Cymbalta dosage, forms, and strengths

Cymbalta is a brand-name prescription drug (generic name: duloxetine hcl) used to treat major depressive disorder (MDD), generalized anxiety disorder, fibromyalgia, diabetic peripheral neuropathy (nerve pain due to diabetes), and chronic musculoskeletal pain such as back pain or arthritic pain. 

Duloxetine hydrochloride, the active ingredient in Cymbalta, belongs to a class of drugs called serotonin and norepinephrine reuptake inhibitors (SNRIs). SNRIs raise the levels of two chemicals, serotonin, and norepinephrine, that are responsible for active communication between nerves in the brain. This increases nerve activity in the areas of the brain that regulate mood. For all indications, Cymbalta is taken by mouth as a delayed-release capsule once or twice per day with or without food.

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Cymbalta forms and strengths

Cymbalta is always taken by mouth as a delayed-release capsule. Doses may vary, so Cymbalta capsules come in three strengths:

• Delayed-release capsules: 20 milligrams (mg), 30 mg, 60 mg

Cymbalta dosage for adults

Cymbalta is approved by the U.S. Food and Drug Administration (FDA) to treat major depressive disorder, generalized anxiety disorder, fibromyalgia, diabetic peripheral neuropathic pain, and chronic musculoskeletal pain in adults. It may sometimes be prescribed off-label to treat stress urinary incontinence in adult women.

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Cymbalta dosage for major depressive disorder

As an antidepressant, Cymbalta is commonly prescribed to patients diagnosed with major depressive disorder. A diagnosis of major depressive disorder requires that symptoms of depression, such as sadness, lack of enjoyment, and suicidal thoughts, persist for two or more weeks. Duloxetine increases neurotransmitters in areas of the brain responsible for mood, but it takes a few weeks of continuous dosing to start improving the symptoms of depression.

• Standard adult dosage for major depressive disorder: 20 mg taken twice per day (40 mg per day) or 60 mg taken once per day or in two divided doses of 30 mg each 

• Maximum adult dosage for major depressive disorder: 120 mg per day

Cymbalta dosage for generalized anxiety disorder

Generalized anxiety disorder is diagnosed when people experience excessive worry and distress throughout the day, often about ordinary, everyday situations. This excessive worry can cause significant impairment in daily life as well as physical problems such as insomnia, chronic headaches, and digestive system problems. SNRIs like Cymbalta increase serotonin and norepinephrine in the areas of the brain responsible for mood regulation, helping patients better regulate distress and emotions.

• Standard adult dosage for generalized anxiety disorder: 60 mg taken once per day 

• Maximum adult dosage for generalized anxiety disorder: 120 mg per day

Cymbalta dosage for fibromyalgia

In addition to treating psychiatric disorders, Cymbalta is a highly effective medication for controlling pain. It is commonly prescribed to manage the symptoms of fibromyalgia, a chronic condition marked by muscle pain, fatigue, and difficulty sleeping. Although fibromyalgia has a range of symptoms, healthcare providers consider it to be primarily a pain syndrome involving disordered pain processing by the nervous system. Healthcare providers do not understand exactly how duloxetine helps manage fibromyalgia pain, but it is one of only three pain medications approved by the FDA to treat the condition. For fibromyalgia as well as other pain conditions, it may take a few weeks for duloxetine to improve pain symptoms.

• Standard adult dosage for fibromyalgia: 60 mg taken once per day 

• Maximum adult dosage for fibromyalgia: 60 mg per day

Cymbalta dosage for diabetic peripheral neuropathy

Chronic high blood sugar can damage nerves, particularly peripheral nerves that are located in extremities such as the hands, arms, feet, and legs. This nerve damage is painful. Cymbalta is effective at reducing diabetic peripheral neuropathy (DBNP), but how it works is not completely understood. Healthcare providers believe that increasing neurotransmitters in one part of the spine helps to block pain signals from traveling up the spine to the brain. As with fibromyalgia, Cymbalta will take a few weeks to improve DBNP pain symptoms.

• Standard adult dosage for diabetic peripheral neuropathy: 60 mg taken once per day 

• Maximum adult dosage for diabetic peripheral neuropathy: 60 mg per day

Cymbalta dosage for chronic musculoskeletal pain

Finally, Cymbalta is also approved to reduce pain in people who experience chronic musculoskeletal pain, a broad category that includes back pain and osteoarthritis pain. Pain relief is not immediate, as it would be for other pain medications. It takes a few weeks of daily Cymbalta dosing to improve musculoskeletal pain.

• Standard adult dosage for chronic musculoskeletal pain: 60 mg taken once per day 

• Maximum adult dosage for chronic musculoskeletal pain: 60 mg per day

Cymbalta dosage for children

Cymbalta is FDA approved to treat generalized anxiety disorder in children ages 7 years and older and to treat fibromyalgia in children ages 13 years and older. However, healthcare providers may sometimes prescribe Cymbalta off-label in children as young as 7 years of age to treat major depressive disorder.

Cymbalta dosage restrictions

Because of physical or medical conditions, some people may have problems taking Cymbalta. Cymbalta should never be prescribed to those with conditions that are contraindicated to it. These conditions include a history of allergic reactions to duloxetine, severe renal impairment, liver disease, or cirrhosis. Other conditions will require a dose reduction or closer monitoring when taking Cymbalta.

• Geriatric patients: For the treatment of major depressive disorder or generalized anxiety disorder, older patients should be started on a daily dose of 30 mg per day. Standard and maximum doses are unchanged.

• Patients with renal impairment (kidney disease): 

  • Creatinine clearance greater than 30 mL/min: Possible lower dose

  • Creatinine clearance less than 30 mL/min: Not recommended

  • Hemodialysis: Not defined 

  • Parenteral dialysis: Not defined

• Patients with hepatic impairment (liver problems): 

  • Severe hepatic disease or cirrhosis: Not recommended

Cymbalta dosage for pets

Veterinarians do not give duloxetine to pets. Because the drug can be toxic to animals, never give a dog or cat Cymbalta. If a pet accidentally ingests Cymbalta, take the animal immediately to a veterinarian for treatment.

How to take Cymbalta

Cymbalta is taken as a delayed-release capsule once or twice a day depending on the condition being treated. Cymbalta can be taken with or without food.

• Take Cymbalta as directed by a healthcare provider. The dose may need to be changed a few times to find what works for you.

• This medicine should come with a medication guide. Please read it before taking the medication.

• Swallow the Cymbalta capsule whole. Do not crush, chew, break, or open it. 

• Do not open the capsule and sprinkle the contents on food or in liquids.

• Store this medicine at room temperature (68–77°F) and out of the reach of children.

Cymbalta dosage FAQs

How long does it take Cymbalta to work?

People will need to take Cymbalta every day for one to two weeks before they notice any improvement in depression or anxiety symptoms. It may take longer to improve pain symptoms.

How long does Cymbalta stay in your system?

With a half-life of 12 hours, it takes the body about two days to completely clear a dose of Cymbalta from the body, but this will vary from person to person.

What happens if I miss a dose of Cymbalta?

If a dose is missed, take it as soon as it’s remembered. However, if it is nearly time for the next dose, skip the missed dose and take the next dose on schedule. Do not take extra medicine to make up for a missed dose.

How long can you take Cymbalta?

Antidepressant therapy typically takes four to six weeks to relieve the symptoms of depression or anxiety but will require six to nine months of continuous therapy to prevent recurrence. Severe depression or anxiety disorders may require a year or more of continuous treatment. There are no known problems associated with long-term use of duloxetine, so pain treatments using duloxetine can last indefinitely.

Is it safe to take Cymbalta during pregnancy?

Cymbalta is given cautiously in pregnant women, particularly in the third trimester. The risk of harming the fetus is small, but when given in the third trimester, there is a risk that the baby will be born with withdrawal symptoms or serotonin syndrome. 

Women who are breastfeeding should be cautious about taking Cymbalta. Duloxetine is found in breast milk and can affect the baby. If a breastfeeding mother is taking Cymbalta, caregivers should watch infants carefully for unusual changes in the baby such as sedation, poor feeding, or poor weight gain.

Related resources for Cymbalta dosages:

• Cymbalta, Epocrates

• Cymbalta delayed-release capsules prescribing information, U.S. National Library of Medicine

• Duloxetine, National Alliance on Mental Illness

• Duloxetine, National Health Service

• Duloxetine, StatPearls

• Duloxetine compound summary, U.S. National Library of Medicine

• Duloxetine for the treatment of fibromyalgia, Expert Review of Clinical Immunology

• Living with fibromyalgia, drugs approved to treat pain, U.S. Food and Drug Administration

• Steps following attainment of remission: discontinuation of antidepressant therapy, Primary Care Companion to The Journal of Clinical Psychiatry