Everyones thoughts on this appreciated:
http://pi.lilly.com/us/cymbalta-pi.pdf
DOSAGE AND ADMINISTRATION
"• There is no evidence that doses greater than 60 mg/day confers additional benefit, while some adverse reactions were observed to be dose-dependent.
• Discontinuing Cymbalta: A gradual dose reduction is recommended to avoid discontinuation symptoms (5.6)."
"If the decision has been made to discontinue treatment, medication should be tapered, as rapidly as is feasible, but with recognition that discontinuation can be associated with certain symptoms [see Dosage and Administration (2.4) and Warnings and Precautions (5.6) for descriptions of the risks of discontinuation of Cymbalta]."
2.4 Discontinuing Cymbalta
"Symptoms associated with discontinuation of Cymbalta and other SSRIs and SNRIs have been reported. A gradual reduction in the dose rather than abrupt cessation is recommended whenever possible [see Warnings and Precautions (5.6)]."
5.6 Discontinuation of Treatment with Cymbalta
"Discontinuation symptoms have been systematically evaluated in patients taking duloxetine. Following abrupt or tapered discontinuation in placebo-controlled clinical trials, the following symptoms occurred at a rate greater than or equal to 1% and at a significantly higher rate in duloxetine-treated patients compared to those discontinuing from placebo: dizziness, nausea, headache, fatigue, paresthesia, vomiting, irritability, nightmares, insomnia, diarrhea, anxiety, hyperhidrosis and vertigo.
During marketing of other SSRIs and SNRIs (serotonin and norepinephrine reuptake inhibitors), there have been spontaneous reports of adverse events occurring upon discontinuation of these drugs, particularly when abrupt, including the following: dysphoric mood, irritability, agitation, dizziness, sensory disturbances (e.g., paresthesias such as electric shock sensations), anxiety, confusion, headache, lethargy, emotional lability, insomnia, hypomania, tinnitus, and seizures. Although these events are generally self-limiting, some have been reported to be severe.
Patients should be monitored for these symptoms when discontinuing treatment with Cymbalta. A gradual reduction in the dose rather than abrupt cessation is recommended whenever possible. If intolerable symptoms occur following a decrease in the dose or upon discontinuation of treatment, then resuming the previously prescribed dose may be considered. Subsequently, the physician may continue decreasing the dose but at a more gradual rate"
Thanks for that. Interesting that Eli Lilly don't make available doses of Cymbalta which would make tapering properly for those who need it possible. In Australia we don't even have the 20mg capsule, leaving many doctors to advise taking 30mg on alternate days for a while then stopping. What else can they suggest?
IF Eli Lilly DID put down in writing (for doctors) what was REALLY necessary (i.e. making up increasingly reduced doses for individual patients by a pharmacy) no doctor would prescribe it.
There's no doubt Eli Lilly know these facts; unfortunately they're not conveying them to doctors.
regards, Maureen.
