include selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs). Caution should be exercised when using serotonergic drugs with Cymbalta or Effexor. Drugs such as paroxetine or fluoxetine may interfere with the metabolism of Cymbalta and increase its blood levels. This may lead to an increased risk of serious side effects when taking Cymbalta. Cymbalta and Effexor should be used with caution or avoided with non-steroidal anti-inflammatory drugs (NSAIDs) and anticoagulants. Using these drugs together may increase your risk of bleeding.
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Please contact your doctor or health care provider for more information. 
These antidepressants can cause mania, hypomania, or seizures in some people. 
But they are not the same medicine. In addition to treating major depression and anxiety, Cymbalta is also FDA approved for treating certain types of nerve pain. On the other hand, Effexor is FDA approved for the treatment of panic attacks and social anxiety. 
